The perinatal periods of risk (PPOR) methods provide a framework and tools to guide large urban communities in investigating their feto-infant mortality problem. The PPOR methods have 11 defined steps divided into three analytic parts: (1) Analytic Preparation; (2) Phase 1 Analysis—identifying the opportunity gaps or populations and risk periods with largest excess mortality; and (3) Phase 2 Analyses—investigating these opportunity gaps. This article focuses on the Phase 2 analytic methods, which systematically investigate the opportunity gaps to discover which risk and preventive factors are likely to have the largest effect on improving a community’s feto-infant mortality rate and to provide additional information to better direct community prevention planning. This article describes the last three PPOR epidemiologic steps for investigating identified opportunity gaps: identifying the mechanism for excess mortality; estimating the prevalence of risk and preventive factors; and estimating the impact of these factors. While the three steps provide a common strategy, the specific analytic details are tailored for each of the four perinatal risk periods. This article describes the importance, prerequisites, alternative approaches, and challenges of the Phase 2 methods. Community examples of the methods also are provided.
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Thanks to Dr. Brian McCarthy for developing and sharing his original methods and encouraging us to modify the approach for use in US cities. Thanks to the Perinatal Periods of Risk City Teams, Pat Simpson and Jennifer Skala for their help in developing and adapting the methods for use in urban communities. Special thanks to Dr. Milton Kotelchuck and Dr. Laurin Kasehagen for their advice in writing these articles for publication. This work was supported in part by the following Cooperative Agreements: Merging Research and Practice for Urban Child Health—TS-283-14/16 (under CDC Cooperative Agreement U50/CCU300860); Building Urban MCH Capacity—TS 0922 (under CDC Cooperative Agreement U50/CCU300860); Toward Greater Science Use in Urban Health Agencies—TS-1337 (under CDC Cooperative Agreement U50/CCU300860); and the Maternal, Infant, and Reproductive Health: Science-Based Capacity Building for Major Urban Public Health Agencies (5 U65 DP724969-05) between CityMatCH at the University of Nebraska Medical Center and the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, with supplemental support from the National Center for Birth Defects and Developmental Disabilities, and the Health Resources and Services Administration, Maternal and Child Health Bureau. Additional support was provided by the National March of Dimes Birth Defects Foundation, and the University of Nebraska Medical Center, Department of Pediatrics.
The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Sappenfield, W.M., Peck, M.G., Gilbert, C.S. et al. Perinatal Periods of Risk: Phase 2 Analytic Methods for Further Investigating Feto-Infant Mortality. Matern Child Health J 14, 851–863 (2010). https://doi.org/10.1007/s10995-010-0624-5
- Perinatal periods of risk (PPOR)
- Feto-infant mortality
- Health disparities methodology