There were 21,950 natural deaths of children under the age of one in the United States in 2012, excluding SIDS. The leading cause of death was the category of congenital anomalies. The second leading cause was disorders related to pre-term birth and low birth weight. In 2009, pre-term birth (before 37 weeks gestation) accounted for 35% of the infant deaths. The pre-term birth rate is worse for African American, Native mothers and Hispanic mothers than for white and Asian mothers. Sixty percent of infant deaths occur during the first 28 days of life. The infant mortality rate for black infants is 2.2 times that of white infants. Prematurity and low birth weight are the greatest predictors of infant mortality.
The rate of preterm birth had reached a 15-year low in 2012, although the rate was worst in the South, as high as 17% in Mississippi. For reasons not fully understood, pre-term birth takes a disproportionate toll on black Americans. Nationally, black mothers are twice as likely to give birth pre-term as white mothers.
There are still many gaps in our knowledge of why some women go into labor well ahead of schedule. It is believed that cigarette smoking, disorders that raise blood pressure, prior pre-term birth, and certain pregnancy complications increase the risk of prematurity. Other significant risks include genital tract infections, stress, anxiety, depression and other psychological factors. Adequate prenatal care is an effective intervention that improves pregnancy outcomes. Early access to quality pre-natal care, including health promotion, risk assessment and appropriate interventions can prevent both pre-term births and ensure that babies are born at normal birth weights.
Major Risk Factors
For pre-term delivery
- Prior pre-termdelivery of family history of pre-term birth
- Lack of health insurance
- Smoking and other harmful environmental exposures or substances
- Previous infant or fetal loss
- Pregnancy with multiples
- Poor nutrition
- Interval less than 6 months between pregnancies
- Inadequate prenatal care
- Medical conditions of the mother
- Maternal age (under 17, over 35)
- Poor nutritional status and not gaining enough weight during pregnancy
- Under or overweight
- Poverty, less than 12th grade education
- Substance, alcohol and tobacco use
- Stressors and lack of social support
- Physical and emotional abuse of mother
Risk factors for medical/genetic conditions of infant
- Alcohol and smoking immediately before and/or during pregnancy
- Taking unapproved medications or vaccinations during pregnancy
- Infections during pregnancy
- Lack of prenatal care
Records Needed for Case Review
- Birth records
- Pediatric records for well and sick visits
- Death certificates
- Prenatal carerecords
- Hospital birthrecords
- Emergency Department records
- Any support services utilized, including WIC and Family Planning
- Police reports
- Prior CPS reports on caregivers
- Maternal Home Interview, if available
- Pregnant women get sufficient folic acid
- Ensure that all women have available preconception care and counseling and prenatal care that is acceptable, accessible, appropriate and available.
- Ensure that all women have postpartum care options available that include contraception, pregnancy planning, and preconception care.
- Improve local provider knowledge of pre-conception health care issues.
- Improve emergency response and transport systems.
- Foster maternal and infant support services to improve the social/psychological environment for women and families at risk.
- Encourage the comprehensive assessment of risks due to sexually transmitted infection, substance abuse including alcohol, smoking, domestic violence, depression, social support, housing, employment, transportation, etc. by all localproviders and perhaps as a local hospital delivery policy.
- Develop and distribute community resource directories to make consumers and providers aware of where to go for help and services.
- Provide mentoring, support, outreach, and advocacy at the community level utilizing paraprofessionals, indigenous health workers, and faith-based initiatives.
- Develop systems to provide transportation and childcare to women seeking prenatal care.
- Coordination of care between programs and parts of the health care system.
- Forums to raise awareness of consumers, providers, and policy makers of infant mortality issues.
- Local community/business/health care partnerships to broaden the number of stakeholders.
- Enhanced community education to include unplanned/unwanted pregnancy prevention, including teen pregnancy prevention services and early detection of signs and symptoms of pre-term labor.
Finding Evidence-Based Prevention Programs to Accomplish the Prevention Goals
- Evidence-based, cost-effective interventions: how many newborn babies can we save? The Lancet, Volume 365, Number 9463, 12 March 2005
- CDC’s National Center on Birth Defects and Developmental Disabilities Strategic Plan February 10, 2011
- Evidence-based information and recommendations related to Maternal, Infant, and Child Health; Healthy People.gov.