Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden Infant Death Resource Center. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

May 30, 2008

1. American Academy of Pediatrics Releases Online Version of Bright Futures Guidelines
2. Report Tracks Country-Level Implementation of Interventions Proven to Reduce Mortality Among Mothers, Newborns, or Children
3. Panel Reviews National Study Plan on Environmental and Genetic Effects on Health in Children
4. Researchers Review Evidence on the Impact of Weight Gain Among Women During Pregnancy
5. Authors Examine Evidence on the Benefits and Harms of Screening for Gestational Diabetes Mellitus
6. Article Investigates Neighborhoods' Influence on the Association Between Maternal Age and Birthweight

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1. AMERICAN ACADEMY OF PEDIATRICS RELEASES ONLINE VERSION OF BRIGHT FUTURES GUIDELINES

Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents --Third Edition provides information to help pediatricians provide better health care, save time, and keep up with changes in families, communities, and society that impact infant, child, and adolescent health. The guidelines, recently made available for download from the American Academy of Pediatrics' Bright Futures Web site, are organized into 10 themes common to all stages of development, followed by specific guidance for each of 31 recommended health supervision visits from infancy through late adolescence. Growth charts and the newly revised periodicity schedule are included. The guidelines and reference information are available at http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html. Slides and handouts for use and customization in making presentations about Bright Futures are also available for download at http://brightfutures.aap.org/bright_futures_power_point_presentations.html.

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2. REPORT TRACKS COUNTRY-LEVEL IMPLEMENTATION OF INTERVENTIONS PROVEN TO REDUCE MORTALITY AMONG MOTHERS, NEWBORNS, OR CHILDREN

Tracking Progress in Maternal, Newborn, and Child Survival: The 2008 Report focuses attention on national coverage levels for high-impact interventions in 68 countries with the highest maternal and child mortality rates. The report, published as a working document by the United Nations Children's Fund, summarizes the activities of Countdown 2015, a collaboration of individuals and institutions established in 2005 to stimulate country action by tracking implementation levels for interventions needed to reduce child mortality and improve maternal health. The report summary presents the Countdown's principles, priority countries, interventions and indicators, key findings and conclusions, and challenges to progress, as well as the call to action. In the main body of the report, the authors explain why and how the priority countries were selected; summarize the selection of indicators, the data sources, and the methods used to track progress; and discuss the findings. The authors take specific note of countries with demonstrated progress in raising implementation levels and areas where intensified effort is needed within and across the priority countries. Profiles for each of the 68 Countdown priority countries contain information on selected demographic measures of maternal, newborn, and child survival and nutritional status; implementation rates for priority interventions; and selected indicators of equity, policy support, human resources, and financial flows. The executive summary (available in English, French, and Spanish) and full report are available at http://www.countdown2015mnch.org/reports. Country profiles are also available separately at http://www.countdown2015mnch.org/index.php?option=com_content&view=article&id=62.

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3. PANEL REVIEWS NATIONAL STUDY PLAN ON ENVIRONMENTAL AND GENETIC EFFECTS ON HEALTH IN CHILDREN

The National Children's Study Research Plan: A Review presents a scientific assessment of a national longitudinal study to examine the effects of environmental influences (including chemical, biological, and psychosocial) on the health and development of approximately 100,000 children across the United States, following them from before birth until age 21. The report, published by the National Academies Press, is based on a review conducted by the National Research Council in collaboration with the Institute of Medicine to ensure that the National Children's Study (NCS) is scientifically rigorous and is being carried out with the best available methods. Topics include NCS goals, conceptual framework, and core hypotheses; priority outcome and exposure measures; study design, data collection, and analysis; ethical procedures and community engagement; and conclusions and recommendations. An executive summary, references, and biographical sketches of the review panel members are included. The report is available at http://www.nap.edu/catalog.php?record_id=12211 (requires sign-in for free .pdf download).

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4. RESEARCHERS REVIEW EVIDENCE ON THE IMPACT OF WEIGHT GAIN AMONG WOMEN DURING PREGNANCY

Outcomes of Maternal Weight Gain presents findings from a systematic literature review focusing on evidence for the influence of gestational weight gain on birth, infant health, and maternal health outcomes. The report, published by the Agency for Healthcare Research and Quality, provides background information on weight gain recommendations and gestational weight gain patterns in the United States. Additional chapters contain information on the methods and results and a discussion of the findings. Selected topics include outcomes of gestational weight gain, confounders and effect modifiers of outcomes of maternal weight gain, risks and benefits of gestational weight gain recommendations, and anthropometrics of weight measurement during pregnancy. Limitations of the evidence base and review as well as future research directions are also discussed. The abstract and full report (large file) are available at http://www.ahrq.gov/clinic/tp/admattp.htm.

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5. AUTHORS EXAMINE EVIDENCE ON THE BENEFITS AND HARMS OF SCREENING FOR GESTATIONAL DIABETES MELLITUS

"We identified no randomized, controlled trials of gestational diabetes screening at 24 weeks' gestation or later. . .

• No randomized, controlled trials of screening and subsequent treatment.
• Little evidence on sensitivity and specificity for the primary health outcomes.
• One good-quality study suggesting that treatment of a screening-detected population with mild gestational diabetes reduced serious neonatal and maternal outcomes in a population similar to the U.S. population in terms of ethnicity and obesity levels. This new evidence adds to evidence from a 1966 study that found a reduction in macrosomia (abnormally large body size) with gestational diabetes treatment compared with no treatment.
• Fair evidence that during the first few weeks after screening, women with positive results on screening for gestational diabetes may report higher anxiety, more psychological distress, and poorer perceptions of their general health than women with negative results. However, these differences do not persist into the late third trimester or postpartum period.
• Limited evidence that quality of life is not worse in women receiving gestational diabetes treatment than in women not receiving treatment.

• Neighborhood maternal age-birthweight slopes ranged from a decrease of 17g per additional year of maternal age to an increase of 10g per additional year of maternal age.
• Neighborhood clusters (NCs) with negative slopes had higher levels of concentrated poverty and lower levels of neighborhood support. (NCs were defined based on geographic boundaries and knowledge of traditional Chicago neighborhoods.)
• Concentrated poverty was a significant predictor of mean birthweight and of maternal age-birthweight slope within a neighborhood. As concentrated neighborhood poverty in the neighborhood increased, the lower level of birthweight found in older mothers became more pronounced.
• The significant variations across neighborhoods in the association between maternal age and birthweight are stable over time.