Story by: Norton Children’s on March 9, 2021
A pregnant patient’s race, social status, access to medical care and living conditions all can affect whether they are more likely to deliver a baby weighing less than 5 pounds, 8 ounces (low birth weight), according to Scott D. Duncan, M.D., MHA, neonatologist with Norton Children’s Neonatology, affiliated with the UofL School of Medicine.
According to the Centers for Disease Control and Prevention, preterm birth and low birth weight are among the leading causes of infant mortality, which it defines as the death of a baby before their first birthday.
Dr. Duncan, who also holds the endowed Rounsavall professorship of neonatology and is chief of the Division of Neonatal Medicine at the UofL School of Medicine, offers some strategies to reduce the infant mortality rate by addressing these risk factors:
An unhealthy environment around expectant mothers can affect the baby’s health.
“Measures such as housing damage, property damage, home vacancy, crime and percentage of home rentals have all been shown to affect the risk of preterm birth,” Dr. Duncan said.
Pollution and poor air quality can have a negative effect on pregnant people and infants.
Protecting the environment and reducing crime can effectively reduce the risk of preterm birth, according to Dr. Duncan.
Those who are pregnant can eat a healthy diet and take proper supplements to promote a healthy birth weight.
“Folic acid and multivitamin supplementation may decrease the risk of preterm birth and increase birth weight,” Dr. Duncan said, adding that this is especially true for African Americans.
On the other hand, behaviors such as “cigarette smoking, alcohol intake and drug use” are risk factors for low birth weight, according to Dr. Duncan.
Smoking cessation programs as well as programs that address substance use can make a difference in healthy pregnancies and birth outcomes.
Greater access to quality health care during pregnancy can make a big difference in the health outcomes of the infant, according to Dr. Duncan.
Improved access to prenatal care that includes mental health services can have a positive effect on infant mortality, according to Dr. Duncan. Health care initiatives such as “care plans, teaching and counseling, and comfort and talk” are essential forms of prenatal care.
When a person who is pregnant does not have access to quality prenatal care, which is often the case for more disadvantaged populations, the baby is at risk for multiple factors that can lead to infant mortality.
A Level III neonatal intensive care unit (NICU) at Norton Women’s & Children’s Hospital and a top-tier Level IV NICU at Norton Children’s Hospital are dedicated to caring for babies born prematurely or in need of advanced care or surgery.
College-educated African Americans who receive adequate prenatal care deliver babies with a low birth weight more than twice as often as college-educated whites with adequate care, according to Dr. Duncan.
“Weathering” is a theory that suggests the cumulative stress that African Americans may experience over a lifetime can have negative effects on fetal development.
“Women who reported more experiences of racial discrimination also had higher levels of psychological distress,” Dr. Duncan said.
It is essential to apply all preventive measures to reduce risks in pregnancies in African Americans in particular, according to Dr. Duncan. Improving access to quality health care, improving socioeconomic opportunity and working to eliminate racial discrimination in the health care setting and beyond all have potential to reduce the racial disparities of infant mortality.
The infant mortality rate reflects the health of both mother and child, according to Dr. Duncan.
“Not only is it a marker, but symbolic of the benchmark of the society’s overall health,” he said.
Providing comprehensive care and addressing disadvantages and disparities across every aspect of an expectant mother’s life effectively can reduce the risk for premature and low birth weights that lead to infant mortality.