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Objective To identify the association of newly developed prepregnancy overweight and obesity with stillbirth and infant mortality. Methods We studied subsequent pregnancies of mothers who were normal weight at fertilization of their first identified pregnancy, from a population-based cohort that linked birth registry with death records in Pennsylvania, 2003-2013. Women with newly developed prepregnancy overweight and obesity were defined as those whose body mass index (BMI) before second pregnancy was between 25 and 29.9 or 30 or higher, respectively. Our main outcomes of interest were stillbirth (intrauterine death at 20 weeks of gestation or greater), infant mortality (less than 365 days after birth), neonatal death (less than 28 days after birth) and postneonatal death (29-365 days after birth). Associations of both prepregnancy BMI categories and continuous BMI with each outcome were estimated by nonparametric targeted minimum loss-based estimation and inverse-probability weighted dose-response curves, respectively, adjusting for race-ethnicity, smoking, and other confounders (eg, age, education). Results A cohort of 212,889 women were included for infant mortality analysis (192,941 women for stillbirth analysis). The crude rate of stillbirth and infant mortality in these final analytic cohorts were 3.3 per 1,000 pregnancies and 2.9 per 1,000 live births, respectively. Compared with women who stayed at a normal weight in their second pregnancies, those becoming overweight had 1.4 (95% CI 0.6-2.1) excess stillbirths per 1,000 pregnancies. Those becoming obese had 3.6 (95% CI 1.3-5.9) excess stillbirths per 1,000 pregnancies and 2.4 (95% CI 0.4-4.4) excess neonatal deaths per 1,000 live births. There was a dose-response relationship between prepregnancy BMI increases of more than 2 units and increased risk of stillbirth and infant mortality. In addition, BMI increases were associated with higher risks of infant mortality among women with shorter interpregnancy intervals (less than 18 months) compared with longer intervals. Conclusion Transitioning from normal weight to overweight or obese between pregnancies was associated with an increased risk of stillbirth and neonatal mortality.

Objectives-This report presents final 2019 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2019," the National Center for Health Statistics' annual report of final mortality statistics.

Objectives-This report presents final 2018 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2018," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2018. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanic-origin data are based on the Office of Management and Budget's 1997 standards for reporting race and Hispanic origin. Results-In 2018, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Chronic lower respiratory diseases; Cerebrovascular diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 73.8% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2018 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Diseases of the circulatory system; Respiratory distress of newborn; and Neonatal hemorrhage. Variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Background The reductions achieved in infant mortality in Japan are globally regarded as remarkable. However, no studies in Japan have classified infant mortality trends into neonatal and postneonatal or considered regional issues. This study aimed to explore trends in neonatal and postneonatal deaths, both overall for Japan and in a region affected by a natural disaster. Methods Drawing on national infant death data, we used a multi-attribute compositional study design to examine all infant deaths occurring in a region affected by a disaster (Tohoku, which consists of Iwate, Miyagi, and Fukushima) between 2002 and 2012. We used conjoint analysis to clarify the associations between infant and maternal characteristics and age of infant death. Results We obtained data of a total of 31,012 infant deaths between 2002 and 2012, which included 1450 from Tohoku. Infant mortality rates in Japan overall declined over the period but increased in 2011. There were more postneonatal (29–364 days post-birth) than neonatal (0–28 days post-birth) deaths. Infant deaths in Tohoku declined slightly overall, with a fluctuation in 2011. In Tohoku, the trends in postneonatal death rates were similar; the overall rates for males increased, but those for females decreased in 2011. We found that the cause and place of infant death differed by gender for neonatal and postneonatal deaths in both Japan in general and Tohoku. The conjoint analysis showed that most variables affected the age of postneonatal death. The factor with the largest influence on the variation in infant death age was gestational week (55.5%). A maternal gestational week ≤36 was linked to an average age at death of 43.4 days, and > 37 was linked to an average of 83.7 days. Conclusions In Japan, infant death rates have declined steadily over the past 10 years. The recent trends indicated that postneonatal death rates were higher than neonatal rates, especially in Tohoku. However, not much attention has been focused on postneonatal deaths in Japan. Our findings may help health planners to prioritise work on the factors that are linked to infant deaths in the neonatal and postneonatal periods. Trial registration Not applicable.

Introduction: Sudden unexpected death in infancy (SUDI) represents the commonest presentation of postneonatal death, yet despite full postmortem examination (autopsy), the cause of death is only determined in around 45% of cases, the majority remaining unexplained. In order to aid counselling and understand how to improve the investigation, we explored whether machine learning could be used to derive data driven insights for prediction of infant autopsy outcome. Methods: A paediatric autopsy database containing >7,000 cases in total with >300 variables per case, was analysed with cases categorised both by stage of examination (external, internal and internal with histology), and autopsy outcome classified as explained-(medical cause of death identified) or unexplained. For the purposes of this study only cases from infant and child deaths aged ≤ 2 years were included (N=3100). Following this, decision tree, random forest, and gradient boosting models were iteratively trained and evaluated for each stage of the post-mortem examination and compared using predictive accuracy metrics. Results: Data from 3,100 infant and young child autopsies were included. The naive decision tree model using initial external examination data had a predictive performance of 68% for determining whether a medical cause of death could be identified. Model performance increased when internal examination data was included and a core set of data items were identified using model feature importance as key variables for determining autopsy outcome. The most effective model was the XG Boost, with overall predictive performance of 80%, demonstrating age at death, and cardiovascular or respiratory histological findings as the most important variables associated with determining cause of death. Conclusion: This study demonstrates the feasibility of using machine learning models to objectively determine component importance of complex medical procedures, in this case infant autopsy, to inform clinical practice. It further highlights the value of collecting routine clinical procedural data according to defined standards. This approach can be applied to a wide range of clinical and operational healthcare scenarios providing objective, evidence-based information for uses such counselling, decision making and policy development.

ObjectiveBoth pregestational and gestational diabetes mellitus (PGDM, GDM) occur more frequently in First Nations (North American Indians) pregnant women than their non-Indigenous counterparts in Canada. We assessed whether the impacts of PGDM and GDM on perinatal and postneonatal mortality may differ in First Nations versus non-Indigenous populations.DesignA population-based linked birth cohort study.Setting and participants17 090 First Nations and 217 760 non-Indigenous singleton births in 1996–2010, Quebec, Canada.Main outcome measuresRelative risks (RR) of perinatal and postneonatal death. Perinatal deaths included stillbirths and neonatal (0–27 days of postnatal life) deaths; postneonatal deaths included infant deaths during 28–364 days of life.ResultsPGDM and GDM occurred much more frequently in First Nations (3.9% and 10.7%, respectively) versus non-Indigenous (1.1% and 4.8%, respectively) pregnant women. PGDM was associated with an increased risk of perinatal death to a much greater extent in First Nations (RR=5.08[95% CI 2.99 to 8.62], pConclusionsThe study is the first to reveal that PGDM may increase the risk of perinatal death to a much greater extent in First Nations versus non-Indigenous populations, but may substantially increase the risk of postneonatal death in non-Indigenous infants only. The underlying causes are unclear and deserve further studies. We speculate that population differences in the quality of glycaemic control in diabetic pregnancies and/or genetic vulnerability to hyperglycaemia’s fetal toxicity may be contributing factors.

Slum-dwellers are the most considerable but overlooked section of Indian society. The slum people of India are treated like third rate citizens in their own country. They are characterised by having inefficient living areas, a growing population living below the poverty line, nil drinking water, and latrines shared among hundreds, a nonexistent sewage system. The inaccessibility to basic living conditions results in a “slum lifestyle” modelled by several characteristics. The lives of these people are illustrated by high rates of poverty and their socio-economic condition does not push them to live a healthy life. The present study makes an effort to explain the possible causes of infant mortality with special regard to slum households in Dibrugarh City, India. The study is based on primary data collection through fieldwork, secondary data collection and use of statistical methods wherever required. Findings indicate birth asphyxia (35.30%) is the highest cause of the infant death in the neonatal period, along with significant observations with respect to other diseases. A huge 29.41% of postneonatal death infant stands as an unknown cause of mortality in the study area. Therefore, findings of the present study not only have larger implications in terms of understanding the infant mortality scenario of slum areas but also will help in framing adequate policies for uplifting their standard of living as well as basic well-being.

OBJECTIVE: To evaluate whether participation in a statewide enhanced prenatal and postnatal care program, the Maternal Infant Health Program (MIHP), reduced infant mortality risk. METHODS: Data included birth and death records, Medicaid claims, and program participation. The study population consisted of Medicaid-insured singleton infants born between January 1, 2009, and December 31, 2012, in Michigan (n = 248 059). The MIHP participants were propensity score–matched with nonparticipants based on demographics, previous pregnancies, socioeconomic status, and chronic disease. Infant mortality, neonatal mortality, and postneonatal mortality analyses were presented by race. RESULTS: Infants with any MIHP participation had reduced odds of death in the first year of life compared with matched nonparticipants (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.63–0.84). Infant death odds were reduced both among black infants (OR 0.71, 95% CI 0.58–0.87) and infants of other races (OR 0.74, 95% CI 0.61–0.91). Neonatal death (OR 0.70, 95% CI 0.57–0.86) and postneonatal death odds (OR 0.78, 95% CI 0.63–0.96) were also reduced. Enrollment and screening in MIHP by the end of the second pregnancy trimester and at least 3 additional prenatal MIHP contacts reduced infant mortality odds further (OR 0.70, 95% CI 0.58–0.85; neonatal: OR 0.67, 95% CI 0.51–0.89; postneonatal: OR 0.74, 95% CI 0.56–0.98). CONCLUSIONS: A state Medicaid-sponsored population-based home-visitation program can be a successful approach to reduce mortality risk in a diverse, disadvantaged population. A likely mechanism is the reduction in the risk of adverse birth outcomes, consistent with previous findings on the effects of the program.

Background High prevalence of infant macrosomia (up to 36%, the highest in the world) has been reported in some First Nations communities in the Canadian province of Quebec and the eastern area of the province of Ontario. We aimed to assess whether infant macrosomia was associated with elevated risks of perinatal and postneonatal mortality among First Nations people in Quebec. Methods We calculated risk ratios (RRs) of perinatal and postneonatal mortality by birthweight for gestational age, comparing births to First Nations women ( n = 5193) versus women whose mother tongue is French ( n = 653 424, the majority reference group) in Quebec 1991–2000. Results The prevalence of infant macrosomia (birthweight for gestational age > 90th percentile) was 27.5% among births to First Nations women, which was 3.3 times (confidence interval [CI] 3.2–3.5) higher than the prevalence (8.3%) among births to women whose mother tongue is French. Risk ratios for perinatal mortality among births to First Nations women were 1.8 (95% CI 1.3–2.5) for births with weight appropriate for gestational age, 4.1 (95% CI 2.4–7.0) for small-for-gestational-age ( Interpretation Macrosomia was associated with a generally protective effect against perinatal death, but substantially greater risks of postneonatal death among births to First Nations women in Quebec versus women whose mother tongue is French.

Background In circumpolar countries such as Canada, northern regions represent a unique geographical entity climatically, socioeconomically and environmentally. There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous subpopulations within northern regions and compared with southern regions. Methods A cohort study of all births by maternal mother tongue to residents of northern (2616 First Nations (North American Indians), 2388 Inuit and 5006 non-Indigenous) and southern (2563 First Nations, 810 643 non-Indigenous) Quebec, 1991–2000. Results Compared with births to southern non-Indigenous mother tongue women, births to northern women of all three mother tongue groups were at substantially elevated risks of infant death (adjusted OR (aOR) 1.7–2.9), especially postneonatal death (aOR 2.2–4.4) after controlling for maternal education, age, marital status and parity. The risk elevation in perinatal death was greater for southern First Nations (aOR 1.6) than for northern First Nations (aOR 1.2). Infant macrosomia was highly prevalent among First Nations in Quebec, especially in the north (31% vs 24% in the south). Within northern regions, Inuit births were at highest risk of preterm delivery (aOR 1.4) and infant death (aOR 1.6). Conclusion All northern infants (First Nations, Inuit or non-Indigenous) were at substantially elevated risk of infant death in Quebec, despite a universal health insurance system. Southern First Nations newborns have not benefited from the more advanced perinatal care facilities in southern regions. Environmental influences may partly account for the very high prevalence of macrosomia among First Nations in northern Quebec.

Objective: Little is known about the possible impacts of neighborhood socioeconomic status on birth outcomes and infant mortality among Aboriginal populations. We assessed birth outcomes and infant mortality by neighborhood so- cioeconomic status among First Nations and non-First Nations in Manitoba. Study Design: We conducted a retrospective birth cohort study of all live births (26,176 First Nations, 129,623 non-First Nations) to Manitoba residents, 1991-2000. Maternal residential postal codes were used to assign four measures of neigh- borhood socioeconomic status (concerning income, education, unemployment, and lone parenthood) obtained from 1996 census data. Results: First Nations women were much more likely to live in neighborhoods of low socioeconomic status. First Nations infants were much more likely to die during their first year of life (risk ratio (RR) =1.9) especially during the postneonatal period (RR=3.6). For both First Nations and non-First Nations, living in neighborhoods of low socioeconomic status was associated with an increased risk of infant death, especially postneonatal death. For non-First Nations, higher rates of pre- term and small-for-gestational-age birth were consistently observed in low socioeconomic status neighborhoods, but for First Nations the associations were less consistent across the four measures of socioeconomic status. Adjusting for neigh- borhood socioeconomic status, the disparities in infant and postneonatal mortality between First Nations and non-First Nations were attenuated. Conclusion: Low neighborhood socioeconomic status was associated with an elevated risk of infant death even among First Nations, and may partly account for their higher rates of infant mortality compared to non-First Nations in Manitoba.

Objective: Little is known about community remoteness in relation to birth outcomes among Indigenous popu- lations. We assessed whether community remoteness matters for perinatal outcomes and infant mortality in Quebec First Nations communities. Study Design: A retrospective cohort study of all births (n=11,033) to residents of First Nations communities in Quebec 1991-2000, using linked vital statistics data. First Nations communities were grouped by community remoteness into four zones from the least to most remote. Results: Preterm birth rates declined progressively from the least remote (8.0%) to the most remote (5.7%) zones (p=0.002). In contrast, total fetal and infant mortality rose progressively from the least remote (10.4 per 1000) to the most remote (22.7 per 1000) zones (p

Objective The objective of this study was to investigate the incidence of mortality risk among children of parents with mental illness. Method The study sample comprised all women giving birth in Taiwan between 1999 and 2001; the dataset was created by linking birth certificate, death certificate, and National Health Insurance research databases. The deaths of the subjects were classified into 5 groups: stillbirths, early neonatal death, late neonatal death, postneonatal death, and early childhood death. A Cox proportional hazard regression was then performed on a pooled 3-year population-based dataset to examine the relationship between parental mental status and survival rates for children younger than 3 years, with the crude and adjusted hazard ratios (HRs) being calculated. Results Around 2316 affected children were compared with a general population of 605 107. No stillbirths were observed among any children of parents with schizophrenia or affective disorder. Mothers with affective disorder are prone to higher risk of child death, with a crude HR of 4.86 (95% confidence interval, 3.06-7.73), and a reduced adjusted HR of 3.51 (95% confidence interval, 2.22-5.57). However, fathers with affective disorder played no role. Children born to schizophrenic women have a significant higher risk of child death with a crude HR of 2.47, whereas those born to schizophrenic fathers have a similarly high risk with a crude HR of 2.69. Conclusion A focus needs to be placed on the identification and treatment of parental schizophrenia and affective disorder through antenatal and postnatal intervention, so as to reduce mortality risks for children exposed to risk during their first 3 years of life.

Aim: To examine the diversity of Escherichia coli serotypes found in the intestinal contents of infants who died of Sudden Infant Death Syndrome (SIDS) compared with that in comparison infants. Methods and Results: Over the 3-year period, 1989–1991, in South Australia and Victoria (Australia), a total of 687 E. coli isolates from 231 patients with SIDS (348 isolates), 98 infants who had died from other causes (144 isolates) and 160 healthy infants (195 isolates) were studied. The isolates from patients with SIDS were found to represent 119 different serotypes; the isolates from ‘other cause’ infants represent 97 different serotypes; and the isolates from healthy infants represent 117 different serotypes. The seven common serotypes isolated most frequently from infants with SIDS belonged to those associated with extra-intestinal infections in humans. Compared to healthy infants (6%), these were found in significantly higher proportions among infants who died of other causes (13%, P

Background: There is a lack of data on the safety of midwife-led maternity care in remote or Indigenous communities. In a de facto natural "experiment", we assessed birth outcomes by primary birthing attendant in two sets of remote Inuit communities. Methods: A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989-2000: primary birth attendants were Inuit midwives in the Hudson Bay (1,529 Inuit births) versus Western physicians in Ungava Bay communities (1,197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, postneonatal death, preterm, small-for-gestational-age and low birth weight birth. Multi-level logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects. Results: The aOR (95% confidence interval) for perinatal death comparing the Hudson Bay versus Ungava Bay communities were 1.29 (0.63, 2.64) for all Inuit births, and 1.13 (0.48, 2.47) for Inuit births at >=28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined. Conclusion: Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care as compared to the Ungava Bay communities with physician-led maternity care. Our findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote Indigenous communities.

Little is known about how birth outcomes vary in rural areas by degree of rural isolation. We conducted a retrospective cohort study of all births in Quebec, 1991-2000 to assess birth outcomes by the degree of rural isolation according to metropolitan influence as measured by work force commuting flows between rural and urban areas. Compared with urban areas, crude risks of preterm birth, small-for-gestational age birth, stillbirth, neonatal death and postneonatal death were similar in rural areas with strong metropolitan influence, but were significantly higher for preterm birth, stillbirth and postneonatal death in rural areas with weak or no metropolitan influence, and for neonatal death in rural areas with no metropolitan influence. Adjustment for maternal characteristics (age, mother tongue, education, marital status, parity, plurality and infant sex) attenuated the associations. The adjusted odds ratios [95% confidence intervals] were 1.36 [1.12, 1.64] for stillbirth in rural areas with weak metropolitan influence, 1.63 [1.14, 2.32] for neonatal death in rural areas with no metropolitan influence, 1.78 [1.21, 2.63] and 1.37 [1.07, 1.75] for postneonatal death in rural areas with weak and no metropolitan influence, respectively. Much higher neonatal death rates were observed for preterm or low-birthweight babies in rural areas with no metropolitan influence, suggesting inadequate access to optimal neonatal care. We conclude that birth outcomes in rural areas differ according to the degree of rural isolation. Fetuses and infants of mothers from rural areas with weak or no metropolitan influence are particularly vulnerable to the risks of death during the perinatal and postnatal periods.

SummaryThis study presents an ecological analysis of the relationship between infant mortality and economic status by race in metropolitan Ohio, using census data on mother’s residence and economic status determined by the percentage of low-income families living in each area. The analysis updates previous studies as white–non-white comparisons for total infant mortality are examined for the US censuses of 1960, 1970, 1980, 1990 and 2000; and more detailed period- and broad cause-specific rates are presented for 2000. A pronounced inverse association is consistently found between income status and infant mortality for whites, while for non-whites this pattern first emerges in 1979–81, disappears during the 1980s and then returns more strongly during the 1990s. Similarly, the 2000 data reveal a consistent inverse pattern between income status and infant mortality for white and non-white neonatal and postneonatal death rates, as well as exogenous cause-specific death rates. It is concluded that low-income whites and non-whites have infant mortality rates substantially higher than the overall rate for the population. Policy implications are discussed.

Objective To assess the effects of pregnancy-induced hypertension on infant mortality in triplets stratified by gestational age at birth. Methods A retrospective cohort study was conducted using the linked 1995–2000 US birth/infant death database. Generalized estimating equations were used to evaluate the observed association. Results Pregnancy-induced hypertension was associated with lesser neonatal mortality (odds ration [OR]: 0.34, 95% CI: 0.21, 0.54), postneonatal mortality (OR: 0.54, 95% CI: 0.30, 0.99) and infant mortality (OR, 0.37, 95% CI: 0.25, 0.55) in triplets. It was also associated with a decreased risk of neonatal death (OR, 0.38; 95% CI, 0.21–0.67), postneonatal death (OR, 0.45; 95% CI, 0.21–0.97), and infant death (OR, 0.39; 95% CI, 0.24–0.64) in early preterm triplets, whereas the association was not significant in late preterm or in full-term triplets. Conclusion Pregnancy-induced hypertension is associated with a decreased risk of infant mortality in triplets. This effect varies with gestational age at birth.

The weight distribution pattern of all births can be divided into a "skewing to the left" to lower weights and high neonatal mortality, a "skewing to the right" to higher weights (>3500g) and minimum neonatal and postneonatal mortality, and a "symmetrical distribution" with mortality in between. This study was initiated with the hypothesis that a deficit in newborns of more than 3500 g would adversely affect postneonatal death. Higher and rising postneonatal mortality solely attributable to sudden infant death of unknown cause (sudden infant death syndrome; SIDS) was observed in the Nordic countries with a lower proportion of heavy newborns. Minor environmental intervention almost eliminated excess mortality from this cause, supporting raised susceptibility with a depressed birthweight in postneonatal SIDS. This contrasts with classical neonatal low birthweight SIDS, which is stable despite numerous attempts at reduction, supporting a multi-factorial aetiology: low maternal age, low education, low socioeconomic status, maternal smoking, infection, etc. The postneonatal SIDS epidemic associated with a deficit in heavy newborns is thought to be a result of changing behaviour in pregnancy: moderate iatrogenic dietary restriction and young women favouring a low-calorie, low-fat diet, especially in the third trimester when the foetus is most vulnerable, which delays myelination and somatic growth and renders the infant susceptible to minor morbidity and irregularity. The timing of death and neuropathological findings suggestive of repeated hypoxic episodes in more than 80% of cases of SIDS prior to death support this theory. The similar weight distribution patterns in SIDS and all births in Denmark, the UK and the USA suggest a substantial proportion of the neonates in these countries could be growth-retarded and at risk of hypoxic episodes in infancy. A few cases, particularly males (sex-ratio = 1.7), suffer SIDS, the majority survive. Many, mostly males, present minor CNS signs and learning and behaviour problems. The male predominance accords with males more than 500 g higher optimal birthweight than females and susceptibility to a depressed weight at birth. In order to prevent postneonatal dying, SIDS and reduce learning/behaviour disorders it is necessary to raise the proportion of heavy newborns by promoting foetal growth rate equal to the maternal intrinsic rate by eating to one's appetite a balanced diet, favouring a diet high in marine fat, especially in third trimester, in order to ensure maturation of the CNS and prolong gestation, thereby increasing birthweight. Although the increased survival of some very low birthweight neonates confounds the issue, a division between SIDS in neonatal and postneonatal death is recommended in order to assess the proportion of "avoidable infant death" as opposed to persistent classical neonatal SIDS.

OBJECTIVE. We evaluated the influence of outdoor air pollution on infant death in the South Coast Air Basin of California, an area characterized by some of the worst air quality in the United States.METHODS. Linking birth and death certificates for infants who died between 1989 and 2000, we identified all infant deaths, matched 10 living control subjects to each case subject, and assigned the nearest air monitoring station to each birth address. For all subjects, we calculated average carbon monoxide, nitrogen dioxide, ozone, and particulate matter RESULTS. The risk of respiratory death increased from 20% to 36% per 1-ppm increase in average carbon monoxide levels 2 weeks before death in early infancy (age: 28 days to 3 months). We also estimated 7% to 12% risk increases for respiratory deaths per 10-μg/m3 increase in particulate matter CONCLUSIONS. Our results add to the growing body of literature implicating air pollution in infant death from respiratory causes and sudden infant death syndrome and provide additional information for future risk assessment.

Objective To assess the association between pregnancy-induced hypertension (PIH) and infant mortality. Design Retrospective cohort study. Setting Birth and infant death registration dataset of the USA. Population A total of 17 432 987 eligible, liveborn singleton births in 1995–2000. Methods Multivariate logistic regression was applied to evaluate the association between PIH and infant mortality, with adjustment of potential confounders. Main outcome measures Infant death (0–364 days) and its three components: early neonatal death (0–6 days), late neonatal death (7–27 days), and postneonatal death (28–364 days). Results There was a significant reduction in infant mortality associated with PIH in early preterm infants (OR = 0.59, 95% CI: 0.56–0.63) and in late preterm infants (OR = 0.80, 95% CI: 0.73–0.87), but a significant increase in term infants (OR = 1.08, 95% CI: 1.02–1.14). Both in early preterm and late preterm births, early neonatal mortality (OR = 0.38, 95% CI: 0.34–0.42; OR = 0.68, 95% CI: 0.61–0.77) and late neonatal mortality (OR = 0.59, 95% CI: 0.50–0.70; OR = 0.76, 95% CI: 0.61–0.96) were decreased in infants born to mothers with PIH compared with those born to mothers with normal blood pressure. The PIH-associated reduction in neonatal mortality among preterm singletons was stronger in small-for-gestational-age infants than in normal growth infants and stronger in infants born to nulliparous women than in those born to multiparous women. Conclusions PIH is associated with lower risk of infant death in preterm births but higher risk in term births.

Aims: To investigate infant deaths in Cumbria, 1950–93, in relation to individual and community level socioeconomic status. Methods: Retrospective birth cohort study of all 283 668 live births and 4889 infant deaths in Cumbria, 1950–93. Community deprivation (Townsend score) and individual social class were used to estimate socioeconomic status. Logistic regression was used to investigate risk of infant death (early neonatal, neonatal, and postneonatal) in relation to social class and Townsend deprivation score, adjusting for year of birth, birth order, multiple births, and stratified by time period, 1950–65, 1966–75, 1976–85, 1986–93. Results: The risk of infant death in all categories was higher in the lower social classes and more deprived communities, although inequality in risk of neonatal death declined after 1975 to such an extent that there was no significant difference in neonatal death rates by socioeconomic status in the most recent time period. By contrast, there was no narrowing in socioeconomic inequality in postneonatal death risk over the study period. Community deprivation was associated with a significant increased risk of postneonatal death after adjusting for individual level socioeconomic status. Conclusions: Postneonatal deaths remain higher in the most deprived communities and in the more disadvantaged social classes. The social, lifestyle, and environmental determinates of adverse health outcomes for children need to be fully understood, and interventions should be designed and targeted at the more socially deprived sectors of our community.

Objective. Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality. We evaluated the effect of breastfeeding on postneonatal mortality in United States using 1988 National Maternal and Infant Health Survey (NMIHS) data.Methods. Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included. We calculated overall and cause-specific odds ratios for ever/never breastfeeding among all children, conducted race and birth weight–specific analyses, and looked for duration–response effects.Results. Overall, children who were ever breastfed had 0.79 (95% confidence interval [CI]: 0.67–0.93) times the risk of never breastfed children for dying in the postneonatal period. Longer breastfeeding was associated with lower risk. Odds ratios by cause of death varied from 0.59 (95% CI: 0.38–0.94) for injuries to 0.84 (95% CI: 0.67–1.05) for sudden infant death syndrome.Conclusions. Breastfeeding is associated with a reduction in risk for postneonatal death. This large data set allowed robust estimates and control of confounding, but the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child. Assuming causality, however, promoting breastfeeding has the potential to save or delay ~720 postneonatal deaths in the United States each year.

Objective to estimate the association between maternal nutritional extremes and offspring mortality in the Brazilian population. Methods this cross-sectional study used secondary data from Brazilian women of reproductive age obtained from the National Demographic and Health Survey 2006. Maternal anthropometric indices were used: height, body mass index (BMI), and waist circumference. Logistic regression modelling was used to evaluate the relationship between obesity and offspring mortality. The data analysis was appropriate for the complex sample design. Results children of mothers of short stature were at greater risk of death in the postnatal period than children of mothers of normal height, even after adjusting for sociodemographic characteristics [odds ratio (OR) 4.54, 95% confidence interval (CI) 1.31–15.77]. Maternal obesity was associated with mortality, and children whose mothers were abdominally obese were at greater risk of dying in the neonatal period (OR 3.19, 95% CI 1.23–8.27). Children of mothers who were overweight or obese (BMI≥25kg/m 2 ) were at greater risk of dying in the neonatal period (OR 2.41, 95% CI 1.12–5.16), and children of malnourished mothers (BMI 2 ) were at greater risk of dying during the postneonatal period (OR 9.47, 95% CI 2.07–43.41). Conclusion maternal obesity is a risk factor for neonatal death, maternal malnutrition is a risk factor for postneonatal death, and maternal short stature is a risk factor for mortality among Brazilian children.

Commentary on : Aune D, Saugstad OD, Henriksen T, et al. Maternal body mass index and the risk of fetal death, stillbirth and infant death: a systematic review and meta-analysis. JAMA 2014;311:1536–46.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Forty-two per cent of deliveries in England in 2007 involved obese or overweight women.1 Raised body mass index (BMI) has been associated with various adverse pregnancy outcomes, most notably stillbirth.2 ,3 Relatively few studies have reported on associations with infant death, particularly beyond the neonatal period, or with sufficient power to consider the full range of BMI categories. This study examines the association between maternal BMI and the full range of fetal and infant mortality outcomes. This was a review of cohort studies reporting adjusted relative risk estimates of fetal and infant death for at least three categories of maternal BMI reported before or during early pregnancy. Outcome measures … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D311%26rft.spage%253D1536%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.2014.2269%26rft_id%253Dinfo%253Apmid%252F24737366%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jama.2014.2269&link_type=DOI [3]: /lookup/external-ref?access_num=24737366&link_type=MED&atom=%2Febmed%2F19%2F6%2F237.atom [4]: /lookup/external-ref?access_num=000334306000021&link_type=ISI

Background To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. Methods A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. Results The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. Conclusions This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases.

CONTEXTE : La mortalité infantile a diminué au Canada depuis les années 1990 et 2000 mais nous ignorons si toutes les classes socioéconomiques ont bénéficié également de ce progrès. OBJECTIFS : La présente étude portait sur les différences entre les taux de mortalité néonatale et postnéonatale et de mort subite du nourrisson entre les différents quintiles de revenu des quartiers au Canada de 1991 à 2005. MÉTHODES : Le fichier couplé des naissances vivantes et des décès infantiles au Canada a été utilisé à l’exclusion des naissances survenues en Ontario, au Yukon, dans les Territoires du Nord-ouest et au Nunavut. Les taux de mortalité néonatale et postnéonatale et de mort subite du nourrisson ont été calculé par quintile de revenu des quartiers et par période (1991-1995, 1996-2000, 2001-2005). Les rapports de risque (RR) ont été calculés par quintile de revenu et période avec ajustement pour la province de résidence, l’âge de la mère, la parité, le sexe du nourrisson et les naissances multiples. RÉSULTATS : En zone urbaine, pour toute la période étudiée (1991- 2005), le quintile de revenu le plus pauvre avait un risque plus élevé de mortalité néonatale (RR ajusté 1,24; IC 95% 1,15-1,34), de mortalité postnéonatale (RR ajusté 1,58; IC 95% 1,41-1,76) et de mort subite du nourrisson (RR ajusté 1,83; IC 95% 1,49-2,26) par rapport au quintile le plus riche. Les taux de mortalité post néonatale et de mort subite du nourrisson ont décliné respectivement de 37 % et de 57 % de 1991- 1995 à 2001-2005 alors que le taux de mortalité néonatale n’a pas changé de façon significative. Cette diminution de la mortalité postnéonatale et de la mort subite du nourrisson a été observée dans tous les quintiles de revenu. CONCLUSION : Malgré une diminution de la mortalité postnéonatale et du syndrome de mort subite du nourrisson dans tous les quintiles de revenu, les inégalités subsistent au Canada. Ce résultat démontre le besoin de stratégies efficaces de promotion de la santé visant spécifiquement les populations vulnérables. MOTS CLÉS : mort subite du nourrisson; mortalité infantile; statut socioéconomique, [À l'origine dans / Was originally part of : ESPUM - Dép. médecine sociale et préventive - Travaux et publications]

OBJECTIVES: To evaluate severe (grade 3/4) morbidity and mortality in HIV-exposed uninfected infants. DESIGN: : Secondary data analysis of The Breastfeeding Antiretrovirals and Nutrition (BAN) clinical trial. METHODS: BAN randomized 2369 mother-infant pairs to maternal infant or no extended antiretroviral prophylaxis during breastfeeding. Morbidity outcomes examined were pneumonia/serious febrile illness diarrhea/growth faltering and malaria. Infant death was defined as neonatal (

Importance Maternal psychiatric disease is associated with adverse pregnancy outcomes. Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown. Objective To study risk of stillbirth and infant mortality associated with use of SSRIs during pregnancy. Design, Setting, and Participants Population-based cohort study from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) at different periods from 1996 through 2007. The study included women with singleton births. We obtained information on maternal use of SSRIs from prescription registries. Maternal characteristics, pregnancy, and neonatal outcomes were obtained from patient and medical birth registries. Main Outcome Measures We used logistic regression to estimate relative risks of stillbirth, neonatal death, and postneonatal death associated with SSRI use during pregnancy taking into account maternal characteristics and previous psychiatric hospitalization. Results Among 1 633 877 singleton births in the study, 6054 were stillbirths; 3609, neonatal deaths; and 1578, postneonatal deaths. A total of 29 228 (1.79%) of mothers had filled a prescription for an SSRI during pregnancy. Women exposed to an SSRI presented with higher rates of stillbirth (4.62 vs 3.69 per 1000, P = .01) and postneonatal death (1.38 vs 0.96 per 1000, P = .03) than those who did not. The rate of neonatal death was similar between groups (2.54 vs 2.21 per 1000, P = .24). Yet in multivariable models, SSRI use was not associated with stillbirth (adjusted odds ratio [OR], 1.17; 95% CI, 0.96-1.41; P = .12), neonatal death (adjusted OR, 1.23; 95% CI, 0.96-1.57; P = .11), or postneonatal death (adjusted OR, 1.34; 95% CI, 0.97-1.86; P = .08). Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease. The adjusted OR for stillbirth in women with a previous hospitalization for psychiatric disease was 0.92 (95% CI, 0.66-1.28; P = .62) and was 1.07 (95% CI, 0.84-1.36; P = .59) for those who had not been previously hospitalized. The corresponding ORs for neonatal death were 0.89 (95% CI, 0.58-1.39; P = .62) for women who were hospitalized and 1.14 (95% CI, 0.84-1.56; P = .39) for women who were not. For postneonatal death, the ORs were 1.02 (95% CI, 0.61-1.69; P = .95) for women who were hospitalized and 1.10 (95% CI, 0.71-1.72; P = .66) for women who were not. Conclusions and Relevance Among women with singleton births in Nordic countries, no significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or postneonatal mortality. However, decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness.

This study examines whether the association between maternal educational level and postneonatal death has changed over time.All single survivors of the neonatal period in Norway in three periods, 1968-1971, 1978-1981 and 1989-1991 were studied. There were 582 046 births and 1717 postneonatal deaths. Logistic regression analyses were applied.There has been an increasing inverse relationship between maternal educational level and postneonatal mortality in recent years. There was no statistically significant association between educational level and postneonatal mortality in the late 1960s. In the second period (1978-1981) the association is statistically significant for first-born children. In the third period (1989-1991) postneonatal mortality for first-born and later-born children was associated with maternal educational level, with adjusted odds ratios of 2.5 and 2.1 respectively. The overall level of education has increased tremendously, and the proportion of women with the lowest level of education has decreased from 56.3 to 10.7% in the period under study.The underlying causes of changes in the impact of educational level are hard to determine and are indicative of the complexity of using maternal educational level as an indicator of social status over time. Possible mechanisms by which certain variables may covary with educational level, and thus have an adverse effect on postneonatal mortality, are discussed. The fact that the inverse association between educational level and postneonatal mortality has increased over time should be a matter for concern. It may indicate that the growth of the welfare state has not reached all segments of the population.

OBJECTIVE To explore the association between the presence of maternal heart disease and maternal, perinatal, and infant outcomes. METHODS We conducted a population-based retrospective cohort study using Washington State birth certificates linked with hospital discharge records of mothers noted to have maternal congenital heart disease, ischemic heart disease, heart failure, or pulmonary hypertension. Women who gave birth between 1987 and 2009 (n=2,171) were compared with a sample of mothers without these conditions (n=21,710). We described characteristics of pregnant women with heart disease over time. Logistic regression estimated the association between chronic maternal heart disease and small-for-gestational-age (SGA) neonates as well as perinatal, postneonatal, and maternal death. RESULTS The proportion of births to women with reported heart disease increased 224% between the 1987 and 1994 and 2002 and 2009 calendar periods. Chronic maternal heart disease was associated with increased risk of SGA (62 additional SGA newborns per 1,000 births, 95% confidence interval [CI] 46-78; P

This study addresses the question of whether maternal smoking is related to postneonatal mortality and which are the contributing causes of death. Mortality of births in Sweden between 1 January 1983 and 31 December 1989 (n = 714,389) registered in the Medical Birth Registry was followed until 31 December 1990. The registry carries information on maternal smoking habits in early pregnancy. The Mantel-Haenszel procedure was used to control for confounding effects of maternal age, parity and year of birth: relative risks (95% confidence interval) associated with smoking were: 1.24 (1.17-1.31) for fetal death, 1.08 (1.01-1.16) for early neonatal death, 1.22 (1.08-1.39) for late neonatal death, 1.31 (1.23-1.41) for postneonatal mortality during the first year, and for the period between 1 and 8 years of age it was 1.19 (1.06-1.32). When birthweight was controlled for, the increased relative risk for postneonatal mortality during the first year disappeared. Mortality between 1 and 8 years still showed an elevated risk of 1.43 (1.00-2.06). In order to control for confounding by social factors, 1986 births were linked to data from the 1985 Swedish census. The measure used was the socio-economic index (SEI), which reflects the parental education level. When maternal, paternal or family SEI was controlled for, late neonatal death was not significantly related to maternal smoking, but postneonatal death still showed a significantly increased relative risk of about 1.35. Four causes of death based on International Classification of Diseases (ICD) 8 and 9 were significantly related to maternal smoking: sudden infant death syndrome, injuries and poisoning, perinatal causes and infections.

The association of parity and infant mortality was studied using linked birth-death files for 46,985 infants born to 11- to 19-year-old Minnesota residents between 1980 and 1988. Compared with infants of primiparas, infants of multiparas were at twice the risk for infant and postneonatal death but at no increased risk for neonatal death. They were also at two to three times the risk for deaths due to accidents, infections, and sudden infant death syndrome. The higher sociodemographic disadvantage and poorer prenatal care of multiparas did not explain the excess infant mortality risk that was concentrated in causes of death that are potentially preventable through primary care and parent education.

The risk of stillbirth after 32 weeks of gestation increases with gestational age, and half of these late fetal deaths occur at term.1 Term stillbirth theoretically can be avoided through the judicious use of labor induction, and stillbirth prevention lies at the heart of many of the accepted indications for labor induction. However, once the child is born, he or she faces new mortality risks, often risks that may be determined partially by gestational age at birth. Determining the optimal time of delivery to minimize the risk of stillbirth necessarily must include considering the mortality risk faced by the child after birth. For nonanomalous infants born at term, the most common causes of death are asphyxia, infection, and sudden infant death syndrome (SIDS). Rates of infection and SIDS decrease with increasing gestational age at term, with the highest rates at 37 weeks.2 The risk of both neonatal and infant death has been shown in multiple studies to decrease with gestational age at term but then increase again at 41 weeks of gestation.2–5 Part of the relationship between gestational age and infant death is driven by the fact that SIDS deaths decrease with gestational age until 40–41 weeks, after which they begin to increase again; SIDS is the leading cause of postneonatal death in nonanomalous infants.4,6,7 This study attempts to use epidemiologic information to describe the multiple dimensions of risk faced by pregnant women and their health care providers when comparing the risks of stillbirth at term with the risk of infant death after birth, considering that gestational age is one of the many shared risk factors for both stillbirth and infant death.8 Previous studies have attempted to examine the optimal time for delivery by comparing stillbirth risk with a composite of infant morbidity and mortality; in this study, we attempted to develop a risk estimate of mortality alone.9

Aims: This study examines predictors of neonatal and postneonatal mortality among infants born to black, white, and Hispanic women. Methods: Linked birth/infant death records from North Carolina for the period 1999–2007 were the source of data. Logistic regression models were constructed to estimate the effect of maternal and infant characteristics on neonatal (

OBJECTIF: Chez les Autochtones, la relation entre le degré d'éloignement et les issues de naissance est inconnue. L’objectif de cette étude est d’évaluer cet impact parmi les Premières Nations du Québec. MÉTHODE : Nous avons utilisé les données vitales de Statistique Canada pour la province du Québec pour la période 1991-2000. L’ensemble des naissances géocodées parmi les communautés des Premières Nations groupées en quatre zones en se basant sur le degré d'éloignement a été analysé. Nous avons utilisé la régression logistique multi-niveaux pour obtenir des rapports de cotes ajustés pour les caractéristiques maternelles. RESULTATS : Le taux de naissances prématurées varie en fonction de l’éloignement de la zone d’habitation (8,2% dans la zone la moins éloignée et 5,2% dans la Zone la plus éloignée, P, OBJECTIVE: It is unknown whether Aboriginal birth outcomes may be affected by the degree of community remoteness. We assessed community remoteness and birth outcomes among Quebec First Nations. METHODS: We used Statistics Canada's vital data for the province of Quebec, 1991-2000. Postcode geo-coding linkage was used to identify all births in First Nations communities (reserves). Communities were grouped into four zones based on the degree of remoteness. Multilevel logistic regression was used to obtain the ORs adjusting for maternal characteristics. RESULTS: Preterm birth rates rose progressively from the most remote (5.2%) to the least remote (8.2%) zone (P

SummaryThe purpose of this study was to show the differences in the mortality rates of children from Catholic and Lutheran families in 19th century Poznań, and to elucidate the causes of these differences. Data from Catholic and Lutheran parish death registers were used. The infant death rate (IDR), neonatal and postneonatal death rates and life table biometric functions were calculated and causes of deaths were characterized. The worst child mortality values (IDR=394.4; neonatal and postneonatal death rates, respectively, 117.1 and 277.4; e0=16.14 years; Crow's Index=2.47) were obtained for the poor Catholic Parish of St Margaret. The lowest infant and neonatal and postneonatal death rates were observed to have occurred in the Catholic Parish of St Maria Magdalena situated in the city's more affluent central area (mortality rates, respectively, 269.9, 93.1 and 176.9; e0=24.63 years; Crow's Index=0.96). The widest range of differences with regard to death rates was found for the Lutheran Parish of St Cross (the infant, neonatal and postneonatal death rates were, respectively, 293.1, 99.1 and 193.9; e0=28.03 years; Crow's Index=0.92). The St Cross Parish encompassed a fairly large area of the city characterized by varying ecological conditions. Among infants and young children from the three studied populations a high frequency of deaths due to infectious diseases, diarrhoeas, dysenteries and tuberculosis were observed. Differences in the mortality of children from Catholic and Lutheran families in 19th century Poznań resulted from ecological conditions, among which water played the most important role, rather than from religious differences.

The aim of this study was to examine the effect of socioeconomic status and demographic factors on infant mortality, classified by cause of death, in a group of children born in Seoul, Korea during 1999–2003. Linked infant birth and death data were collected from the Korea National Statistical Office. Logistic regression models were used to investigate the effect of socioeconomic and demographic factors on infant mortality. The results were adjusted to take into account the infants’ length of gestation and birth weight. Infant death rates from all causes tended to decrease as the parents’ educational level increased. We observed a similar pattern for deaths from other specific causes. We also found higher mortality rates for mothers less than 20 years of age and over 35. Our analysis shows that socioeconomic and demographic factors affect infant mortality. In the case of postneonatal infant death, we confirmed that adequate follow-up care can reduce the risks of death from these acquired factors. This suggests that these are important factors to consider in reducing infant mortality.

Objectives. We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time. Methods. We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births. Results. Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985–1987, 36.3%; 1995–1997, 26.3%) and postneonatal death (1985–1987, 7.1 per 1000; 1995–1997, 4.8 per 1000) improved significantly. However, disparities between American Indians and Alaska Natives and Whites in adjusted odds ratios (AORs) of postneonatal death (1985–1987, AOR = 1.55; 95% confidence interval [CI] = 1.41, 1.71; 1995–1997, AOR = 1.46; 95% CI = 1.31, 1.64) and adjusted risk ratios (ARRs) of inadequate prenatal care (1985–1987, ARR = 1.67; 95% CI = 1.65, 1.69; 1995–1997, ARR = 1.84; 95% CI = 1.81, 1.87) persisted. Conclusions. Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close persistent health gaps for this group.

Maternal obesity (often defined as prepregnancy body mass index [BMI] ≥30 kg/m2) increases the risk of fetal death.1–7 Several studies have suggested that maternal obesity increases the risk of neonatal death, defined as death in the first 7 or 28 days of life.1,2,5,8–10 Previous studies have also suggested adverse effects of maternal obesity on the overall risk of infant death.11,12 Lucas et al11 reported increased risk of mortality up to 18 months in preterm babies born to obese mothers, but the study was limited to babies with birth weights of

The records of 10,204 pairs of twins born in Norway 1967–1984 in the Norwegian Birth Registry were examined. The probabilities of stillbirth, neonatal death and post-neonatal death, conditional on the fate of the cotwin, were calculated. The neonatal death rate was four times increased when the cotwin was stillborn. When the cotwin died neonatally, the probability of postneonatal death was increased ninefold. The concordance rate for stillbirth and for neonatal death was above 0.4. In striking contrast, there was no correlation in postneonatal death for members of a twin pair. This finding suggests that genetic or common environmental factors play a minor role in the aetiology of post-neonatal death.

Background: This study examined changes in the educational gradients in neonatal and postneonatal mortality over a 20-year period in the four largest Nordic countries. Methods: The study populations were all live-born singleton infants with gestational age of at least 22 weeks from 1981 to 2000 (Finland 1987–2000). Information on births and infant deaths from the Medical Birth Registries was linked to information from census statistics. Numbers of eligible live-births were: Denmark 1 179 831, Finland 834 299 (1987–2000), Norway 1 017 168 and Sweden 1 971 645. Differences in mortality between education groups were estimated as risk differences (RD), relative risks (RR) and index of inequality ratio (RII). Results: Overall, rates of infant mortality were in Denmark 5.9 per 1000 live-births, in Finland 4.2 (1987–2000), in Norway 5.3 and in Sweden 4.7. Overall the mortality decreased in all educational groups, and the educational level increased in the study period. The time-trends differed between neonatal and postneonatal death. For neonatal death, both the absolute and relative educational differences decreased in Finland and Sweden, increased in Denmark, whereas in Norway a decrease in absolute differences and a slight increase in relative differences occurred. For postneonatal death, the relative educational differences increased in all countries, whereas the absolute differences decreased. Conclusions: All educational groups experienced a decline in infant mortality during the period under study. Still, the inverse association between maternal education and RR of postneonatal death has become more pronounced in all Nordic countries.

Context: Sudden infant death syndrome is the leading cause of postneonatal death in developed countries. Little is known about risks linked with parental mental illness per se or how such risks are modified by specific psychiatric conditions and by maternal vs paternal psychopathological abnormalities. Objective: To investigate cause-specific postneonatal death, including sudden infant death syndrome, in infants whose parents had been admitted as psychiatric inpatients. Design: National cohort study. Setting: The entire Danish population. Patients: All of the singleton live births registered from January 1, 1973, to December 31, 1998. Linkage to the national psychiatric register enabled identification of all of the parental admissions from April 1, 1969, onward. Main Outcome Measure: All of the cases of sudden infant death syndrome in the postneonatal period classified via national mortality registration between January 1, 1973, and December 31, 1998. Results: Psychiatric admission history in either parent doubled the risk of sudden infant death syndrome, but there was no difference in risk whether infants were exposed to maternal or paternal admission. Risk was particularly high if both parents had been admitted for any psychiatric disorder (relative risk, 6.9; 95% confidence interval, 4.1-11.6). Among specific parental disorders, the greatest risk was associated with admission for alcohol- or drug-related disorders (mothers: relative risk, 5.0; 95% confidence interval, 3.4-7.5; fathers: relative risk, 2.5; 95% confidence interval, 1.7-3.8). Contrary to prior expectation, parental schizophrenia and related disorders did not confer higher risks than other parental disorders that resulted in admission. Conclusions: Infants whose parents have been admitted for psychiatric treatment are at greater risk for sudden infant death syndrome. However, risks may be lower than previously thought with maternal schizophrenia and related disorders. Clinicians should be aware of particularly high risks if both parents have received any psychiatric inpatient treatment or if either parent (but the mother especially) was admitted with an alcohol- or drug-related disorder. ©2007 American Medical Association. All rights reserved.

Background: The health care system in Canada provides essential health services to all women irrespective of socioeconomic status. Our objective was to determine whether perinatal and infant outcomes varied by family income and other socioeconomic factors in this setting. Methods: We included all 92 914 women who delivered in Nova Scotia between 1988 and 1995 following a singleton pregnancy. Family income was obtained for 76 440 of these women through a confidential link to income tax records and was divided into 5 groups. Outcomes studied included pregnancy complications, preterm birth, small-for-gestational-age live birth, perinatal death, serious neonatal morbidity, postneonatal death and infant death. Logistic regression models were used to adjust for potential confounders. Results: Compared with women in the highest family income group, those in the lowest income group had significantly higher rates of gestational diabetes (crude rate ratio [RR] 1.44, 95% confidence interval [CI] 1.21–1.73), preterm birth (crude RR 1.20, 95% CI 1.06–1.35), small-for-gestational-age live birth (crude RR 1.81, 95% CI 1.66–1.97) and postneonatal death (crude RR 5.54, 95% CI 2.21–13.9). The opposite was true for rates of perinatal death (crude RR 0.74, 95% CI 0.56–0.96), and there was no significant difference between the 2 groups in the composite of perinatal death or serious neonatal morbidity (crude RR 1.01, 95% CI 0.82–1.24). Adjustment for behavioural and lifestyle factors accentuated or attenuated socioeconomic differences. Interpretation: Lower family income is associated with increased rates of gestational diabetes, small-for-gestational-age live birth and postneonatal death despite health care services being widely available at no out-of-pocket expense.

Objective To assess the effect of pregnancy-induced hypertension (PIH) on infant mortality in different birthweight centiles (small for gestational age [SGA], appropriate for gestational age [AGA], and large for gestational age [LGA]) and gestational ages (early preterm, late preterm, and full term). Design Retrospective cohort study. Setting Linked birth and infant death data set of USA between 1995 and 2000. Population A total of 17 464 560 eligible liveborn singleton births delivered after 20th gestational week. Methods Multivariate logistic regression models were applied to evaluate the association between PIH and infant mortality, with adjustment of potential confounders stratified by birthweight centiles and gestational age. Main outcome measure Infant death (0–364 days) and its three components: early neonatal death (0–6 days), late neonatal death (7–27 days), and postneonatal death (28–364 days). Results PIH was associated with decreased risks of infant mortality, early neonatal mortality, and late neonatal mortality in both preterm and term SGA births, and PIH was associated with lower postneonatal mortality in preterm SGA births. PIH was associated with decreased risks of infant mortality, early neonatal mortality, late neonatal mortality and postneonatal mortality in preterm AGA births. Decreased risk of infant mortality and early neonatal mortality was associated with PIH in early preterm LGA births. Conclusions The association between PIH and infant mortality varies depending on different birthweight centiles, gestational age, and age at death. PIH is associated with a decreased risk of infant mortality in SGA births, preterm AGA births, and early preterm LGA births.