Neonatal Mortality as a Function of Secular Events During Pregnancy: Changes in Statistical Modeling Needed to Improve Obstetric Care & Neonatal Health

Abstract:     
Neonatal deaths are used as one measure of the 'State of the Nation's Health'. These data are compiled on a calendar year basis. For 2002, an anomalous one-time jump in neonatal mortality was reported, originally attributed to artificial reproduction technologies (ART) used increasingly by older women delaying childbirth. Subsequently, it was determined that the bulk of neonatal deaths occurred in 20-34 year old mothers. An increase in maternal complications during pregnancy, low birth weight babies and pre-term deliveries were identified as the prime underlying causes of the aberrant rates, although birth defects remained the main overall cause of neonatal deaths. Various hypotheses were examined for these increases, but no valid explanation accounts for the 2002 anomaly as yet.

As maternal complications and chromosomal abnormalities occur during pregnancy, it is suggested that current analytical methods preclude investigating aberrant conditions to which infants born in the first nine months of any given year may be subjected. Specifically, it is theorized that the unusual 2002 data may be associated with the extraordinary events occurring in calendar year 2001. Investigating such a relationship would require consideration of neonatal mortality on a floating calendar year basis. To fully understand the implications of pregnancy on neonatal health, a correlation of trimester of pregnancy with ensuing neonatal mortality would be required.

This paper examines data behind the continued claim that an aging female population delaying childbirth is the main factor behind our relatively high neonatality mortality figures, as compared to other industrialized countries. Other emerging secular trends will be raised which may be contributory. Finally, events of 2001 that may be related to increased 2002 neonatal mortality will be discussed.

Only when we account for critical events impacting neonatal deaths that transcend the artificial calendar year of their birth, can we increase our understanding of, and implement programs to reduce infant mortality.

Number of Pages in PDF File: 19

Keywords: health care, pregancy, obstetrics, neonatal mortality, infant deaths, healthmetrics, vital statistics

JEL Classification: C13, C22, C32, C42, I12, I18, K32, J11, Z10

working papers series