Risking infants' health.

Byline: The Register-Guard

Health officials don't know exactly what's behind Lane County's alarmingly high fetal-infant mortality rate - the number of babies who die anywhere from the 24th week of pregnancy to one year of age. But if they could find out, the odds are good they could save more babies.

What's known from an analysis of Lane County's fetal and infant deaths from 1999 to 2003 is that the mortality rate is particularly high in two groups: low birthweight babies (17.6 ounces to 3.3 pounds) from 24 weeks' gestation to one year after birth; and higher birthweight babies from 29 days after birth to one year old.

The mortality rate in the first group - low birthweight babies - is most affected by the mother's overall health before conception and how prematurely a baby is born. The second group is most affected by factors that promote infant health: breastfeeding, injury prevention and sleep position.

Researchers seeking clues about possible contributors to the higher death rates used what's called a Pregnancy Risk Assessment Monitoring System to analyze data during the five-year study period. The PRAMS study examined census records, alcohol and drug statistics, mental health data and other health studies to produce a statistical profile of women in Lane County.

Some of the results were surprising. One-quarter of Lane County women binge drank at least once before becoming pregnant. Binge drinking for women is defined as consuming four or more alcoholic drinks on a single occasion. By comparison, 17.3 percent of women statewide reported a pre-pregnancy episode of binge drinking.

Binge drinking is an especially troubling red flag for health officials. The harmful effects of alcohol on a developing fetus are well known.

Binge drinking is rarely a one-time behavior. Since most women don't immediately know when they become pregnant, there is a higher probability that a repeat binge drinking episode could occur during early pregnancy.

There's also a correlation between binge drinking, smoking and illegal drug use that further suggests binge drinking could be a telling factor in compromising the health of Lane County mothers and babies.

Speaking of smoking, 26 percent of Lane County women smoked during the three months before they became pregnant, compared with 23 percent statewide, according to the PRAMS study. Interestingly, many of those women tried to quit after learning they were pregnant, but about half (12 percent) reported smoking during the last three months of their pregnancies. At the end of their pregnancies, almost 20 percent of Lane County women were smoking again.

Smoking is going to be a health menace at every stage for mothers and babies: It affects pre-pregnancy, fetal development, birthweight and a newborn infant's lungs. But while smoking and drinking are among the more obvious factors in the fetal-infant mortality rate, there are still many unknowns.

Preliminary data suggest that the mortality rate is higher in rural areas. Among statistical groups of Lane County women, the rate is much higher for women with fewer than 13 years of education and for women who received minimal care during the first trimester of preg- nancy.

The silver lining around these depressing statistics is that targeted public health efforts can drive significant improvement in the fetal-infant mortality rate. Education, substance abuse prevention and treatment efforts, smoking cessation assistance, access to prenatal care, encouraging breastfeeding and informing young women about the importance of taking folic acid before becoming pregnant are proven methods of reducing fetal and infant deaths.

The key is determining which strategies will make the biggest difference for the most people within the fiscal constraints of an already underfunded county Public Health Department. That's why additional data from a Fetal-Infant Mortality Review, which will cost about $150,000 that the county doesn't have, is absolutely essential.

The Public Health Department is seeking grants for the $150,000, but the FIMR study alone won't provide the solution.

Lane County's fetal-infant death rate is higher than the state's and the nation's. People and organizations in Lane County that want to save more babies will need to join the effort.