197681 Fetal and early neonatal death: Do the determinants vary?

Tuesday, November 10, 2009

Ashley O. Carter, MPH , Division of Disease Prevention, Virginia Department of Health, Richmond, VA
Derek Chapman, PhD , Office of Family Health Serivces, Virginia Department of Health, Richmond, VA
Background: Much attention is devoted to reducing the infant mortality rate which was declining until 2002. The recent rise was found to stem from an increase in deaths during the early neonatal period. Fetal deaths are not well understood and not routinely included when evaluating infant mortality.

Methods: Using data collected from 2001 to 2006 fetal death and linked infant birth and death certificates by the Virginia Department of Health, crude mortality rates and leading causes of death were calculated for singleton fetal and early neonatal deaths. Rates were calculated for each period of death and mapped to depict distribution. Logistic regression was used to evaluate sociodemographic and pregnancy characteristics and chi-square analyses were used to determine if the determinants varied by timing of death.

Results: During the study period, the fetal death rate was 5.4/1,000 fetal deaths plus live births and the early neonatal death rate was 2.5/1,000 live births. Trends over time, gestational age specific mortality, geographic distribution and cause of death were comparable between both death periods. Extremely low birth weight was the most significant risk factor for early neonatal death (OR = 1747.06). Congenital anomalies of the child were the leading predictor of fetal death (OR = 26.24) and second highest for early neonatal death (OR = 52.26).

Conclusions: Because of the similarities in geographic distribution, sociodemographic factors, pregnancy risk factors and causes of death, analyzing neonatal and infant mortality rates in isolation from fetal deaths does not accurately depict the burden of adverse pregnancy outcomes.

Learning Objectives:
Compare the distribution and determinants of fetal and early neonatal mortality. Name three leading determinants for both fetal and early neonatal mortality. Discuss the importance of including fetal mortality with infant mortality, for a feto-infant mortality rate, to more accurately depict the burden of adverse pregnancy outcomes.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The College of William and Mary, Bachelor of Science, May 2007; Virginia Commonwealth University, Master of Public Health, December 2008; Master's research project: "Fetal and early neonatal death: Do the determinants vary?"
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.