Blog Post

Three strategies that reduce infant mortality—and one that doesn't

February 14, 2019

    We talk a lot about managing high-risk Medicare patients. Or addressing social determinants of health for Medicaid patients. But what about patients just beginning their lives? In the United States, there are 5.9 infant deaths per 1,000 births—and most of the major contributing factors present clear opportunities for population health intervention: preterm birth and low birth weight, sudden infant death syndrome (SIDS), maternal pregnancy conditions, and injuries.

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    We compared the literature out there and learned four takeaways that will help you take a smart approach to reducing infant mortality. Here's our short take: focus on prenatal interventions to support healthy, full-term pregnancies and on raising awareness of proper infant care. Read on to learn about how providers can influence infant mortality rates.

    1. Offer specialized care coordination services to women at risk of adverse birth outcomes

    Women struggling with unaddressed psychosocial needs face high risk of adverse health outcomes, and this risk doesn't go away during pregnancy. Enhancing prenatal care for these women through care coordination (e.g., clinical coordination support, social service referrals, patient education, etc.) ensures that they're effectively connected with the services they need, clinical or otherwise. Studies associate prenatal care coordination with improvements in birth weight and preterm birth rates as well as maternal feelings of empowerment. Two staff types take the lead in providing maternal care coordination:

    1. The community health worker (CHW) is an increasingly common role used by health systems to address non-clinical needs. Deploying CHWs helps women access needed services and alleviates stress related to unmet needs.

    2. Doulas are specifically trained to provide continuous support through pregnancy and especially childbirth. They promote health literacy and healthy behavior among pregnant women and, like CHWs, help address unmet social needs.

    2. Use multiple strategies to promote smoking cessation

    Five to seven percent of preterm-related deaths and 13 to 19% of low birth weight deliveries are attributable to prenatal smoking. Providers often choose one of many approaches to promoting smoking cessation, but there actually isn't a strong base of evidence behind individual cessation interventions on birth outcomes. Instead, a 2017 systematic review found that combined psychosocial interventions increased smoking cessation in late pregnancy by 35%, curbed incidence of low birthweight by 17%, increased mean birth weight by 56g, and reduced NICU admissions by 22%. Interventions studied included counseling[1], health education, providing feedback on fetal health status, and tobacco-related maternal health indicators throughout pregnancy, and peer/partner support.

    3. Raise awareness of safe sleep behaviors using educational, public health and clinical campaigns

    Every year, 3,500 infant deaths are attributable to sleep-related causes. Some providers team up with public health organizations and use educational campaigns to raise public awareness of safe sleep behaviors. Effective campaigns are tailored to specific target populations through their modalities and messaging. For example, campaigns targeting grandparents may be printed in the newspaper rather than on Facebook, and may feature older individuals caring for a grandchild; campaigns targeting cultural or ethnic groups with high incidence of sleep-related deaths may be written in different languages.

    Studies demonstrate that awareness-raising efforts successfully increase provider and parent likelihood to demonstrate safe sleep behaviors. It's difficult to tie safe sleep education directly to infant mortality outcomes, but data show that as the percentage of babies placed supine to sleep increased throughout the NIH-sponsored Back to Sleep Campaign (1993-2011), the incidence of SIDS correspondingly decreased.

    4. Don't spend too much time on maternal nutrition alone, if the goal is to reduce infant mortality

    Maternal diet, nutrition, and weight directly affect fetal health, because nutrients pass directly from mother to baby in-utero. Therefore, a malnourished mom is less likely to have a healthy pregnancy and more likely to have adverse birth outcomes. However, studies evaluating the impact of nutrition-based interventions like nutrition supplementation, education, and counseling show either little-to-no impact or highly inconsistent impact on infant health or mortality outcomes.

    [1] Section 4107 of the ACA requires states to provide coverage of counseling and pharmacotherapy for tobacco cessation for pregnant women. Many state Medicaid entities provide additional tobacco cessation coverage (e.g., different types of nicotine replacement therapy, Zyban, Chantix).

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