CDC Study Links Premature Births, High Infant Mortality In U.S.

Main Category: Pregnancy / Obstetrics
Also Included In: Pediatrics / Children's Health
Article Date: 06 Nov 2009 - 2:00 PST

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The U.S. infant mortality rate is one of the highest among developed countries, primarily because of the nation's high number of premature births, according to a new Centers for Disease Control and Prevention study, the New York Times reports (Grady, New York Times, 11/4). Based on 2005 data, the U.S. ranked 30th -- between Poland and Slovakia -- with 6.9 infants dying before age one for every 1,000 births (MacDorman/Mathews, National Center for Health Statistics data brief, November 2009). Infant mortality is often viewed as a gauge of a country's health, according to the Times. Most European nations -- as well as Australia, Canada, Hong Kong, Israel, Japan, New Zealand and Singapore -- have infant mortality rates lower than those in the U.S.

According to the study, 12.4% of U.S. births were premature, compared with 6.3% in Sweden, which had the lowest infant mortality rate among Western nations at 2.4 deaths per 1,000 births (New York Times, 11/4). Infants born prematurely are at higher risk of dying because they are especially fragile and have under-developed lungs, according to the study's lead author, CDC statistician Marian MacDorman (Stobbe, AP/San Diego Union-Tribune, 11/3). Though premature infants in the U.S. are more likely to survive than those born elsewhere, the volume of premature births -- 540,000 per year -- contributes to the high infant mortality rate (New York Times, 11/4).

The report cited inadequate care of low-income pregnant women as a key factor driving premature births (AP/San Diego Union-Tribune, 11/3). Alan Fleischman, medical director of the March of Dimes, said the study amounts to "an indictment of the U.S. health care system" and its shortcomings in caring for women and children (New York Times, 11/4). He noted that the U.S. does not guarantee prenatal care to pregnant women (AP/San Diego Union-Tribune, 11/3). The highest rates of infant mortality occurred among non-Hispanic black, American Indian, Alaska Native and Puerto Rican women. The smallest, most premature and most fragile infants tend to be born to low-income and minority women who lack health care and social support. In relating premature birth to infant mortality, the report "puts together two very important issues, both of which we knew about but hadn't linked tightly," Fleischman said (New York Times, 11/4).

The report also attributed the high prematurity rate to increased use of fertility treatments, which are more likely to result in multiple infants who tend to be delivered early. Maternal obesity and smoking are also linked to premature births. The researchers also expressed concern about increasing rates of induced labor and caesarean sections prior to the 37th week of a pregnancy, although Fleischman noted that most infant deaths do not occur to children born only slightly prematurely (AP/San Diego Union-Tribune, 11/3). Fleischman said treating pregnant women's illnesses and addressing drinking, drug use and smoking before and during pregnancy can help reduce the risk of premature birth.

Premature birth is not the sole driver of the high infant mortality rate, MacDorman said. Full-term infants in the U.S. also had higher mortality rates than those in Europe from sudden infant death syndrome, accidents, assaults and homicides (New York Times, 11/4).

Broadcast Coverage

NPR's "All Things Considered" on Wednesday reported on the study. The segment included comments from MacDorman and Courtney Lynch, a professor at Ohio State University (Wilson, "All Things Considered," NPR, 11/4).

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