|
|
|
|
|
|
E-mail to a Friend Printer
friendly |
|
|
|
|
|
|
|
|
Every
now and then, Al Brann goes to the top floor of Grady Hospital
in the late afternoon to watch the planes descend methodically on
their final approach to Atlanta's airport. The pediatrics
professor likens his calling, and that of his colleagues in obstetrics,
to an air traffic controller. All want to ensure a "safe landing"
for each pregnancy.
But that continues to be a challenge
in Georgia, where some 2,500 babies are born each year at less than
eight months' gestation and weighing less than 3.3 lbs.
Brann and his colleagues want to know
why. Highly specialized obstetric and neonatal care, regionalized
under Governor Jimmy Carter in the early 1970s, has led to improved
survival for all newborn infants. But while infant mortality has
declined 50% statewide over the past 25 years, Georgia still ranks
a dismal 40th nationwide in infant mortality. |
|
|
|
|
|
And
unfortunately, the frequency of very low birth weight (VLBW) births
has remained unchanged. As these babies account for half of the
nearly 1,200 infant deaths in the state annually, reducing their
numbers is crucial to further decreasing infant mortality.
As obstetricians know, the rate
of newborn infant deaths varies according to where the mother lives
and other sociodemographic characteristics of her life. In North
Georgia, Caucasian women 20 or older and with 13 or more years of
education have a feto-infant mortality rate of five per 1,000 births.
But for infants born to African American women statewide and to
Caucasian women living in central and southern Georgia, the rate
is almost three times higher, with 14.35 deaths per 1,000 births.
It would be easy to assume that factors
such as economic status and education level drive the higher rates,
but the answer is not so simple. Infants born to educated African
American women 20 or older still have a greater risk of infant mortality
than those born to Caucasian teenagers. "African American
women, compared with Caucasian women, are three to four times more
likely to have a very low birth weight infant who is at greater
risk of dying," says Brann. So what gives?
The World Health Organization Collaborating
Center in Reproductive Health, a partnership led by Brann with Emory,
the CDC, and Georgia's Division of Public Health, is analyzing
birth outcomes throughout the state to identify census tracts with
a significant concentration of VLBW babies. The project started
in Fulton and DeKalb counties, where census tracts were identified
with a VLBW infant rate as high as 4%. The statewide average ranges
from 0.9% to 1.2%. If doctors understand more about what leads to
these poor outcomes, they can predict and prevent bad outcomes in
more first-time pregnancies, Brann says. Currently, that's
impossible to do. |
|
|
|
|
|
|
|
|
|
"The
problem is that we haven't had data on the mothers of VLBW
infants to know if there are environmental effects on women's
health that may lead to bad pregnancy outcomes," says Brann.
"Having such data will tell us what we should be recommending.
We are using the surveillance system to identify specific risks
amenable to intervention within these census tracts."
Generally, conditions adversely
affecting the health of mothers, such as hypertension, sexually
transmitted diseases, domestic violence, and depression, account
for 60% of Georgia's feto-infant mortality. The collaborating
center team will look for demographic and environmental factors
common to mothers who deliver VLBW infants and the census tracts
in which they live, including the cost of housing, income, education
level, race and age of residents in the tract, the types of illness
they have, and neighborhood crime and violence. "Once we obtain
this information," Brann says, "we can determine not
only where but how to intervene."
A recent study at Grady Hospital led
by Brann and Emory physician Anne Lang Dunlop indicates that health
care interventions targeting women after the birth of a VLBW baby
can influence subsequent reproductive outcomes. Results showed that
women who received primary health care, who spaced their children
24 months apart after delivering a VLBW baby, and who received vocational
and educational counseling had fewer adverse pregnancy outcomes
than expected statistically. Building on that study, Brann is seeking
to identify additional demographic factors that can be targeted
to improve birth outcomes statewide.
Ultimately, the lessons learned may
lead to fewer infant deaths in Georgia, the nation, and the world. |
|
|
|
|
|
|
|
|
|
|