Assessing Perinatal Risk for Fetal-Infant Mortality

Fetal-infant mortality is a key indicator of community health. A Perinatal Periods of Risk (PPOR) analysis underscored that poor maternal preconceptional and prenatal health is a major contributor to fetal-infant mortality in Kalamazoo County, Michigan. Given the multitude of factors associated with maternal preconceptional and prenatal health, Kalamazoo County Healthy Babies-Healthy Start conducted this study to zero in on the most critical perinatal risk factors.

This was a retrospective study of prenatal and delivery medical records for a control group (a representative sample of women delivering a live infant in 2005, n=195) against a fetal-infant mortality comparison group (which included all women delivering stillborn infants during 2004-2005, N=26, and all women delivering live infants that subsequently died during 2004-2005, N=40).

Bivariate analysis comparing the mortality population with the control group identified multiple significant differences (p<.05), namely: Race, marital status, insurance status, previous teen pregnancy, gravida, previous obstetric loss, multiple birth, Kessner Adequacy of Care, pre-pregnancy BMI and adequacy of prenatal weight gain, delivery condition risk, chlamydia, gonorrhea, anemia, diabetes, oligohydramnios, depression, smoking, prenatal alcohol and prenatal drug use, CPS involvement. Multivariate analyses identified two tiers of risk: (1) Rare but Lethal risks, including CPS involvement, no prenatal care, prenatal alcohol, delivery risk condition, pre-pregnancy diabetes (all with 1% prevalence but with 15:1 (mortality: control) odds ratios); and (2) Common & Dangerous risks, including inadequate prenatal weight gain, anemia, previous adverse birth outcome, and smoking (all much more common (8%-15%) and with mortality odds ratios of 3 to 7).