UAB Synopsis, Vol. 28, No. 6, February 16, 2009
UAB Synopsis talked to Edwin M. Dixon Professor of Pediatrics and Director of the Division of Neonatal and Perinatal Medicine Waldemar A. Carlo, MD, about Alabama’s increasing infant mortality rate. Dr. Carlo recently received the School of Medicine Dean’s Award for Excellence in Clinical Scholarship for his work in reducing morbidity and mortality of low-birth-weight infants.
Synopsis: What is the infant mortality rate in Alabama?
Dr. Carlo: In 2007 it rose 11% to 10 per 1000 births. That year births of underweight babies reached the highest level in 10 years. Alabama’s infant mortality rate is the second highest in the United States and is similar to that of a host of third-world countries. In a recent state-by-state report card, the March of Dimes gave Alabama — and most Southern states — an F.
Synopsis: What groups are experiencing the worst infant mortality?
Dr. Carlo: The state’s death rate for black and Hispanic babies is near the national average, which is about 15% for non-Hispanic black women. The rate for whites has increased and is the highest in the United States.
In addition, teen births are increasing, as is tobacco consumption by pregnant women. Both factors are closely linked to high infant mortality rates.
Synopsis: What are the main factors contributing to this problem?
Dr. Carlo: Multiple elements contribute to infant mortality. Prematurity and low birth weight, limited access to neonatal intensive care, inadequate or no prenatal care, obesity, low maternal weight gain, multiple births, and maternal smoking are among the commonest. Alabama has high obesity rates, leading to diabetes and other health problems that affect infant survival.
Alabama has one of the highest prematurity rates in the nation. About 16% of deliveries are premature. Low birth weight also is a contributor to mortality, and the number of very-low-birth-weight babies (<1500 g) is increasing.
Synopsis: What does UAB do to help?
Dr. Carlo: Each year approximately 150 extremely low-birth-weight (<1000 g) babies are born at UAB and about 400 sick babies are transferred here after delivery elsewhere. The survival rate for these babies and the rate of survival without appreciable disability is significantly higher at UAB than the national average.
The UAB Division of Maternal-Fetal Medicine (MFM) provides care for women with high-risk pregnancies, including those with medical, obstetric, or surgical problems that place either the mother’s well-being or that of the fetus at risk. The division also offers specialized care for women carrying fetuses with or at risk for genetic diseases, chromosomal abnormalities, or structural birth defects.
UAB MFM clinics provide prenatal care for high-risk patients through several portals, including the Jefferson County Health Department and Western Health Clinic. Total obstetric care and consultative services are available, as well as preconception and early pregnancy counseling.
Other clinics include the Obstetrics Complications Clinic at UAB Hospital; the Prenatal Diagnosis Clinic, which offers traditional second trimester diagnostic care; a Prenatal Genetics Clinic; and a First Trimester Prenatal Diagnosis Clinic.
UAB’s Regional Newborn Intensive Care Unit is the only full-service level IIIC facility in the state with neonatologists in-house 24 hours a day. It provides care for preterm and term infants with any medical condition. This centralized availability of care has led to enormous improvements in survival for babies.
The new Women and Infants Center will serve as a statewide resource for MFM services and a wide range of female-related patient care.
Synopsis: What have we learned about infant mortality through our research?
Dr. Carlo: The causes and prevention of preterm birth, a major contributor to infant mortality, have been a research focus at UAB for many years. The MFM division has participated in numerous large single- and multicenter clinical trials aimed at identifying causes or predictors of preterm birth and evaluating treatment modalities.
Research at UAB has linked genital tract inflammation to preterm birth; has shown that progesterone injections reduce risk of preterm birth in select women; has determined that elective repeat, cesarean deliveries before 39 weeks gestation are two to four times more likely to cause adverse neonatal outcomes; and much more.
UAB is part of the Maternal-Fetal Medicine Units Research Network, the Neonatal Research Network of the National Institute of Child Health and Human Development (NICHHD), the Global Network for Women’s and Children’s Health Research of the NICHHD and is the only university involved in all three NIH clinical research initiatives for maternal, child, and family health.