Maternal and Child Health Journal

, Volume 9, Issue 2, pp 199–205

Perinatal Periods of Risk: Analysis of Fetal–Infant Mortality Rates in Kansas City, Missouri

  • Jinwen Cai
  • Gerald L. Hoff
  • Paul C. Dew
  • V. James Guillory
  • Josie Manning


Objectives: The Perinatal Periods of Risk (PPOR) technique was used to analyze resident fetal and infant death data from Kansas City, Missouri, for the period 1998–2002. Results offer important information that can be used to develop community-based prevention strategies related to racial/ethnic disparities in infant mortality rates (IMR). Methods: The PPOR approach for fetal and infant mortality can be mapped by birthweight at delivery and time of death into four strategic prevention areas: 1) Maternal Health/Prematurity (MHP), 2) Maternal Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). For this analysis, all fetal and infant death certificates from the metropolitan Kansas City area were linked to their birth certificates and those associated with residents of Kansas City, Missouri, proper were used to create the dataset used in this analysis. Due to the small number of fetal and infant deaths among other ethnic groups, the analysis was restricted to a comparison of the disparity of IMR between Blacks, Whites, and a national non-Hispanic white reference group. The Kitagawa formula was used to determine contribution to excess deaths from birthweight-specific mortality and birthweight distribution rates. Logistic regression techniques were used to identify risk factors for death among Black fetuses and infants with very low birthweights and also deaths due to sudden infant death syndrome (SIDS). Results: The PPOR analysis showed that of the excess deaths among black infants, when compared to a national reference group, 47% was attributable to MHP and another 29% was attributable to IH. Differences in MC and NC only accounted for 27 and 8% of the total excess deaths. During the study period, rates of sudden infant death syndrome (SIDS) were found to be significantly higher among Blacks as compared to Whites (2.12 vs. 0.81 per 1,000). An analysis of maternal characteristics for SIDS deaths among blacks using a step-wise logistic regression model, found that maternal age less than 20 years old, previous births, inadequate prenatal care, and being a Medicaid recipient were significant—adjusted odds ratios of 23.7 (95% Cl 10.48, 53.67), 8.4 (95% Cl 3.64, 19.21), 2.9 (95% Cl 1.38, 6.05) and 2.5 (95% Cl 1.04, 5.84), respectively. Conclusions: PPOR is an easy to use approach that helps focus community initiatives for improving maternal and infant health. In Kansas City, Missouri, efforts to further lower IMR in blacks can be achieved through the reduction of risk factors affecting maternal health and through maternal education to improve infant health.


infant mortality rate perinatal periods of risk sudden infant death syndrome fetal and infant mortality 


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  1. 1.
    Herrera LR, Kakehashi M. An international data analysis on the level of maternal and child health relation to socioeconomic factors. Hiroshima J Med Sci 2001;50:9–16.PubMedGoogle Scholar
  2. 2.
    Richardus JH et al. The perinatal mortality rate as an indicator of quality of care in international comparisons. Med Care 1998;36:54–66.CrossRefPubMedGoogle Scholar
  3. 3.
    Murray CJ. The infant mortality rate, life expectancy at birth, and a linear index of mortality as measures of general health status. Int J Epidemiol 1988;17:122–8.PubMedGoogle Scholar
  4. 4.
    Anthony S et al. Changes in perinatal care and survival in very preterm and extremely preterm infants in The Netherlands between 1993 and 1995. Eur J Obstet Gynecol Reprod Biol 2004;10:170–7.CrossRefGoogle Scholar
  5. 5.
    Meadow W et al. Changes in mortality for extremely low birth weight infants in the 1990s: implications for treatment decisions and resource use. Pediatrics 2004;113:1223–9.CrossRefPubMedGoogle Scholar
  6. 6.
    RAND Corporation. Preventing very low birthweight births: A bundle of savings, 1998 (
  7. 7.
  8. 8.
    Hoff GL, Cai J. Community health assessment 2004. ( Scholar
  9. 9.
    Okah FA, Cai J, Hoff GL. Term-gestation low birth weight and health-compromising behaviors during pregnancy. Obstet Gynecol 2005;105:543–50.PubMedGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention. Racial/ethnic trends in fetal mortality—United States 1990–2000. MMWR 2004;25:529–32.Google Scholar
  11. 11.
    Headley AJ. Generations of loss: Contemporary perspectives on black infant mortality. J Natl Med Assoc 2004;96:987–94.PubMedGoogle Scholar
  12. 12.
    Chibber R. Unexplained antepartum fetal deaths: what are the determinants? Arch Gynecol Obstet 2004; Epub prior to publication 7 May 2004Google Scholar
  13. 13.
    Cnattingius S, Stephansoon O. The epidemiology of stillbirth. Semin Perinatol 2002;26:25–30.PubMedGoogle Scholar
  14. 14.
    Maloni JA et al. Implementing evidence-based practice: Reducing the risk for low birth weight through pregnancy smoking cessation. J Obstet Gynecol Neonatal Nurs 2003;32:676–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Moore ML. Preterm labor and birth: what have we learned in the past two decades? J Obstet Gynecol Neonatal Nurs2003;32:638–49.CrossRefPubMedGoogle Scholar
  16. 16.
    Stephansson O, Dickman PW, Cnattingius S. 2003. The influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death. Obstet Gynecol 2003;102:101–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Tiedje LB. Psychosocial pathways to prematurity: Changing our thinking toward a lifecourse and community approach. J Obstet Gynecol Neonatal Nur2003;32:650–8.CrossRefGoogle Scholar
  18. 18.
    Froen JF et al. Comparative epidemiology of sudden infant death syndrome and sudden intrauterine unexplained death. Arch Dis Child Fetal Neonatal Ed 2002;87:F118–21.CrossRefGoogle Scholar
  19. 19.
    Hauck FR et al. Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study. Pediatrics 2003;111:1207–14.PubMedGoogle Scholar
  20. 20.
    Kemp JS et al. Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: results of a four-year, population-based, death-scene investigation study of sudden infant death syndrome and related deaths. Pediatrics 2000;106:E41.CrossRefPubMedGoogle Scholar
  21. 21.
    Sheers NJ, Rutherford GW, Kemp JS. Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations. Pediatrics 2003;112:883–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Martin JA et al. Births: final data for 2002. Centers for Disease Control and Prevention, Natl Vital Stat Rep 2003;52(10).Google Scholar
  23. 23.
    Andres RL, Day MC. Perinatal complications associated with maternal tobacco use. Semin Neonatol 2000;5:231–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Billaud N, Lemarie P. Negative effects of maternal smoking during the course of pregnancy. Arch Pediatr 2001;8:875–81.CrossRefPubMedGoogle Scholar
  25. 25.
    Winbo I et al. Maternal risk factors for cause-specific stillbirth and neonatal death. Acta Obstet Gynecol Scand2001;80:235–44.CrossRefPubMedGoogle Scholar
  26. 26.
    Zotti ME, Replogle WH, Sappenfield WM. Prenatal smoking and birth outcomes among Mississippi residents. J Miss State Med Assoc2003;44:3–9.PubMedGoogle Scholar
  27. 27.
    Getahun D et al. Maternal and obstetric risk factors for sudden infant death syndrome in the United States. Obstet Gynecol 2004;103:646–52.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Jinwen Cai
    • 1
    • 3
  • Gerald L. Hoff
    • 1
  • Paul C. Dew
    • 2
  • V. James Guillory
    • 2
  • Josie Manning
    • 1
  1. 1.Kansas City Health DepartmentOffice of Epidemiology and Community Health MonitoringKansas City
  2. 2.Department of Preventive MedicineKansas City University of Medicine and BiosciencesKansas City
  3. 3.Kansas City Health DepartmentOffice of Epidemiology and Community Health MonitoringKansas City

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