Stanislaus County infant mortality rate high

Research team sees need for better prenatal care, substance abuse prevention

By KEN CARLSON
kcarlson@modbee.com

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The number of infants dying in Stanislaus County continues to rise -- bucking state and national trends.

County health officials suspect drug and alcohol use during pregnancy is a factor, but not the only cause, and want to take action now that they know more about the problem.

A research team with the Stanislaus County Health Services Agency did a two-year study on why more babies are dying before their first birthday and the study was presented Thursday at the annual Perinatal Conference held by the March of Dimes in Modesto.

In 2006, 47 infants died in the county; there also were 27 fetal deaths after five months of gestation. That compares with 32 infant and 21 mid- to late-term fetal deaths in 2005.

The county has an infant mortality rate of 6.8 per 1,000 live births -- above the statewide rate of 5.4 per 1,000 births. Last year, the county ranked 53rd among California's 58 counties.

Dr. Stephanie Kim, the project's director, said the study's findings will assist in attacking the problem. The team recommended placing an emphasis on better prenatal care and preventing drug, alcohol and tobacco use during pregnancy.

During the study, the researchers pored over medical records and interviewed 38 women who had lost their babies. They also made comparisons with a control group of mothers who had healthy babies at hospitals throughout the county.

Infant deaths were more likely to occur with single mothers, and about 25 percent of mothers whose babies died were teenagers, the study found. Income and insurance status didn't appear to be a factor: 60 percent of the women who lost babies were in the state's Medi-Cal program for low-income residents and a similar percentage of mothers who had healthy babies were on Medi-Cal.

The two leading causes of death were malformations as the fetus developed in the womb and premature births, the study found.

High rate of preemies

Premature births, in which the infant is too immature to live outside the womb, accounted for a higher percentage of deaths than the state and national rate. Deaths from sudden infant death syndrome and maternal complications were lower than the state and national percentages.

"Prematurity seems to be an issue in our county," Kim said.

The researchers looked at the health care the women received during pregnancy, when doctors monitor the development of the fetus, check for complications and give advice on nutrition and physical activity.

According to the study, only 31 percent of the women received what's considered adequate prenatal care; that is, examinations starting in the first trimester and then visits with a provider every four to six weeks.

About 43 percent of the women whose babies died had early prenatal care, compared with 64 percent in the control group. Even among those who had early prenatal care, many of the women went seven to eight weeks or up to three months between visits.

Prenatal care wasn't so good among the control group, either. Just more than half received what's considered adequate care during pregnancy, the researchers said.

A couple of women said they were not concerned when they felt no movement in the womb for one to three days, but thought it meant they were close to going into labor, Kim said.

Another factor was the use of illegal drugs, alcohol and tobacco during pregnancy, which raises the risk of birth defects and pregnancy complications.

Health care providers administered toxicology tests for four out of 10 women in the study during pregnancy or when they gave birth. Of those, 28 percent tested positive, with methamphetamine and marijuana showing up the most frequently.