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Maternal, Infant, and Child Health

Maternal, Infant, and Child Health

Goal

Improve the health and well-being of women, infants, children, and families.

Overview

Improving the well-being of mothers, infants, and children is an important public health goal for the United States. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. The objectives of the Maternal, Infant, and Child Health topic area address a wide range of conditions, health behaviors, and health systems indicators that affect the health, wellness, and quality of life of women, children, and families.

Why Are Maternal, Infant, and Child Health Important?

Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children. These health risks may include:

  • Hypertension and heart disease
  • Diabetes
  • Depression
  • Intimate partner violence
  • Genetic conditions
  • Sexually transmitted diseases (STDs)
  • Tobacco, alcohol, and substance use
  • Inadequate nutrition
  • Unhealthy weight

The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy), prenatal (during pregnancy), and interconception (between pregnancies) care.1 Moreover, healthy birth outcomes and early identification and treatment of developmental delays and disabilities and other health conditions among infants can prevent death or disability and enable children to reach their full potential.2, 3, 4

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Understanding Maternal, Infant, and Child Health

Many factors can affect pregnancy and childbirth, including:

  • Preconception health status
  • Age
  • Access to appropriate preconception, prenatal, and interconception health care
  • Poverty

Infant and child health are similarly influenced by sociodemographic and behavioral factors, such as education, family income, and breastfeeding, but are also linked to the physical and mental health of parents and caregivers.

There are racial and ethnic disparities in mortality and morbidity for mothers and children; in particular, maternal and infant mortality and morbidity are highest for African Americans.3, 5, 6 These differences are likely the result of many factors.

Determinants of Maternal, Infant, and Child Health

Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. Environmental and social factors such as access to health care and early intervention services, educational, employment, and economic opportunities, social support, and availability of resources to meet daily needs influence maternal health behaviors and health status.7

The determinants that influence maternal health also affect pregnancy outcomes and infant and child health. Racial and ethnic disparities exist in infant mortality and can be partly attributed to disparities in social determinants of health.8, 9, 10, 11, 12, 13, 14 Child health status varies by both race and ethnicity, as well as by family income15 and related factors, including educational attainment among household members and health insurance coverage.16 Child health status and well-being can also be influenced by access to high-quality health care, such as that received through a medical home17 and maternity care practices that promote breastfeeding18 and safe sleep environments.19

The cognitive and physical development of infants and children may be influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Consumption of recommended amounts of folic acid before and during pregnancy can reduce the risk for neural tube defects. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development.20, 21 Furthermore, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other adverse childhood experiences, are more likely to have better outcomes as adults.22, 23, 24

Emerging Issues in Maternal, Infant, and Child Health

Recent efforts to address persistent disparities in maternal, infant, and child health have employed a “life course” perspective to health promotion and disease prevention. At the start of the decade, about half of all pregnancies were unplanned. Unintended pregnancy is associated with a host of public health concerns such as delayed initiation of prenatal care, poor maternal health, and preterm birth. In response, perinatal health initiatives have been aimed at improving the health of women and infants before and during pregnancy through a variety of evidence-based interventions and attention to emerging public health concerns, such as Zika.1, 25, 26

The life course perspective also supports the examination of quality of life, including the challenges of male and female fertility. An estimated 6.9 million American women ages 15 to 44 have received infertility services (including counseling and diagnosis) in their lifetime.27 Disparities in infertility diagnosis and treatment exist among racial and ethnic groups, and may increase as childbearing practices continue to change. In particular, African American women experience higher rates of infertility.28

References

1Centers for Disease Control and Prevention. Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR. 2006;55(RR-06):1–23.

2Centers for Disease Control and Prevention. Newborn screening for cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn screening programs. MMWR. 2004;53(RR-13):1–36.

3Centers for Disease Control and Prevention. Identifying infants with hearing loss—United States, 1999–2007. MMWR. 2010;59(8):220–23.

4Watson MS, Mann MY, Lloyd-Puryear MA, et al. Newborn screening: Toward a uniform screening panel and system [executive summary]. Pediatrics. 2006;117(5 Pt. 2):S296–307.

5Tucker MJ, Berg CJ, Callaghan WM, et al. The black-white disparity in pregnancy-related mortality from 5 conditions: Differences in prevalence and case-fatality rates. Am J Public Health. 2007 February 1;97(2):247–51.

6Williams DR, Collins C. US Socioeconomic and racial differences in health: Patterns and explanations. Ann Rev Soc. 1995;21:349–86.

7Braveman PA, Egerter SA, Mockenhaupt RE. Broadening the focus: the need to address the social determinants of health. Am J Prev Med. 2011 Jan;40(1 Suppl 1):S4–18.

8Bryant AS, Worjoloh A, Caughey AB, et al. Racial/ethnic disparities in obstetric outcomes and care: Prevalence and determinants. Am J Obstet Gynecol. 2010 Apr;202(4):335–43.

9Williams DR. Racial/Ethnic Variations in Women’s Health: The Social Embeddedness of Health. Am J Public Health. 2002 April;92(4):588–97.

10Siddiqi A, Jones MK, Bruce DJ, Erwin PC. Do racial inequities in infant mortality correspond to variations in societal conditions? A study of state-level income inequality in the U.S., 1992-2007. Soc Sci Med. 2016 Sep;164:49–58.

11Loggins S, Andrade FC. Despite an overall decline in U.S. infant mortality rates, the Black/White disparity persists: recent trends and future projections. J Community Health. 2014 Feb;39(1):118–23.

12Gorman BK. Racial and ethnic variation in low birthweight in the United States: individual and contextual determinants. Health & Place. 1999 Sept;5(3):195–207.

13Blumenshine P, Susan Egerter, Colleen J. Barclay, et al. Socioeconomic Disparities in Adverse Birth Outcomes: A Systematic Review. Am J Prev Med. 2010 Sept;39(3):263–72.

14Braveman PA, Heck K, Egerter S, et al. The Role of Socioeconomic Factors in Black–White Disparities in Preterm Birth. Am J Pub Health. 2015 April;105(4):694–702.

15Larson K, Halfon N. Family income gradients in the health and health care access of US children. Matern Child Health J. 2010 Jun 5;14(3):332–42.

16Larson K, Russ SA, Crall JJ, et al. Influence of multiple social risks on children’s health. Pediatrics. 2008 Feb 1;121(2):337–44.

17Long W, Bauchner H, Sege R, Cabral H, Garg A. The Value of the Medical Home for Children Without Special Health Care Needs. Pediatrics. 2012 Jan;129(1):87–98.

18U.S. Department of Health and Human Services, Office of the Surgeon General [Internet]. The Surgeon General’s Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General. c2011– [updated 2014 Aug 12]. Available from: http://www.surgeongeneral.gov/library/calls/breastfeeding

19Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016 Oct:e20162938. Available from: http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938

20U.S. Department of Health and Human Services (HHS), Office on Women’s Health. HHS blueprint for action on breastfeeding. Washington, DC: HHS; 2000.

21Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007. AHRQ Publication No. 07-E007.

22Shonkoff J, Philips D, editors, and National Research Council and Institute of Medicine Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press; 2000.

23Anda RF, Felitti VJ, Walker J, et al. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174–86.

24Culhane JF and Elo IT. Neighborhood context and reproductive health. Am J Obstet Gynecol. 2005 May;192(5S): S22–S29.

25Centers for Disease Control and Prevention [Internet]. Zika Virus: Pregnancy. Atlanta: CDC. c2017– [updated 2017 Apr 4]. Available from: https://www.cdc.gov/zika/pregnancy/index.html

26Petersen EE, Meaney-Delman D, Neblett-Fanfair R, et al. Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure — United States, September 2016. MMWR. 2016;65:1077­–81.

27Chandra A, Copen CE, Stephen EH. Infertility service use in the United States: data from the National Survey of Family Growth, 1982-2010. Natl Health Stat Report. 2014 Jan 22;(73):1–21. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr073.pdf

28Chandra A, Copen CE, Stephen EH. Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. Natl Health Stat Report. 2013 Aug 14;(67):1–18. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr067.pdf

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