Fetal and early neonatal death: Do the determinants vary?

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.