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Health Indicator Report of Infant and Fetal Death

Fetal mortality - the intrauterine death of a fetus at any gestational age - is a major but often overlooked public health issue. Much of the public concern surrounding reproductive loss has focused on infant mortality, due in part to a lesser knowledge of the incidence, etiology, and prevention strategies for fetal mortality.^[https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_08.pdf 2]^

Notes

The infant death rate is the number of deaths of live-born infants under 1 year of age per 1,000 live births. The fetal death rate is the number of fetal deaths of 20 or more weeks gestation per 1,000 live births plus fetal deaths of 20 or more weeks gestation.

Data Sources

  • Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health
  • Fetal Death Certificate Database, Office of Vital Statistics and Registration, New Jersey Department of Health
  • Linked Infant Death-Birth Database, Center for Health Statistics, New Jersey Department of Health

Data Interpretation Issues

Only fetal deaths from the latter half of pregnancy (20 or more weeks gestation) are required to be reported to the NJDOH. Fetal deaths early in pregnancy can occur before a mother even knows she's pregnant, therefore a full count is impossible and each states' reporting requirements are based on a minimum gestational age and/or minimum weight.[https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_08.pdf ^1^]

Definition

An '''infant death''' is the death of a live-born infant within the first year of life. A '''fetal death''' is what is commonly called a stillbirth. The technical definition is "a death prior to the complete expulsion or extraction from its mother of a product of conception; the fetus shows no signs of life such as breathing or beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles."

Numerator

'''Infant Death''': Number of infant deaths (death < 1 year of age) '''Fetal Death''': Number of fetal deaths of 20 or more weeks gestation

Denominator

'''Infant Death''': Number of live births '''Fetal Death''': Number of live births plus fetal deaths of 20 or more weeks gestation

How Are We Doing?

Prior to 1997, there were more infant deaths in New Jersey each year than there were fetal deaths of 20 or more weeks gestation. While the infant mortality rate (IMR) has been steadily declining, the fetal mortality rate (FMR) has not and appears to have leveled off. FMR is greater than IMR for each major racial/ethnic group in New Jersey and the disparity between Blacks and other races/ethnicities often noted in discussions of IMR, is also seen in FMR. IMR and FMR are about the same among mothers who previously delivered one live infant, but FMR is significantly higher than IMR among nulliparous women and those with 2 or more previous live births. FMR is about the same among mothers who used tobacco during pregnancy as among those who abstained. The same is true for alcohol use or abstinence during pregnancy. However, IMR is significantly higher among mothers who smoked or drank during pregnancy compared to those who did not. FMR is more than double IMR among mothers who received no prenatal care. Both IMR and FMR are higher earlier in pregnancy and both rates decline steadily with each additional week of gestation. Between 20 and 26 weeks of gestation, IMR is higher than FMR. After 26 weeks, FMR is higher than IMR. Delivery weight and gestational age are highly correlated and IMR and FMR follow the same pattern of higher rates among lower weights with a steady decline as weight increases. IMR is higher than FMR for weights less than 1,000 grams (approximately 2.2 lbs). Above 1,000 grams, FMR is higher than IMR. Four of the five leading causes of infant death and fetal death are the same: * maternal complications of pregnancy * complications of the placenta, cord, or membranes * congenital anomalies * short gestation/low birth weight The first two are more likely to result in fetal death than infant death and the last two are more likely to cause infant deaths than fetal deaths.

How Do We Compare With the U.S.?

"Despite minor fluctuations, the U.S. fetal mortality rate has remained relatively unchanged since 2006. In contrast, the infant mortality rate has declined 11% in the same time period. Additionally, although the total fetal mortality rate has historically been lower than the total infant mortality rate, as of 2011 these two rates have been essentially the same."^[https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_08.pdf 3]^ New Jersey's FMR is about the same as that of the U.S. as a whole, but our IMR is consistently lower than the U.S. rate and is declining more rapidly.

What Is Being Done?

The [http://www.nj.gov/health/fhs/ Division of Family Health Services] in the New Jersey Department of Health administers several programs aimed at improving children's health, including reducing infant and fetal mortality. Infant and fetal deaths are reviewed by the [http://www.nj.gov/health/fhs/maternalchild/outcomes/mortality-reviews/ Fetal Infant Mortality Review Team] and recommendations to reduce future deaths are made to public and private sources of care including hospitals, clinics, and health care professionals throughout the state. Information on programs that promote availability and use of prenatal care services may be found at: [http://www.nj.gov/health/fhs/maternalchild/outcomes/] or [http://njparentlink.nj.gov/njparentlink/health/before/] The Department of Health has provided state funding to improve perinatal public health services and birth outcomes in communities. Efforts are continuing to increase public and provider awareness of needs for greater access to maternal preconception care, more awareness of risky preconception and post-conception behavior, and for better general maternal health care. New Jersey is a participant in the [https://www.nichq.org/project/collaborative-improvement-and-innovation-network-reduce-infant-mortality-im-coiin Collaborative Improvement and Innovation Network to Reduce Infant Mortality] (CoIIN-IM). CoIIN is a multiyear national movement engaging federal, state, and local leaders; public and private agencies; professionals; and communities to employ quality improvement, innovation, and collaborative learning to reduce infant mortality and improve birth outcomes. The [http://www.nj.gov/health/fhs/maternalchild/consortia.shtml Maternal and Child Health Consortia] are non-profit partners that engage in various activities that work closely with the Department of Health to promote quality health services in New Jersey.

Available Services

The Division of Family Health Services (FHS) provides support for pregnant women and newborns through several programs, including the [http://www.nj.gov/health/fhs/wic/ Supplemental Nutrition Program for Women, Infants and Children] (WIC). Perinatal Mood Disorders (e.g., postpartum depression) Helpline: 1-800-328-3838 or [http://www.nj.gov/health/fhs/maternalchild/mentalhealth/getting-help/] FHS supports professional and public [http://www.nj.gov/health/fhs/maternalchild/outcomes/index.shtml Perinatal Addiction] education services, promotes perinatal screening, and has developed a network of available resources to aid pregnant, substance-using women. [http://njparentlink.nj.gov/njparentlink/ NJ Parent Link], an interdepartmental website, is New Jersey's online Early Childhood, Parenting, and Professional Resource Center offering "one-stop shopping" for State services and resources.

Health Program Information

Maternal and Child Health: [http://www.nj.gov/health/fhs/maternalchild/] Special Child Health and Early Intervention Services: [http://www.nj.gov/health/fhs/sch/] WIC: [http://www.nj.gov/health/fhs/wic/]
Page Content Updated On 02/15/2018, Published on 05/17/2018
The information provided above is from the Department of Health's NJSHAD web site (https://nj.gov/health/shad). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 16 August 2018 10:06:08 from Department of Health, New Jersey State Health Assessment Data Web site: https://nj.gov/health/shad ".

Content updated: Wed, 23 May 2018 05:01:08 EDT