Child Health

Health Of Mothers

Last Updated Oct 5, 2008 00:03 AM

The health of mothers, infants, and child health is of critical importance, both as a reflection of the current child health status of a large segment of the U.S. population and as a predictor of the health of the next generation. This focus area addresses a range of indicators of maternal, infant, and child health those primarily affecting pregnant and postpartum women (including indicators of maternal illness and death) and those that affect infants’ and child health and survival (including infant mortality rates; birth outcomes; prevention of birth defects; access to preventive care; and fetal, perinatal, and other infant deaths).

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Infant mortality is an important measure of a nation’s child health and a worldwide indicator of child health status and social well-being. As of 1995, the U.S. infant mortality rates ranked 25th among industrialized nations.[1] In the past decade, critical measures of increased risk of infant death, such as new cases of low birth weight (LBW) and very low birth weight (VLBW), actually have increased in the United States. In addition, the disparity in infant mortality rates between whites and specific racial and ethnic groups (especially African Americans, American Indians or Alaska Natives, Native Hawaiians, and Puerto Ricans) persists. Although the overall infant mortality rate has reached record low levels, the rate for African Americans remains twice that of whites.[2]

Issues and Trends
In 1997, 28,045 infants died before their first birthday, for an overall rate of 7.2 deaths per 1,000 live births. This rate has declined steadily over the past 20 years; in 1975, the infant mortality rate was over 15 per 1,000 live births.2 In 1997, two-thirds of all infant deaths took place during the first 28 days of life (the neonatal period). The overall neonatal mortality rate in 1997 was 4.8 per 1,000 live births.2 The remaining one-third of infant deaths took place during the postneonatal period from an infant’s 29th day of life until the first birthday. The U.S. postneonatal mortality rate in 1997 was 2.4 deaths per 1,000 live births.2

Four causes account for more than half of all infant deaths: birth defects, disorders relating to short gestation and unspecified LBW, sudden infant death syndrome (SIDS), and respiratory distress syndrome. The leading causes of neonatal death in 1997 were birth defects, disorders related to short gestation and LBW, respiratory distress syndrome, and maternal complications of pregnancy. After the first month of life, SIDS is the leading cause of infant death, accounting for about one-third of all deaths during this period. Maternal age also is a risk factor for infant death. Mortality rates are highest among infants born to young teenagers (aged 16 years and under) and to mothers aged 44 years and older.

The death of fetuses before birth is another important indicator of perinatal child health. In 1996, nearly 7 fetal deaths were reported for every 1,000 live births and fetal deaths combined, representing a slight decline from the fetal mortality rate of 7.6 per 1,000 in 1987.2 Fetal death sometimes is associated with pregnancies complicated by such risk factors as problems with amniotic fluid levels and maternal blood disorders.[3] Early, comprehensive, and risk-appropriate care to manage such conditions has contributed to reductions in fetal mortality rates.

Short gestation and LBW are among the leading causes of neonatal death, accounting for 20 percent of neonatal deaths. In 1998, a total of 11.6 percent of births were preterm, and 7.6 percent were LBW.[4] Included in these statistics were VLBW infants weighing less than 1,500 grams (3.3 pounds). The rate of VLBW births was 1.4 percent in 1998. The VLBW rate has increased slightly since 1990 among whites and other population groups including African Americans, Puerto Ricans, and American Indians.1

LBW is associated with long-term disabilities, such as cerebral palsy, autism, mental retardation, vision and hearing impairments, and other developmental disabilities. (See Focus Area 6. Disability and Secondary Conditions and Focus Area 28. Vision and Hearing.) Despite the low proportion of pregnancies resulting in LBW babies, expenditures for the care of LBW infants total more than half of the costs incurred for all newborns. In 1988, the cost of a normal, child healthy delivery averaged $1,900, whereas hospital costs for LBW infants averaged $6,200.[5]

The general category of LBW infants includes both those born too early (preterm infants) and those who are born at full term but who are too small, a condition known as intrauterine growth retardation (IUGR). Maternal characteristics that are risk factors associated with IUGR include maternal LBW, prior LBW birth history, low prepregnancy weight, cigarette smoking, multiple births, and low pregnancy weight gain. Cigarette smoking is the greatest known risk factor.[6]

VLBW usually is associated with preterm birth. Relatively little is known about risk factors for preterm birth, but the primary risk factors are prior preterm birth and spontaneous abortion, low prepregnancy weight, and cigarette smoking.6 These risk factors account for only one-third of all preterm births.

The use of alcohol, tobacco, and illegal substances during pregnancy is a major risk factor for LBW and other poor infant outcomes. Alcohol use is linked to fetal death, LBW, growth abnormalities, mental retardation, and fetal alcohol syndrome (FAS).[7] Overall rates of alcohol use during pregnancy have increased during the 1990s, and the proportion of pregnant women using alcohol at higher and more hazardous levels has increased substantially. Smoking during pregnancy is linked to LBW, preterm delivery, SIDS, and respiratory problems in newborns. In addition to the human cost of these conditions, the economic cost of services to substance-exposed infants is great: child health expenditures related to FAS are estimated to be from $75 million to $9.7 billion each year.7 Over $500 million a year is spent on medical expenses for infants exposed to cocaine in utero.[8] Smoking-attributable costs of complicated births in 1995 were estimated at $1.4 billion (11 percent of costs for all complicated births, based on smoking prevalence during pregnancy of 19 percent) and $2.0 billion (15 percent for all complicated births, based on smoking prevalence during pregnancy of 27 percent).[9]

See also Child Health 418 1 - 8