Premature Births Are Fueling Higher Rates of Infant Mortality in U.S.,

I note here that some conservatives have falsely claimed
that the high US infant mortality rates are due to a difference
in collective the statistics. This claim was due to an error
in reporting in USAtoday years ago, and is discussed in
the wiki article on infant mortality rates. So, PJ, abstain
from posting you lies.

A real problem exists in a lack of prenatal care in the USA
among the poor.  Social medicine is the answer.

****


Premature Births Are Fueling Higher Rates of Infant Mortality in U.S.,
By DENISE GRADY

Published: November 3, 2009


High rates of premature birth are the main reason the United States has
higher infant mortality than do many other rich countries, government
researchers reported Tuesday in their first detailed analysis of a
longstanding problem.

In Sweden, for instance, 6.3 percent of births were premature, compared with
12.4 percent in the United States in 2005, the latest year for which
international rankings are available. Infant mortality also differed
markedly: for every 1,000 births in the United States, 6.9 infants died
before they turned 1, compared with 2.4 in Sweden. Twenty-nine other
countries also had lower rates.

If the United States could match Sweden¹s prematurity rate, the new report
said, ³nearly 8,000 infant deaths would be averted each year, and the U.S.
infant mortality rate would be one-third lower.²

The first author of the report, Marian F. MacDorman, a statistician at the
National Center for Health Statistics, said in an interview that the strong
role prematurity played came as a surprise to her.

Dr. Alan R. Fleischman, medical director for the March of Dimes, said the
new report was ³an indictment of the U.S. health care system² and the poor
job it had done in taking care of women and children. The report, Dr.
Fleischman added, ³puts together two very important issues, both of which we
knew about but hadn¹t linked tightly.²

Infant mortality is widely used as a way to gauge the health of a nation,
and the relatively high rates in the United States have long dismayed health
officials. Most European countries ‹ as well as Australia, Canada, Hong
Kong, Israel, Japan, New Zealand and Singapore ‹ have lower rates of infant
death than the United States.

Premature infants in the United States are more likely to survive than those
elsewhere. Yet they are still more likely to die than full-term babies, and
the sheer numbers born prematurely in the United States ‹ more than 540,000
per year ‹ drive up infant mortality.

The high levels of prematurity in the United States have various causes.

Dr. Fleischman said the smallest, earliest and most fragile babies were
often born to poor and minority women who lacked health care and social
support. The highest rates of infant mortality occur in non-Hispanic black,
American Indian, Alaska Native and Puerto Rican women. But other minorities
have some of the lowest infant mortality rates in the United States: Asian
and Pacific Islanders, Central and South Americans, Mexicans and Cubans.

When it comes to prematurity, infertility treatments ‹ drugs that stimulate
ovulation and procedures that implant more than one embryo in the uterus ‹
also play a role by raising the odds of twins or higher multiples, which
have an increased risk of being born too soon.

Professional groups for fertility doctors recommend limiting the number of
embryos transferred to avoid multiple births, but ultimately doctors and
patients make their own decisions. Dr. MacDorman said that because most
insurance in the United States did not cover infertility treatments, some
patients chose to transfer multiple eggs in hopes that doing so would
increase the odds of pregnancy and reduce expensive procedures.

³In Europe, they may have been more successful in limiting the number of
embryos transferred,² Dr. MacDorman said, ³because there is more national
health insurance and people don¹t have to pay out of pocket.²

Another factor in the United States, she said, is the increasing use of
Caesarean sections and labor-inducing drugs to deliver babies early. The
American College of Obstetricians and Gynecologists has guidelines stating
that babies should not be delivered before 39 weeks without a medical
reason, but doctors may be declaring a medical need more quickly than they
did in the past.

³I don¹t think there are doctors doing preterm Caesarean sections or
inductions without some indications,² Dr. MacDorman said, ³but there sort of
has been this shift in the culture. Fifteen or 20 years ago, if a woman had
high blood pressure or diabetes, she would be put in the hospital, and they
would try to wait it out. It was called expectant management.

³Now I think there¹s more of a tendency to take the baby out early if
there¹s any question at all.²

These births ‹ called ³late preterm,² which occur after 34 to 37 weeks of
pregnancy, instead of the normal 38 to 42 weeks ‹ are the fastest-growing
subgroup of premature births. A late preterm baby¹s risk of dying is about
three times that of a full-term infant. But late preterm babies are still
far more likely to survive than very premature ones, and the very early
babies account for much of the death rate, Dr. Fleischman said.

Taking care of women¹s illnesses and problems like drinking, drug use and
smoking before and during pregnancy can help prevent prematurity, he said,
adding that a state program in Kentucky to provide home visits by nurses to
poor women during pregnancy had decreased preterm births.

Dr. MacDorman said prematurity was not the only factor behind infant
mortality in the United States. She said full-term babies in this country
also had higher death rates than those in Europe from sudden infant death
syndrome, accidents, assaults and homicides.
[ Auf dieses Posting antworten ]