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Assessing Maternal Risk for Fetal-Infant Mortality: A Population-Based Study to Prioritize Risk Reduction in a Healthy Start Community

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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.

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Notes

  1. Five year moving average rate, calculated as number of fetal deaths per 1,000 live births plus fetal deaths.

  2. Five year moving average rate, calculated a number of infant deaths per 1,000 live births.

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Acknowledgments

This research was funded by Kalamazoo County Healthy Babies-Healthy Start as part of their local Evaluation efforts. This study was the result of a collaborative partnership between Kalamazoo County Healthy Babies-Healthy Start, Kalamazoo County Fetal-Infant Mortality Review Team and Kalamazoo County Health & Community Services Department. The authors wish to thank Karin V. Rhodes MD MPH for her critical comments and James Wiley PhD for his statistical advice. This project would not have been possible without the support of Borgess Medical Center and Bronson Methodist Hospital.

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Authors and Affiliations

  1. Research Department & Emergency Department, Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo, MI, USA

    Catherine L. Kothari

  2. Epidemiology Department, Kalamazoo County Department of Health & Human Services, Kalamazoo, MI, USA

    Annie Wendt

  3. Fetal-Infant Mortality Review Team, Kalamazoo County Department of Health & Human Services, Kalamazoo, MI, USA

    Oemeeka Liggins

  4. Michigan State University, Kalamazoo, MI, USA

    Jacqueline Overton

  5. Healthy Babies-Healthy Start, Kalamazoo County Department of Health & Human Services, Kalamazoo, MI, USA

    Luz del Carmen Sweezy

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  1. Catherine L. Kothari
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  2. Annie Wendt
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Correspondence to Catherine L. Kothari.

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Kothari, C.L., Wendt, A., Liggins, O. et al. Assessing Maternal Risk for Fetal-Infant Mortality: A Population-Based Study to Prioritize Risk Reduction in a Healthy Start Community. Matern Child Health J 15, 68–76 (2011). https://doi.org/10.1007/s10995-009-0561-3

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  • DOI: https://doi.org/10.1007/s10995-009-0561-3

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