The Born-Alive Infant Protection Act: impact on fetal and live birth mortality

The Born-Alive Infant Protection Act (BAIPA) of 2002 defined a live birth in the United States without regard to gestation. The objective of this analysis was to determine if a significant decline in the fetal death rate or an increase in the live born death rate at previable gestational ages of 17 to 22 weeks has occurred. U.S. public use fetal death files and linked birth and infant death files were obtained for the years 2000 to 2005 for gestations of 17 to 22 weeks. The fetal death rate declined from 53.8% in the 2000 to 2002 period to 52.6% for the period 2003 to 2005 and the live birth mortality rate increased from 46.2 to 47.4% ( P < 0.02). The average annual live birth death rate increased significantly only at 17 weeks gestation ( P < 0.02). Although there was a small but statistically significant change in the fetal and live birth death rates for infants considered to be previable for the period following the passage of the BAIPA, the change appears to be isolated to only the most immature at 17 weeks gestation.