How to help our infants survive — and have better lives

The numbers tell the sobering story for Georgia’s infants. For too many, their “number is up” before they reach their first birthday.

Georgia’s fetal death rate is well above the national average, and the state ranks 47th in the country for infant mortality. Seventy percent of Georgia infants who die before their first birthday were born low birthweight (LBW, less than 5 pounds, 8 ounces). It is no surprise that Georgia ranks 45th for its LBW rate.

According to the Georgia Department of Public Health, “it costs more than $27,000 per pound to raise a low or very low birthweight baby to normal weight.” On average, the medical care for premature babies (born after less than 37 weeks in the womb) and/or LBW babies costs more than $50,000 per child in the first year of life, compared to approximately $5,000 each for babies born at full term.

Premature and LBW babies do not just cost more in terms of deaths and dollars. Those who survive are more likely to face problems in life. They are at higher risk of lifelong conditions such as asthma and high blood pressure. They are also at greater risk of having lower IQs, attaining less education, and earning less income than their peers.

Nationally, and in Georgia, the top three causes of infant deaths are birth defects, premature births (which includes low birthweight) and sleep-related deaths, including SIDS.

While we cannot change every outcome, there are several ways in which Georgia can improve.

The first is routine dental care every six months for pregnant women. The American College of Obstetricians & Gynecologists (ACOG) and the American Dental Association recommend routine dental care during pregnancy, and nationally 51 percent of pregnant women are getting dental care. Yet the latest data for Georgia showed less than 30 percent receiving dental care, with Medicaid recipients being closer to 15 percent.

Georgia Medicaid covers dental services during pregnancy, yet most Medicaid recipients may not know it. By contrast, Aetna gives repeated dental care education and information to clients throughout their pregnancies. Why? Because Aetna looked at its own data on 29,000 maternity patients who had both medical and dental coverage during their pregnancies. They found that the premature (preterm) birth rate was 42 percent higher and the LBW rate was 33 percent higher for the babies of women who did not receive dental treatment during pregnancy.

A second area of deficiency is maternal influenza immunization. Women who are pregnant during the flu season need a flu shot. That shot protects not just the mother, but the unborn baby too.  Although one recent study showed a marginal association with miscarriage when a woman is vaccinated in the first trimester under certain circumstances, multiple studies have shown a deceased risk of stillbirth and preterm delivery when the vaccine is given during pregnancy.

Additionally, the vaccine also provides protection to the infant for months after birth — decreasing the baby’s risk of influenza hospitalization by more than 80 percent. Both the CDC and ACOG recommend the vaccine for pregnant women, with ACOG stating that it “is a critically important component of prenatal care.”

Nationally, 53.6 percent of women had protection through vaccination when they were pregnant during the 2016-17 flu season — with 16.2 percent of those having been vaccinated before they became pregnant and 37.4 percent having been vaccinated while they were pregnant. In Georgia, birth data shows that just 15 percent of women got a flu shot in pregnancy in 2016.

A third area of concern is that pregnant women should be getting the Tdap vaccine early in the third trimester. This vaccine will provide whooping cough protection to the baby after birth via the maternal antibodies that will pass through the placenta. Nationally, 49 percent of pregnant women are getting this vaccine, while in Georgia only 18 percent are getting it.


A fourth area for improvement involves smoking. While Georgia’s numbers are better than the national average in this measure, any “maternal smoker” is one too many. Mothers who smoke during pregnancy are 1.59 times more likely to deliver a LBW baby compared to nonsmokers. Moreover, maternal smoking is present in the records of more than 35 percent of Georgia’s 2015 sleep-related infant deaths, which is significantly disproportionate to the 5.7 percent of Georgia mothers who indicated smoking during pregnancy.

Finally, some of our mothers and babies are still missing out on the benefits of breastfeeding. We now have a plethora of research regarding the health benefits for both baby and mother. Research shows that an infant who is breastfed for just three months will save at least $750 in medical expenses in his or her first year of life. Notably, breastfeeding is also associated with a 36 percent reduction in the risk of SIDS. While Georgia has made significant progress in the percentage of mothers who initiate breastfeeding, going from 69 percent to 80 percent in one year, that rate still trails the national average of 82.5 percent.Moreover, only 21 percent of Georgia babies are exclusively breastfeeding for six months despite that medical recommendation, with 25 percent achieving that goal nationally.

No one should be satisfied with Georgia’s numbers. Our infants are the future of our state. Addressing these issues will support a healthy future workforce, as well as save the state significant health care dollars. Everyone needs to join in taking action to educate and assist Georgia mothers with these measures so that more of Georgia’s babies will be able to count their own birthdays.

Merrilee Gober, a native of Atlanta, earned her nursing degree from the Medical College of Georgia and her law degree from Georgia State University College of Law. Her professional career includes being an OB nurse, a litigation attorney, and a medical practice administrator. She is a past-president and current board member of Healthy Mothers, Healthy Babies Coalition of Georgia, the immediate past-president and current board member of the Medical Association of Georgia Alliance, and she serves on the Board of Advisors to the Georgia State University School of Public Health.