Why Is This Important?

Fetal mortality - the intrauterine death of a fetus at any gestational age - is a major but often overlooked public health issue. Much of the public concern surrounding reproductive loss has focused on infant mortality, due in part to a lesser knowledge of the incidence, etiology, and prevention strategies for fetal mortality.^[https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-04.pdf 1]^

Definition

An '''infant death''' is the death of a live-born infant within the first year of life. The infant death rate is the number of deaths of live-born infants under 1 year of age per 1,000 live births. A '''fetal death''' is what is commonly called a stillbirth. The technical definition is "a death prior to the complete expulsion or extraction from its mother of a product of conception; the fetus shows no signs of life such as breathing or beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles." The fetal death rate is the number of fetal deaths of 20 or more weeks gestation per 1,000 live births plus fetal deaths of 20 or more weeks gestation.

Data Sources

• Fetal Death Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health; Linked Infant Death-Birth Database, Center for Health Statistics, New Jersey Department of Health
  (https://www.nj.gov/health/vital/; https://www.nj.gov/health/chs/)
• Birth Certificate Database and Fetal Death Certificate Database, Office of Vital Statistics and Registry, NJDOH
  (https://www.nj.gov/health/vital/)

How the Measure is Calculated

How Are We Doing?

Prior to 1997, there were more infant deaths in New Jersey each year than there were fetal deaths of 20 or more weeks gestation. While the infant mortality rate (IMR) has been steadily declining, the fetal mortality rate (FMR) has not and appears to have leveled off. FMR is greater than IMR for each major racial/ethnic group in New Jersey and the disparity between Blacks and other races/ethnicities often noted in discussions of IMR, is also seen in FMR. Delivery weight and gestational age are highly correlated and IMR and FMR follow the same pattern of higher rates among lower weights with a steady decline as weight increases. IMR is higher than FMR for weights less than 1,000 grams (approximately 2.2 lbs). Between 1,000 and 2,499 grams, FMR is higher than IMR. Two of the five leading causes of infant death and fetal death are the same: * maternal complications of pregnancy * congenital anomalies Maternal complications more likely to result in fetal death than infant death but the death rate due to congenital anomalies is about the same for infant and fetal deaths.

How Do We Compare With the U.S.?

New Jersey's FMR is slightly above that of the U.S. as a whole, but our IMR is consistently lower than the U.S. rate and is declining more rapidly.

What Is Being Done?

The [http://www.nj.gov/health/fhs/ Division of Family Health Services] in the New Jersey Department of Health administers several programs aimed at improving children's health, including reducing infant and fetal mortality. Infant and fetal deaths are reviewed by the [https://www.nj.gov/health/fhs/maternalchild/mchepi/mortality-reviews/ Fetal Infant Mortality Review Team] and recommendations to reduce future deaths are made to public and private sources of care including hospitals, clinics, and health care professionals throughout the state. Information on programs that promote availability and use of prenatal care services may be found at: [https://www.nj.gov/health/fhs/maternalchild/hwhf/] or [http://njparentlink.nj.gov/njparentlink/health/before/] The Department of Health has provided state funding to improve perinatal public health services and birth outcomes in communities. Efforts are continuing to increase public and provider awareness of needs for greater access to maternal preconception care, more awareness of risky preconception and post-conception behavior, and for better general maternal health care. New Jersey was a participant in the [https://www.nichq.org/project/collaborative-improvement-and-innovation-network-reduce-infant-mortality-im-coiin Collaborative Improvement and Innovation Network to Reduce Infant Mortality] (CoIIN-IM). CoIIN was a multiyear national movement engaging federal, state, and local leaders; public and private agencies; professionals; and communities to employ quality improvement, innovation, and collaborative learning to reduce infant mortality and improve birth outcomes. In an effort to improve health outcomes among Black and Hispanic infants and mothers in New Jersey, three maternal and child health agencies across the state were awarded $3.5 million in grant funding in July, 2023, as part of the Department of Health's "[https://www.nj.gov/health/news/2023/approved/20230710a.shtml Healthy Women, Healthy Families]" initiative. [https://nj.gov/governor/admin/fl/nurturenj.shtml Nurture NJ] is a multifaceted initiative to eliminate racial disparities in birth outcomes. The [http://www.nj.gov/health/fhs/maternalchild/consortia.shtml Maternal and Child Health Consortia] are non-profit partners that engage in various activities that work closely with the Department of Health to promote quality health services in New Jersey.

Available Services

The Division of Family Health Services (FHS) provides support for pregnant women and newborns through several programs, including the [http://www.nj.gov/health/fhs/wic/ Supplemental Nutrition Program for Women, Infants and Children] (WIC). Perinatal Mood Disorders (e.g., postpartum depression) Helpline: 1-800-328-3838 or [http://www.nj.gov/health/fhs/maternalchild/mentalhealth/getting-help/] [http://njparentlink.nj.gov/njparentlink/ NJ Parent Link], an interdepartmental website, is New Jersey's online Early Childhood, Parenting, and Professional Resource Center offering "one-stop shopping" for State services and resources. [https://www.njstillbirth.org/ Stillbirth: Can Happen to Any Pregnancy] is a fully dedicated stillbirth resource for New Jersey parents and healthcare providers centered on stillbirth awareness, education, and prevention.

More Resources

Gregory ECW, Valenzuela CP, Hoyert DL. [https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-08.pdf Fetal mortality: United States, 2021]. National Vital Statistics Reports; vol 72 no 8. Hyattsville, MD: National Center for Health Statistics. 2023. Hoyert DL, Gregory ECW. [https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-07.pdf Cause-of-death data from the fetal death file, 2018-2020]. National Vital Statistics Reports; vol 71 no 7. Hyattsville, MD: National Center for Health Statistics. 2022. [https://wonder.cdc.gov/fetal.html Fetal Deaths], as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER Online Database.

Health Program Information

Maternal and Child Health: [http://www.nj.gov/health/fhs/maternalchild/] Special Child Health and Early Intervention Services: [http://www.nj.gov/health/fhs/sch/] WIC: [http://www.nj.gov/health/fhs/wic/]

Footnote References

1. Gregory ECW, Valenzuela CP, Hoyert DL. [https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-04.pdf Fetal mortality: United States, 2020]. National Vital Statistics Reports; vol 71 no 4. Hyattsville, MD: National Center for Health Statistics. 2022. 2. Gregory ECW, Valenzuela CP, Hoyert DL. [https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-04.pdf Fetal mortality: United States, 2020]. National Vital Statistics Reports; vol 71 no 4. Hyattsville, MD: National Center for Health Statistics. 2022. Page 18.