title: Assessing maternal risk for fetal-infant mortality: a population-based study to prioritize risk reduction in a healthy start community.
abstract: Study goals were to distinguish between maternal risk factors for fetal versus infant mortality, and to identify which maternal characteristics contributed the greatest risk of mortality overall. This case-control retrospective study abstracted data on more than forty maternal characteristics from 261 prenatal and delivery records: all 26 fetal deaths, all 40 infant deaths and 195 randomly selected surviving births in a high-mortality Healthy Start community. Bivariate and multivariate analyses were conducted. The fetal-mortality population was significantly more likely than the infant-mortality population to have no insurance (P = .047), inadequate prenatal care (P = .039) and previous fetal death (P = .021). Comparing the combined mortality population with the surviving sample, two tiers of risk emerged: Rare-but-lethal risks, including no prenatal care (P < .001) and Child-Protective-Service involvement (P = .001), and common-and-dangerous risks, including inadequate maternal weight gain (OR = 13.55), drug or alcohol abuse (OR = 8.67), obesity (OR = 2.77) and anemia (OR = 3.61). Both fetal and infant mortality groups must be considered when identifying maternal risks. Inadequate prenatal weight gain, obesity and anemia contribute as much to feto-infant mortality as substance abuse. Public health efforts to improve maternal nutrition and healthy weight should be redoubled.
authors.affiliation: Research Department & Emergency Department, Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo, MI, USA. kothari@kcms.msu.edu
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Kothari
authors.forename: Annie
authors.initials: A
authors.lastname: Wendt
authors.forename: Oemeeka
authors.initials: O
authors.lastname: Liggins
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Overton
authors.forename: Luz del Carmen
authors.initials: Ldel C
authors.lastname: Sweezy
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000150:complications; D016022:Case-Control Studies; D005260:Female; D046689:Fetal Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008824:Michigan / Q000453:epidemiology; D009765:Obesity / Q000150:complications; D018743:Perinatal Care; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications; D015430:Weight Gain; D055815:Young Adult