In 2003, the Maternal and Child Health (MCH ) Epidemiology Unit published the first of a series of reference books on the epidemiology of maternal, infant and child health in Alaska. The "Alaska Maternal and Child Health Data Book 2008"
updates and builds upon the work presented in the first
data book, featuring information on the health status of Alaskan mothers, infants, children and families.
OBJECTIVES: The aim of this study was to estimate the recurrence risk for stillbirth and infant death and compare results for offspring of first-cousin parents with results for offspring of unrelated parents. METHODS: The study population consisted of all single births with a previous sibling born in Norway between 1967 and 1994. Altogether, 629,888 births were to unrelated parents, and 3466 births were to parents who were first cousins. The risk of stillbirth and infant death was estimated for subsequent siblings contingent on parental consanguinity and survival of the previous sibling. RESULTS: For unrelated parents, the risk of early death (stillbirth plus infant death) for the subsequent sibling was 17 of 1000 if the previous child survived and 67 of 1000 if the previous child died before 1 year of age. For parents who were first cousins, the risk of early death for the subsequent sibling was 29 of 1000 if the previous child survived and 116 of 1000 if the previous child died. CONCLUSIONS: The risk of recurrence of stillbirth and infant death is higher for offspring of first-cousin parents compared with offspring of unrelated parents.
A 1960-62 study of southwestern Alaskan Eskimos documented an infant mortality rate--102.6 deaths per 1,000 live births--that was four times greater than that of U.S. whites. In 1980-81, 20 years after the original study, a similar cohort was identified in this population so that changes in infant mortality and other birth characteristics could be examined. Average birth weight and the amount of prenatal care received by the mothers increased from 1960 to 1980. Birth weight and prenatal visits were positively correlated. Results of the followup also revealed a 1980-81 infant mortality rate--17.1 deaths per 1,000 live births--that was less than a fifth of the 1960-62 rate and no longer significantly different from the national rate. Major changes associated with the decrease in mortality during the first 28 days of life (neonatal mortality) were a significant increase in the proportion of infants born in hospitals and an associated decrease in the number of deaths of infants weighing less than 2,500 grams at birth. The reduction in mortality during the rest of the first year of life was related to a decrease in deaths due to infectious diseases, particularly measles and pertussis. Changes in infant mortality reflect the increased availability of health care in this region, improved immunization programs, and the establishment of the Bethel Prematernal Home in Bethel, AK.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 1424.
Smoking and drinking habits were registered by a self-administered questionnaire in 36th week of gestation in 11,698 pregnant women, more than 80 percent of all such women in two Danish cities 1984-87. Alcohol consumption of 120 g/week or more was associated with a greater reduction in the average birthweight in the babies of smokers than of non-smokers (about 40 grams for the non-smokers and about 200 grams for the smokers). This is particularly striking considering that the average birthweight for smokers is lower than for non-smokers. A birthweight difference of more than 500 grams was found between babies of mothers who neither smoked nor drank and mothers who smoked and drank heavily. Our data suggest that women's smoking habits should be taken into consideration when giving pregnant women advice about drinking.
OBJECTIVES: This study explored the extent of errors in gestational age as ascertained by last menstrual period. METHODS: More than 1.5 million birth records (covering the years 1967-1994) from the population-based Medical Birth Registry of Norway were used to study variation in gestational age within strata of birthweight. RESULTS: Within 100-g strata of birthweight, it was found that the observed gestational age distribution could be divided into 3 distinct underlying distributions separated by approximately 4 weeks. This pattern was present through all birthweight strata, from 200 g up to 4700 g. In addition, the apparent misclassification causing a gestational age 4 weeks too short was much more common among low-birthweight births than among heavier births. CONCLUSIONS: The separation of the gestational age distributions by intervals of close to 4 weeks suggests that errors in gestational age measurements are caused by factors related to menstrual bleeding. Furthermore, there is evidence for a strong relation between bleeding at the time of the next menstrual period after conception and low birthweight. This conclusion should be approached with caution because of the retrospective nature of the data.
OBJECTIVES: To describe changes in infant mortality rates, including birthweight-specific rates and rates by age at death and cause. METHODS: We analyzed US linked birth/infant-death data for 1989-1991 and 1998-2000 for American Indians/Alaska Native (AIAN) and White singleton infants at > or =20 weeks' gestation born to US residents. We calculated birthweight-specific infant mortality rates (deaths in each birthweight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100000 live births) in infancy (0-364 days) and in the neonatal (0-27 days) and postneonatal (28-364 days) periods. RESULTS: Birthweight-specific infant mortality rates declined among AIAN and White infants across all birthweight categories, but AIAN infants generally had higher birthweight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998-2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated post-neonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. CONCLUSIONS: Although birthweight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities.
OBJECTIVES: We examined disparities in age-related patterns of marijuana initiation in 2 culturally distinct American Indian reservation communities (from the Northern Plains and the Southwest) compared with a national sample. METHODS: We used discrete-time survival models to estimate age-related risk for initiation with data from 2 population-based studies: the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project and the baseline National Comorbidity Survey. RESULTS: Among respondents who were born before 1960, peak risk for marijuana initiation in all samples was at age 18 years, and risk was greatest in the national sample. Among those who were born later than 1960, risk peaked at age 16 years and was highest in the American Indian samples. Males were at increased risk compared with females, especially in the older cohort and the Southwest tribal sample. CONCLUSIONS: Findings of disproportionate risk for marijuana initiation among younger members of the tribal samples raise concerns that American Indian reservation youths may be increasingly vulnerable to drug use and its concomitants, which suggests a need for more aggressive prevention efforts in these communities.
OBJECTIVES: This study examined the effect of maternal smoking during pregnancy on infant body proportion. METHODS: The ponderal index, defined as birthweight divided by crown-heel length cubed, was examined in 207,607 infants from the Swedish Medical Birth Register for 1991 and 1992. RESULTS: Infant ponderal index was used as the outcome variable in an ordinary least squares continuous regression, which included early pregnancy smoking status, gestational age, and birthweight among the predictors. Ponderal index increased by 0.030 (+/- 0.0014) among infants of moderate smokers and by 0.040 (+/- 0.0017) among infants of heavy smokers, showing a dose response. CONCLUSIONS: Smoking differentially alters the trajectory of weight vs length growth in the fetus.