Stanislaus County infant mortality rate high

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.

The researchers suspect the problem is more prevalent, because not all the women had tests and some told health care providers they had used drugs in the past or during pregnancy.

The study recommends some education for health care providers. Most of the women said their doctors asked them about alcohol and tobacco use. But just more than half said their providers discussed the dangers of alcohol and tobacco.

The project, funded by the county's Children and Families Commission, does not stop with the study. The next step is to take action, said Cle Moore of the Health Services Agency.

One recommendation is to make it a standard of care to screen women throughout pregnancy for substance abuse and sexually transmitted diseases. The screening would involve interviewing methods developed by Dr. Ira Chasnoff, an associate professor of pediatrics and psychiatry at Northwestern University and president of the National Association for Perinatal Addiction Research and Education.

Expansion of services planned

During Thursday's conference, an audience member asked if the drug screening might result in women avoiding care during pregnancy.

Julie Falkenstein, a public health nurse and one of the researchers, said she believed expectant mothers wouldn't be offended "if we approach them in a compassionate manner and don't point fingers, and assure them the screening is done for everyone."

The Health Services Agency wants to go beyond prenatal care services with efforts such as the Healthy Birth Outcomes program, which reaches out to vulnerable populations in the county. The county expanded the program from seven to 10 sites in July.

Expectant mothers and their families get together for education and activities centered around pregnancy. The program includes support groups and nurses making home visits to expectant mothers.

Moore also said she's talked with pregnant women who have trouble getting appointments for prenatal care visits and don't have transportation to the medical office.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.