Infant Mortality… A Public Health Crisis

Tamar Krishnamurti, PhD

Pregnancy and infancy should be exciting, healthy experiences. But some infants do not survive what should be a cherished time in life.
The infant mortality rate is measured by how many infants out of every 1,000 born die within the first year of life. The Centers for Disease Control and Prevention (CDC) consider the rate of infant mortality to be a sign of the overall health of a society. The CDC’s most recent data reports that the United States has an infant mortality rate of 5.9. The United States’ rate is much higher than that of comparable (in terms of size and wealth) countries. This is commonly described by health officials as a public health crisis.
Broken down even further, the infant mortality rate for White infants in the United States is much lower than those of every racial and ethnic group (other than Asian). In Allegheny County, the same disparity is exists—in fact, that the mortality rate is three times higher for African American infants.
According to the CDC, the leading causes of infant mortality are birth defects, preterm birth complications, sudden infant death syndrome, injuries and mothers’ pregnancy complications. To monitor any risks that may arise during pregnancy or soon after birth, researchers at the University of Pittsburgh and Carnegie Mellon University developed the MyHealthyPregnancy app.
“My colleagues and I wanted to create a tool that monitors risk during pregnancy at the individual level,” said Tamar Krishnamurti, PhD, assistant professor of medicine, School of Medicine, and of clinical and translational science, University of Pittsburgh. “The app is a tool that picks up on risk and provides actionable, understandable feedback about those risks to patients. The goal is to reduce unwanted outcomes both during pregnancy and in the early period after delivery.”
In a pilot study of women using the MyHealthyPregnancy app, Dr. Krishnamurti and her fellow researchers were able to pinpoint multiple risks women were facing that were not revealed at their health care appointments. These risks included depression, drug use, intimate partner violence and preterm labor contractions. The MyHealthyPregnancy app—Dr. Krishnamurti hopes it will be available for download soon—prompts women every day with questions about, for example, how they are feeling and how their relationships are going. The answers are turned into data that can be modeled and translated to individual-level calculations for risk. The app provides women with feedback about their answers and pairs that feedback with resources to address any risks.
With high rates of smartphone ownership in the United States, the app reaches women who might face barriers to accessing health care. Dr. Krishnamurti points out that barriers are often logistical and in no way reflect the amount of time and interest women are willing to dedicate to their health care and pregnancy. One of the barriers is getting to health care appointments. During the first study of women using the app, attendance at health care appointments went from 50 percent to closer to 90 percent, Dr. Krishnamurti said.
“Mobile health is incredibly powerful in reaching patients,” she said. “In addition to monitoring risk, the app is a way to provide reassurance to women. It provides education so that women know whether or not a pregnancy or postpartum symptom is normal. Women were telling us that Googling answers to their pregnancy questions is stressful because it can be hard to know whether the information they find is true or false. We feel we’ve created an app that feels like a dependable friend as well as a trusted source of information.”
Until the app becomes widely available, or if you do not have a smartphone, discussing any pregnancy or postpartum concerns with a health care professional is a good first step.
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