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Integrated Approaches to Improve Birth Outcomes: Perinatal Periods of Risk, Infant Mortality Review, and the Los Angeles Mommy and Baby Project

Abstract

This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders’ commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the LAMB case–control study (279 controls, 87 cases) identified additional factors associated with LBW births: high blood pressure before and during pregnancy, pregnancy weight gain falling outside of the recommended range, smoking during pregnancy, and feeling unhappy during pregnancy. PT birth was significantly associated with having a previous LBW/PT birth, not taking multivitamins before pregnancy, and feeling unhappy during pregnancy. In response to these findings, community stakeholders gathered to develop strategic actions for targeted prevention to address infant mortality. Subsequently, key funders infused resources into the community, resulting in expanded case management of high-risk women, increased family planning services and local resources, better training for nurses, and public health initiatives to increase awareness of infant safety. Community readiness, mobilization, and alignment in addressing a public health concern in Los Angeles County enabled the integration of PPOR analytic methods into the established IMR structure and [the design and implementation of a population-based l study (LAMB)] to monitor the factors associated with adverse birth outcomes. PPOR proved an effective approach for identifying risk and social factors of greatest concern, the magnitude of the problem, and mobilizing community action to improve infant mortality in the Antelope Valley.

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References

  1. Koontz, A. M., Buckley, K. A., & Ruderman, M. (2004). The evolution of fetal and infant mortality review as a public health strategy. Maternal and Child Health Journal, 8(4), 195–203.

    Article  PubMed  Google Scholar 

  2. GAVEA Economic Roundtable Report. US Census Bureau, 2003.

  3. United Way of Greater Los Angeles. Zip Code Databook for Los Angeles County Service Planning Areas (SPA) 1: Antelope Valley, 2003 Feb. http://www.unitedwayla.org.

  4. Davenport, D., & Harding, C. (2004). Infant mortality in the Antelope Valley: Report to the Board of Supervisors. Los Angeles County Department of Public Health, 2004 Jun.

  5. Black Infant Health (BIH) Program. Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs. http://www.lapublichealth.org/mch/BIH/BIH.htm.

  6. Fetal Infant Mortality Review. Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs. http://publichealth.lacounty.gov/mch/fimr/fimr2.htm.

  7. Peck, M. G., Sappenfield, W. M., Skala, J. Perinatal periods of risk: A community approach for using data to improve women and infants’ health. Maternal and Child Health Journal (in press).

  8. CityMatCH. Using the perinatal periods of risk approach to reduce feto-infant mortality: A framework for assessing community readiness. http://webmedia.unmc.edu/community/citymatch/PPOR/howto/Framework.doc http://webmedia.unmc.edu/community/citymatch/PPOR/howto/10ThingsPPORApproach2.ppt.

  9. Sappenfield, W., et al. Perinatal periods of risk: Analytic preparation and phase 1 analytic methods for investigating feto-infant mortality. Maternal and Child Health Journal (in press).

  10. Sappenfield, W., et al. Perinatal periods of risk: Phase 2 analytic methods for further investigating feto-infant mortality. Maternal and Child Health Journal (in press).

  11. California Department of Public Health. FIMR policies and procedures. Fetal Infant Mortality Review (FIMR) Program. http://ww2.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Documents/MO-FIMR-ProgramPoliciesProcedures.pdf.

  12. National Fetal and Infant Mortality Review Program. NFIMR Data Abstraction Forms. The American College of Obstetricians and Gynecologists. http://www.acog.org/departments/dept_notice.cfm?recno=10&bulletin=2310.

  13. PRAMS model surveillance protocol, Version 3. Centers for Disease Control and Prevention (US). 2003 Sep. http://www.cdc.gov/prams.

  14. Pregnancy Risk Assessment Monitoring System. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health; 2003 May 22. http://www.cdc.gov/reproductivehealth/srv_prams.htm.

  15. Kieman, N. E. Cover Letter for a Survey Tipsheet #22. University Park, PA: Penn State Cooperative Extension. http://www.extension.psu.edu/evaluation/pdf/TS22.pdf.

  16. Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs, Research, Evaluation, and Planning Unit. Los Angeles Mommy and Baby (LAMB) Project. 2005. http://publichealth.lacounty.gov/mch/LAMB/LAMB.html.

  17. Davenport, D., Harding, C. Infant mortality in the Antelope Valley: Follow-up report to the Board of Supervisors. Los Angeles County Department of Public Health, 2005 May.

  18. LA Best Babies. Antelope Valley BBC. http://labestbabies.org/bbc/avBbc.htm.

  19. Lang, J. M., Lieberman, E., & Cohen, A. (1996). A comparison of risk factors for preterm labor and term small-for-gestational-age birth. Epidemiology, 7(4), 369–376.

    CAS  Article  PubMed  Google Scholar 

  20. Moutquin, J. M. (1999). A retrospective assessment of Canadian preterm birth 1979–1999. Maternal and Child Health Journal, 3(2), 93–97.

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

Antelope Valley Partners for Health; Antelope Valley Black Infant Health Program; Los Angeles County, Department of Public Health, Service Planning Areas 1 and 2; and Jonathan E. Fielding, M.D., M.P.H.

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Correspondence to Magda G. Peck.

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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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Chao, S.M., Donatoni, G., Bemis, C. et al. Integrated Approaches to Improve Birth Outcomes: Perinatal Periods of Risk, Infant Mortality Review, and the Los Angeles Mommy and Baby Project. Matern Child Health J 14, 827–837 (2010). https://doi.org/10.1007/s10995-010-0627-2

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  • DOI: https://doi.org/10.1007/s10995-010-0627-2

Keywords

  • Perinatal periods of risk (PPOR)
  • Community health planning
  • Feto-infant mortality
  • Preconception health
  • Health disparities