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Current issues in perinatal epidemiology
1Epidemiology and Biometry Research Program, NICHD, Bethesda, MD 20892.
Insights
Linked birth and death certificate data are unavailable in the U.S., impacting perinatal epidemiology. Research should prioritize preterm labor over low birth weight to understand persistent racial disparities in reproductive outcomes.
Area of Science:
- Perinatal epidemiology
- Reproductive health
- Public health data analysis
Background:
- National data for perinatal epidemiology rely on birth and death certificates, but linked data are not routinely available in the U.S.
- Assessing trends in perinatal events requires consideration of data completeness and quality across jurisdictions.
- Despite a decline in infant mortality, the U.S. has seen minimal reduction in low birth weight rates.
Purpose of the Study:
- To highlight the need for linked birth and death certificate data in the U.S. for robust perinatal epidemiology.
- To advocate for a research focus shift from low birth weight to preterm labor, considering distinct etiologies.
- To address persistent, unexplained racial disparities in reproductive outcomes, particularly low birth weight.
Main Methods:
- Review of current national data sources for perinatal epidemiology (birth and death certificates).
- Discussion of data quality and completeness issues in reporting perinatal events.
- Identification of emerging data resources for intergenerational studies.
Main Results:
- The U.S. lacks routinely linked birth and death certificate data, hindering comprehensive perinatal epidemiology.
- Infant mortality rates have declined significantly, while low birth weight rates show only modest improvement.
- Persistent and significant differences in reproductive outcomes, especially low birth weight, exist between white and black populations.
Conclusions:
- Improved data linkage and quality are crucial for accurate perinatal event tracking and trend analysis.
- Research focus should shift towards preterm labor to better understand diverse etiologies of adverse birth outcomes.
- Further intergenerational studies are needed to elucidate the complex factors contributing to racial disparities in reproductive health.
Abstract:
The main national data sources for perinatal epidemiology are birth and death certificates, yet routinely linked birth and death certificate data are still not available in the U.S. Completeness and quality of the reporting of perinatal events should be considered in examining trends over time and between jurisdictions. The U.S. has experienced a marked decline in its infant mortality rate, but only a very modest decline in the rate of low birth weight. Research must focus more on studies of pre-term labor, rather than low birth weight, which include children who are underground or who are born too early and who, therefore, may represent different etiologies. Sensitive hormonal tests may provide more precise estimates of the rate of very early fetal loss. Management of labor and delivery and of the high-risk newborn have undergone marked changes during the last 15 years, and yet clinical trials have not played a major role in the evaluation of these changes. The difference in reproductive outcomes between whites and blacks, especially in the rate of low birth weight, have persisted and are not understood. Data bases are becoming available for intergenerational studies to determine whether nature or nurture accounts for this difference.