A community-wide infant mortality review: findings and implications.

The authors present the results of a community-wide infant mortality review, describe implications for the delivery of maternal and child health services, and discuss the value of such reviews in addressing local public health concerns. The review included an analysis of birth and death certificates and medical record data; maternal interviews; review of cases and development of recommendations by provider panels; and convening of community groups to develop strategies to improve the health and health care of women and infants. The review focused on 287 infant deaths during 1990-1993. More than half of all neonatal deaths were attributable to "previable" or "borderline viable" births. Sexually transmitted infections were the most frequently identified underlying risk, and smoking was the most frequently identified prenatal risk. Homelessness, physical and sexual abuse, and alcohol use were at least twice as likely among women whose babies died than among a high risk comparison group. Panelists identified fragmented health care over the course of women's reproductive lives as a predominant theme. The authors conclude that: (a) The focus of maternal and child health care should shift to a model of women's health care that addresses the chronicity of social and clinical risks. (b) Infant mortality reviews are a valuable tool for community education, systems review, and policy development and can be applied to other public health issues with local significance. (c) Expectations about the review process's ability to produce conclusions about causality or recommendations narrowly geared to reducing infant mortality rates need to be reframed. (d) The model will be strengthened by greater participation of families affected by infant death.

Mortality rates among 15- to 44-year-old women in Boston: looking beyond reproductive status.

Mortality rates were examined for Boston women, aged 15 to 44, from 1980 to 1989. There were 1234 deaths, with a rate of 787.8/100,000 for the decade. Leading causes were cancer, accidents, heart disease, homicide, suicide, and chronic liver disease. After age adjustment, African-American women in this age group were 2.3 times more likely to die than White women. Deaths at least partly attributable to smoking and alcohol amounted to 29.8% and 31.9%, respectively. Mortality was found to be related more directly to the general well-being of young women than to their reproductive status, and many deaths were preventable. African-American/White disparities were most likely linked to social factors. These findings suggest that health needs of reproductive-age women transcend reproductive health and require comprehensive interventions.

Variation in maternal care and individual differences in play, exploration, and grooming of juvenile Norway rat offspring.

Individual differences in two different forms of maternal licking, time in nest and nursing, were measured during the first 2 weeks after birth. Two treatments were imposed to reduce maternal anogenital licking (AGL): peripheral zinc sulfate to interfere with reception of pup chemosignals, and dietary saline to reduce appetite for pup urine. Both treatments reduced AGL but did not affect other maternal licking. Zinc sulfate was more effective than saline during the first week, but was somewhat less selective as it also increased time in nest. Selected behavioral patterns were measured in male and female juveniles and related by multiple regression to the behavior of their mothers. Independent of the method of manipulation, maternal AGL was a significant predictor of play and open-field defecation males and of some forms of activity in the open field in both sexes. The relationships between other maternal variables and juvenile behavior were more modest. These data demonstrate that intervening in the sensory regulation of maternal behavior can produce predictable changes in stimulation provided by the dam, thereby providing a useful means for investigating the effects of protracted differences in early stimulation in otherwise normal developmental contexts.

Prenatal stress affects mother-infant interaction in Norway rats.

Pregnant Long-Evans rats were stressed by crowding, and subsequent mother-infant interactions were described after cross-fostering. Prenatally stressed pups elicited less maternal licking from unstressed foster dams than controls, and previously stressed dams licked unstressed foster pups less than controls. No other differences in mother-infant interactions were detected. Adult offspring reared by foster dams that were stressed during pregnancy were more active in an open field than controls, but prenatally stressed and unstressed animals reared by control dams did not differ. Thus, stress during pregnancy can alter the maternal behavior of stressed dams, and the differential maternal stimulation can affect adult open-field behavior. Because prenatally stressed pups elicit different maternal care, cross-fostering does not eliminate the possibility that maternal stimulation may mediate some prenatal stress effects.

Prenatal stress eliminates differential maternal attention to male offspring in Norway rats.

Maternal licking behavior was observed in 20 Long-Evans rat dams on two consecutive days. Stimulus pups were male and female foster pups from dams that were either housed with 5 adult males during the last trimester of pregnancy (stressed) or housed alone (unstressed). Unstressed male pups received significantly more maternal licking than their female siblings, but prenatally stressed males and females received similar levels of maternal licking, comparable to that directed to unstressed females. In a second study, urine collected from prenatally stressed male pups elicited significantly less investigation from dams in a choice test than urine from age-matched unstressed males. It is concluded that the chemosignals which stimulate dams normally to provide more maternal attention to male than female neonates are deficient in prenatally stressed males. The results raise the possibility that differential maternal care may mediate some effects of prenatal stress on behavioral development in males.