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Comment on "Compromised birth outcomes and infant mortality among racial and ethnic groups"
1Population Research Centre, University of Groningen, The Netherlands. w.j.van.der.veen@frw.rug.nl
Insights
Analyzing racial and ethnic disparities in infant mortality requires accounting for low birth weight and preterm delivery. Frisbie et al.’s method for intrauterine growth-retardation is flawed for population-level studies.
Area of Science:
- Perinatal epidemiology
- Public health research
- Biostatistics
Background:
- Previous research highlighted the importance of considering low birth weight, preterm delivery, and intrauterine growth-retardation (IUGR) in analyzing birth outcomes and infant mortality across racial and ethnic groups.
- Discrepancies exist between fetal growth curves used by Frisbie et al. (1996) and those commonly applied in obstetric and pediatric fields.
Purpose of the Study:
- To compare findings on birth outcomes and infant mortality between the 1987 and 1988 U.S. birth cohorts.
- To critically evaluate the fetal growth curve calculations by Frisbie et al. and their suitability for population-level IUGR studies.
- To propose an alternative method for assessing normal intrauterine growth using vital statistics data.
Main Methods:
- Utilized linked birth and infant death vital statistics data from the National Center for Health Statistics for the 1987 and 1988 U.S. birth cohorts.
- Compared birth outcome distributions and infant death probabilities using Frisbie et al.'s methodology against other established standards.
- Examined the accuracy of gestational age measurement in the utilized vital statistics data.
Main Results:
- Frisbie et al.'s method for assessing intrauterine growth-retardation demonstrated significant limitations when applied at the population level.
- Major flaws were identified in the measurement of gestational age within the vital statistics data used by Frisbie et al.
- The study found that Frisbie et al.'s fetal growth curves were inconsistent with commonly accepted obstetric and pediatric standards.
Conclusions:
- The methodology proposed by Frisbie et al. is not appropriate for population-level studies of intrauterine growth-retardation due to data limitations, particularly in gestational age measurement.
- An alternative approach involving the application of a standard for normal intrauterine growth, derived from antenatal estimation of fetal weight-for-gestational-age, is recommended for vital statistics data.
- Accurate assessment of intrauterine growth-retardation requires robust gestational age estimation and appropriate growth curve standards for reliable public health research.
Abstract:
Frisbie, Forbes, and Pullum (1996) show that it is meaningful to account for low birth weight, preterm delivery, and intrauterine growth-retardation when analyzing differences in compromised birth outcomes and infant mortality among racial and ethnic groups. I compare their findings for the 1987 U.S. birth cohort with findings for the 1988 U.S. birth cohort, using linked birth and infant death vital statistics from the National Center for Health Statistics. I focus on their calculation of fetal growth curves, which are highly at odds with the curves commonly used in the obstetric and pediatric literature. I compare birth outcome distributions and infant death probabilities using Frisbie et al.'s method and other standards. I conclude that Frisbie et al.'s method is not suited for the study of intrauterine growth-retardation at the population level because of the major flaws in gestational age measurement that exist in the type of data they use. An appropriate alternative is to apply a standard of normal intrauterine growth derived from antenatal estimation of fetal weight-for-gestational-age to the vital statistics data.