Perinatal Periods of Risk Analysis
In Richmond
2001-2005
Healthy Start Initiative
Masho S, Chapman D, Wenner M, Rives M, and Bradford
J,
May 2007
1 Masho et al.
Background
• High Infant Mortality Rate (IMR) is a major
health problem in Richmond
• African American’s are disproportionately
affected by the problem
• 1994-RCDPH became grantee
2 Masho et al.
Perinatal Period of Risk (PPOR)
Assess the major factors contributing to infant
mortality and morbidity
Examine developmental periods existing around the
time of conception, birth, and through the first year of
life
Offer the opportunity to explore risk factors tied to
each perinatal period by examining fetal and infant
deaths by age at death and birth weight
3 Masho et al.
Perinatal Period of Risk (PPOR)
For planning and evaluation: to determine
priorities for public health interventions,
allocate resources to identified needs, and a
forum for a community to discuss strategies
for reducing infant mortality
Identify gaps existing between different
population subgroups
4 Masho et al.
Background
Richmond Healthy Start conducted PPOR in 2002
– Using Data from 1996-2000
This study will assess the PPOR in Richmond using data from
2001-2005 and compares findings with the previous five years
5 Masho et al.
METHODS
6 Masho et al.
Data Source
Virginia Center for Health Statistics, Virginia
Department of Health (VDH)
2001- 2005
– Live birth file
– Fetal death file
– Infant death file
Linked infant birth-death data
7 Masho et al.
Definitions
Live births: an infant born at any gestation
exhibiting signs of life
Fetal death: pregnancy loss 24+ weeks gestation
and 500+ grams
Neonatal death: death of an infant occurring
between birth and 28 days of age
Postneonatal death: death of an infant occurring
between 28 days and one year of age
8 Masho et al.
PPOR Exclusion Criteria*
Spontaneous or induced abortions
Fetal deaths <24 weeks gestation
Fetal deaths <500 grams
Live births <500 grams
Births with unknown birthweight
*Exclusion criteria established to ensure comparability
of findings across regions and time periods through the
use of uniform reporting criteria for births.
9 Masho et al.
Data was categorized in to:
Birth weight
– 500-1499 grams
– 1500-2499 grams
– 2500+ grams
Fetal and infant death
– Fetal death
– Neonatal death (<28 days)
– Post neonatal death (28 days – 1st birthday)
10 Masho et al.
Fetal death file (N=1,844)
– <24 wks gestation (N=1401) (76%)
– Weight unknown = (N=1701)
– <500 gram (N=84)
– 48 fetal deaths were included
Infant death file (N=194)
– <500 gram (N=56)
– 138 infant deaths included
11 Masho et al.
Infant & Fetal Deaths in Richmond
For all Races: 2001-2005
Race Live Births Infant Fetal
death Death
White 5,295 16 15
African 9,040 120 31
American
Other 372 3 2
All Races 14,714 138 48
12 Masho et al.
Perinatal Periods and Weight Categories
Fetal Neonatal -
Postneonatal
Birthweight 24+ wks <28 days 28 d to 1 yr
-
500 1499g
-
15002499g
2500+ g
13 Masho et al.
Feto-Infant Mortality Map
Age at Death
Post
Fetal Neonatal neonatal
Birthweight
500 - Maternal Health/
1499 g Prematurity
1500+ g Maternal Newborn Infant
Care Care Health
14 Masho et al.
Mapping Outcomes to Intervention
Maternal Preconceptional Health
Health/Prematurity Health Behaviors
Perinatal Care
Prenatal Care
Maternal Care Referral System
High Risk OB Care
Perinatal Management
Newborn Care Perinatal System
Pediatric Surgery
Sleep Position
Infant Health Breast-Feeding
15 Injury Prevention
Masho et al.
RESULTS
16 Masho et al.
Figure 1. Trend in Infant Mortality Rate, Richmond VA
30
26.8
25
23.7
22.2
20
Per 1,000 Live Births
19.1
18.5
16.2 16.4 16.3 White
15.5 15.9
15 AA
14.6
All races
13
12.3 12.4 12.4
11.3 11.4
10 9.9
9.2 9.3
8.4
7.1
5.7 6.1
5 4.8
4.3
3.5 3.8 3.5
2.8
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
17 Year
Masho et al.
Five Year Infant Mortality Rate by Race, Richmond, VA
1996-2000 2001-2005
All Races 11.2 13.1
White 5.8 4.1
African 16.5 18.6
American
18 Masho et al.
Spatial Presentation of Infant Mortality Rate in Richmond, 2001-5
19 Masho et al.
Spatial Presentation of Infant Mortality and Median Income, 2001-5
20 Masho et al.
Spatial Presentation of Infant Mortality Rate and Public Housing, 2001-5
21 Masho et al.
Spatial Presentation of Infant Mortality, Median Income and Public Housing
22 Masho et al.
Feto-Infant Mortality Rates
PPOR Rates for All Races
2001-05
Maternal Health/
Prematurity
5.6
Maternal Newborn Infant
Care Care Health
1.4 1.3 2.8
11.2 per1,000
birth & fetal death
23 Masho et al.
Feto-Infant Mortality Rates
PPOR Rates for All Races
Maternal Health/
Prematurity 1996-2000
4.9
12.0 per 1,000
Maternal Newborn Infant
Care Care Health births & fetal deaths
2.3 2.1 2.7
Maternal Health/
Prematurity
2001-05 5.6
11.2 per1,000 Maternal Newborn Infant
birth & fetal death Care Care Health
24 1.4 1.3 et al.
Masho 2.8
Feto-Infant Mortality Rates
Maternal Health/
Prematurity Whites
2.2 2001-05
Maternal Newborn Infant 5.1 per 1,000
Care Care Health
fetal & infant deaths
1.3 0.3 1.3
Maternal Health/
African Americans Prematurity
2001-05 7.9
15.1 per 1,000 Maternal Newborn Infant
fetal & infant deaths Care Care Health
1.5 1.9 3.8
25 Masho et al.
-
Feto-Infant Mortality Rates
PPOR Rates for African Americans
Maternal Health/ 1996-2000
Prematurity
5.5 14.1 per1,000
fetal & infant deaths
Maternal Newborn Infant
Care Care Health
2.7 2.5 3.4
Maternal Health/
2001-05 Prematurity
15.1 per 1,000 7.9
fetal & infant deaths Maternal Newborn Infant
Care Care Health
26 1.5 1.9 3.8
Masho et al.
Excess Feto - Infant Mortality
Richmond City
Richmond City
African Americans Whites
Excess
(reference)
7.9 2.2 5.7
1.5 1.9 3.8 1.3 0.3 1.3 0.2 1.6 2.5
15.1 - 5.1 = 10.0
27 Masho et al.
Mapping Outcomes to Intervention
Maternal Preconceptional Health
Health/Prematurity Health Behaviors
Perinatal Care
Prenatal Care
Maternal Care Referral System
High Risk OB Care
Perinatal Management
Newborn Care Perinatal System
Pediatric Surgery
Sleep Position
Infant Health Breast-Feeding
28 Injury Prevention
Masho et al.
CONCLUSION
29 Masho et al.
Factors Contributing to Fetal-Infant Mortality
Infant Care
25%
Maternal Health/
Prematurity
50%
Maternal Care
13%
Newborn Health
12%
30 Masho et al.
Priority Perinatal Periods
Maternal Preconceptional Health
Health/
Health/ Prematurity Health Behaviors
PerinatalCare
Sleep Position
Infant Health Breast - Feeding
Injury Prevention
31 Masho et al.
Factors
Preconceptional Health: Pregnancy planning, age, healthy
life style (nutrition, exercise, etc), regular medical check up, vit.
& folic acid, income, support, education etc.
Health Behaviors: Good nutrition, regular exercise, no
smoking, no drugs, good mental health, violence free lifestyle
including relationships and neighborhoods etc.
Perinatal Care: Well women’s health, regular physicals,
annual pelvic and pap exams, safe sex, family planning, (wait at
least two years between pregnancies).
32 Masho et al.
Factors
Sleep Positions: Babies need a safe sleeping environment of
their own such as a crib, with a firm mattress, no fluffy blankets
or toys and unless your doctor tells you otherwise, always put
your baby to sleep on their back.
Breast Feeding: Breast milk is like a baby’s first
immunization!! Breastfed babies can fight infection better and
breastfeeding establishes a strong and loving bond between
mother and baby.
Injury Prevention: Use car safety seats. Never leave an
infant unattended. Safety first.
33 Masho et al.
Recommendations
Begin discussing (priority areas, prevention)
Examine existing interventions
Strengthen interventions that worked
New intervention to target priority/needs
Re-examine populations targeted
Further study
34 Masho et al.