Medical and social factors affecting early teenage pregnancy. A literature review and summary of the findings of the Louisiana Infant Mortality Study.

A total of 414 births occurred to women under 15 years of age in Louisiana in 1972. The infant mortality rates of these children ranged from 6 to 50 per thousand live births when various combinations of medical and social factors were considered. Highest risk is asigned to the offspring of mothers who were poor, or white, or married, or with limited prenatal care. Prenatal care was generally less in the teenager than the older woman. The teenage stillbirth, perinatal mortality, prematurity, and infant mortality rates are generally higher than those in older women. This study confirms the findings of other authors that the offspring of teenage mothers are at greater risk than the offspring of older women although quality prenatal care and origin in a favorable socioeconomic background will ameliorate substantial elements of this risk.

The effect of maternal demographic factors on infant mortality rates. Summary of the findings of the Louisiana Infant Mortality Study. Part I.

Birth and infant death certificates for Louisiana in 1972 were matched and reviewed to identify groups particularly in need of close medical support and counselling during the identify groups particularly in need of close medical support and counselling during the life phases of preparation for reproduction, gestation, and parenthood. From all recorded birth and infant death certificates for 1972 (69,556 birth and 1,541 death certificates) infant, neonatal, and postneonatal mortality rates were computed for maternal demographic (intrinsic patient physiocal and life-style characteristics) factors including age, race, parity by age cohort, education, and legitimacy. Excessive infant deaths were found among illegitimate offspring, except in mothers less than 15 years of age or nonwhites over 35 years of age; the less educated; those having too many children too soon; those of low birth weight; and whites relying on Charity Hospitals. An increased mortality rate was seen with nonwhites and with the younger and older mothers.

PIP: 69,556 birth and 1541 death certificates for infants in Louisiana du ring 1972 were matched and reviewed to identify groups needing special medical care. This, the 1st of 3 reports, analyzes the effect of intrinsic patient factors such as age, child spacing, legitimacy, education, socioeconomic status, and race on infant mortality rates. In general, nonwhites have higher infant mortality than whites (24.5 vs. 15.8). This pattern is unchanged when controlled by education, legitimacy status, age (except under age 15), number of children, or place of delivery. Only white patients who delivered in state charity hospitals, or who had fewer than 9 prenatal visits, or infants weighting less than 5 1/2 pounds at birth had greater rates. Rates were higher for illigitimate babies than for those born in wedlock (22.8 vs. 15.5) and for babies born to women under age 15 (41.1 for white women, 29.9 for black women). Very old mothers also had higher infant death rates; for women over 40 infant death rates were 25.1 for white women, 32.9 for black and neonatal death rates were 20.1 for white and 30.4 for black. When parity is examined in relationship to maternal age, the old dictum that "too many children too soon leads to greater risk" is upheld. Infant mortality rates for the 2nd child or a mother aged 15-19 is 30.1; for her 3rd child, 68.3; for a 5th child of a mother aged 20-24, 50. There is a steady decline in infant mortality, both neonatal and postnat al, with increased education regardless of race. There was almost a 75% drop between the rate for women with less than 8th grade education and those who had completed high school (6.8 to 1.9). These data show the less educated, poor, black, unmarried, and the mother who has too many children too soon have higher infant mortality while the educated, middle-class back woman delivering in a private hospital fares about as well as the acomparable white patient. The health professional must continue to try to improve education, nutrition, medical care, and support of community welfare programs.

The effect of availability and utilization of prenatal care and hospital services on infant mortality rates. Summary of the findings of the Louisiana Infant Mortality Study. Part II.

A total of 69,556 birth and 1,541 death certificates from Louisiana, 1972, were reviewed. Infant, neonatal, and postneonatal mortality rates were computed for number of prenatal visits, type of hospital of delivery, hospital vs. nonhospital delivery, and geographical access to health care. The mortality rates were twice as great for infants born outside of hospitals. With no prenatal care, the infant mortality rates were between four- and tenfold greater than the rates of women receiving more than nine visits even when race, poverty, geography, and birth weight were considered. Infant mortality rates were twice as high in the neonatal period and three times greater in the postneonatal period among the poor who utilized charity hospitals. This study illustrates a method which could be incorporated into state vital statistics reports which would detect populations at risk of excess infant deaths and would provide a more refined analysis of birth and infant death data to monitor improvements in care of high-risk groups.

Counseling the patient with sickle cell disease about reproduction: pregnancy outcome does not justify the maternal risk.

PIP: A retrospective study of 35 HbSS and 15 HbSC pregnant patients was undertaken to illustrate the hazards to both mother and child of gestations associated with these hemoglobinopathies. It was found that these patients experienced a 10% to 14% maternal mortality rate and a 51% to 55% perinatal mortality rate. The fact that the mother, due to her illness, cannot care for the child, coupled with the poor medical health that the offspring themselves have if they too inherit the homozygous gene, provides additional support to the concept that some form of relief should be offered these women. Based on the figures of this study and those of others, aggressive genetic counseling to the women is advocated including liberal surgical sterilization and primary abortion in certain cases.^ieng