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APHA Scientific Session and Event Listing

Margaret Chao, PhD, MPH¹, G.M. Donatoni, PhD, MT(ASCP)¹, G. Macias, MPH, MS¹, C. Bemis, MPH¹, A. Hopson, MSN, MPH, RN¹, Deborah Davenport, RN, MS², and Cynthia Harding, MPH¹. (1) Maternal, Child, and Adolescent Health, Los Angeles County Department of Health Services, 600 South Commonwealth, Suite 800, Los Angeles, CA 90005, 213639-6400, schao@ladhs.org, (2) Public Health, Los Angeles County Department of Health Services, 5300 Tujunga Street, North Hollywood, CA 91601

Background: Between 1999 and 2002, Antelope Valley (AV) in LAC experienced a significant increase in the infant mortality rate, from 5.0 per 1,000 live births to 10.6. In fall 2004, MCAH incorporated the Perinatal Periods of Risk (PPOR) approach, initiated Fetal Infant Mortality Review (FIMR), and implemented a population-based case-control study to identify areas of need.

Method: (1) Analyzed birth cohort data by gestational age and birth weight; (2) reviewed 53 infant deaths from 2002 using the FIMR model; and (3) conducted a Case-Control study to identify risk factors (medical, psychosocial and environmental) associated with low birth weight or preterm (LBW/PT) births, which cannot be determined by FIMR alone.

Results: The birth cohort analysis identified pre–/interconceptional and infant health as the most important areas to intervene. FIMR review found high percentages of mothers with previous fetal loss or LBW/PT experiences (85%), psychosocial issues (65%), medical conditions (47%), infections (47%), and infant safety issues (21%). Case-Control study (279 controls, 87 cases) identified being uninsured pre-pregnancy (OR=2.3), previous delivery of a LBW/PT birth (OR = 3.7), high blood pressure during pregnancy (OR=3.4), and having inadequate prenatal care (OR=2.3) to be significantly associated with LBW/PT.

Implications: The project demonstrated an effective model of translating data into community action to affect health status. Based on the findings, the local Healthy Babies Learning Collaborative made 9 short–term and 3 long-term recommendations and commitments to improve birth outcomes. Details will be presented and efforts to overcome challenges and limitations will be discussed.

Learning Objectives: