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APHA Scientific Session and Event Listing

Recorded presentation

Magda G. Peck, ScD¹, William M. Sappenfield, MD MPH², Carol S. Gilbert, MS¹, and Jennifer Skala, MEd¹. (1) Department of Pediatrics/CityMatCH, University of Nebraska Medical Center, 68198-2175 Nebraska Medical Center, Omaha, NE 68198-2175, 402 561 7500, mpeck@unmc.edu, (2) Florida Department of Health, 4052 Bald Cypress Way, Bin A 13, 4025 Esplanade Way, Room 105M, Tallahassee, FL 32399-1721

We used NCHS data (2000-2002) to calculate feto-infant mortality rates, and to estimate excess feto-infant deaths, for urban counties and major cities with >250,000 population (1990 Census), States, and the U.S. overall using Perinatal Periods of Risk (PPOR) analytic methods. The Maternal Health/Prematurity (MH/P) period of risk (fetal, neonatal and postneonatal deaths weighing less than 1500g) had the highest feto-infant mortality in all 61 major cities, in 189 of 192 urban counties, in 48 of 50 States (all but SD and AK), and for the U.S. overall. MH/P dominance (very low birthweight fetal and infant deaths) also was observed by over 20 cities participating in CityMatCH PPOR practice collaborative activities. Follow up Kitagawa analysis in each city showed excess MH/P deaths were mainly attributable to birthweight distribution (vs. birthweight-specific mortality). The PPOR Approach is being used in over 100 localities to improve perinatal health outcomes. Given these common findings, urban communities in the U.S. are eager for evidence-based interventions that have impact prior to conception and very early in pregnancy. Recent publication of National Recommendations for Preconception Health and Health Care (MMWR, April 2006) outline needed changes in consumer education and reproductive health care for women and their partners. As national guidelines for the content, delivery and financing of Preconception Care (PCC) emerge, we can anticipate increased readiness and growing demand for their adoption by consumers and providers in cities and States where PPOR findings of very low birthweight fetal and infant deaths underscore the need to intervene before pregnancy.

Learning Objectives:

• Understand findings from recent analyses of national fetal and infant death and live birth data for the U.S. using the PPOR approach to examine feto-infant mortality at national, state and local levels
• Identify the "Maternal Health/Prematurity" Period of Risk as being the greatest component of feto-infant mortality across all major U.S. urban counties and cities, and for the U.S. as a whole.
• Discuss how PPOR is leading to greaterlocal awareness of very low birthweight fetal and infant deaths and birthweight distribution, and subsequent interest in and demand for preconception health and heath care

Keywords: Pregnancy Outcomes, Data/Surveillance

Related Web page: www.citymatch.org/ppor

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation