Perinatal and infant health
The term 'perinatal health' refers to the health pertaining to the period immediately before and after birth. The perinatal period is defined in varying ways among Member States. Depending on the definition, it starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth.
'Infant health' considers those less than one year of age.
Monitoring perinatal health
The EU funded Euro-Peristat project's goal has been to develop valid and reliable indicators that can be used for monitoring and evaluating perinatal health in the EU. The current Euro-Peristat indicators list includes 10 core and 20 recommended indicators, grouped into 4 themes: (i) fetal, neonatal, and child health, (ii) maternal health, (iii) population characteristics and risk factors, and (iv) health services. Core indicators are those that are essential to monitoring perinatal health, while recommended indicators are considered desirable for a more complete picture of perinatal health across European countries.
See main Euro-Peristat outcomes:
- European Perinatal Health Report: Health and care of pregnant women and babies in Europe in 2010 (2013)
- European Perinatal Health Report: Better statistics for better health for pregnant women and their babies in 2004 (2008)
- The Major and Chronic diseases in the European Union Report (2008) provides a chapter (chapter 10) on maternal and child health.
See other projects on monitoring perinatal health:
- EuroNeoStat II (2008): Expanded European Information System to Monitor Short and Long Term outcomes and Improve Quality of Care and Safety for Very-Low-Birth-Weight Infants
- EURONEOSTAT (2005): European Information System to Monitor Short and Long-Term Morbidity to Improve Quality of Care and Patient-Safety for Very-Low-Birth-Weight Infants.
European Core Health Indicators (ECHI) on maternal and perinatal health
The 2012 shortlist of 88 European Core Health Indicators (ECHI) includes relevant indicators for maternal and perinatal health policies. Following indicators are implemented in the ECHI data tool:
- 2. Birth rate, data source: Eurostat
- 3. Mother's age distribution, data source: Eurostat
- 4. Total fertility rate, data source: Eurostat
- 11. Infant mortality, data source: Eurostat
- 12. Perinatal mortality, data source: WHO
- 28. Low birth weight, data source: WHO.
Three additional indicators are not implemented yet as they need further development: Pregnant women smoking (45), Breastfeeding (51), and Timing of first antenatal visits among pregnant women (61).
Population characteristics and risk factors
The relationship of maternal age to perinatal health outcomes is U-shaped, with the strongest impacts of maternal age on perinatal health being at the extremes of the maternal age distribution. For young mothers the increased risks of perinatal mortality are associated with social and health care factors, including lack on antenatal care, unwanted or hidden pregnancies, poor nutrition and lower social status. In the EU, births in mothers younger than 20 years constitute between 1% and 10% of all births with an EU28 average around 3% (see ECHI 3). With respect to child bearing at older ages, risks of adverse outcomes increase from approximately 35 years of age. In the EU, births in mothers older than 35 years constitute between 14% and 36% of all births with an EU28 average around 23% (see ECHI 3).
Last Euro-Peristat report states that in many European countries, more than 10% of women smoke during their pregnancy. Not all countries could provide data on maternal smoking during pregnancy, and standardised collection procedures are necessary to improve comparability for those countries that did. Tobacco use during pregnancy is insufficient to assess the effectiveness of preventive policies during pregnancy, as this use is largely influenced by habits before pregnancy. Given the adverse effects of smoking on fetal and infant health and since pregnancy care is considered an ideal setting for intervention, having high quality and comparable information on smoking before and during pregnancy should be a priority.
Peri-neonatal and infant mortality by causes of death
Within the causes of death data collection, Eurostat now collects data on causes of peri-neonatal death and infant death broken down by ICD-10 classification (International Statistical Classification of Diseases and Related Health Problems) at national and regional level.
In addition to the total number of stillbirths, data collection of peri-neonatal death provides two detailed groups. Group 1 of late foetal death records stillbirth with birth weight from 500 to 999 g or (when birth weight does not apply) gestational age from 22 to 27 weeks, or (when neither of the two applies) crown-heel length from 25 to 34 cm. Group 2 of late foetal death reports stillbirth with birth weight of 1,000 g and more or (when birth weight does not apply) gestational age after 27 completed weeks, or (when neither of the two applies) crown-heel length of 35 cm or more.
Last Euro-Peristat report states that generally speaking the maternal mortality ratio in Europe is low, due to both the very low level of fertility (fewer than 2 children per woman) and the high levels of care. The range in Europe is from lows under 3 per 100 000 to highs over 10 per 100 000 live births. There is good evidence that maternal deaths derived from routine statistical systems are under-reported, and this must be suspected particularly where ratios are very low.
Breastfeeding is the natural way to feed infants and young children. Breast milk alone provides all the nutrients an infant requires to grow well until about six months: carbohydrates, protein, fat, vitamins, minerals, digestive enzymes, hormones and water in a balanced mix. After the age of six months, breastfeeding, with appropriate complementary foods, continues to contribute to an optimal infant’s and young child’s growth. Breast milk contains antibodies from the mother that help defend the baby against infections. It also contains other substances that limit the growth of or kill harmful germs. Finally, breast milk passes live cells on to the baby that will enhance its defenses.
Last Euro-Peristat report estimates that the percentage of babies breast fed at birth ranges from 54% to 99%. Success of breast feeding during the first 48 hours after birth depends on public health policies and healthcare practices during pregnancy and in the immediate postpartum.
The WHO Global Nutrition Targets 2025 on breastfeeding policy states that exclusive breastfeeding – defined as the practice of only giving an infant breast-milk for the first 6 months of life (no other food or water) – has the single largest potential impact on child mortality of any preventive intervention. It is part of optimal breastfeeding practices, which also include initiation within one hour of life and continued breastfeeding for up to 2 years of age or beyond.
The Area for action 1, 'Support a healthy start in life' of the voluntary Action Plan on Childhood Obesity agreed by the Member States includes actions related to the promotion of breastfeeding. A first monitoring report of this Action Plan will be available in 2017. These actions also aim to support Member States to reach the WHO Global Nutrition Targets 2025 on breastfeeding policy.
The Health at a Glance Europe 2016 report (Chapter 6 – Childhood vaccination programmes) shows that the overall vaccination of children aged one against diphtheria, tetanus & pertussis (DTP) and measles is high in EU countries. On average, 96% of children received the recommended DTP vaccination and 94% received measles vaccinations in accordance with national immunisation schedules. Most countries have followed the WHO recommendation to incorporate hepatitis B vaccine as an integral part of their national infant immunisation programme. Among the 22 Members States applying the recommendation, the European average of immunisation coverage for hepatitis B in children aged one year old was 91%.
- European Core Health Indicator on Vaccination coverage in children (ECHI 56), data source: WHO
- ECDC (European Centre for Diseases Prevention and Control) on vaccine- preventable diseases
- European survey of BCG vaccination policies and surveillance in children, 2005 - Eurosurveillance
- Immunization surveillance, assessment and monitoring - WHO.
Specific indicators on Very Low Birth Weight and Very Low Gestational Age infants
The Euro-Peristat project has defined a core indicator on distribution of birth weight including the concept of Very-Low-Birth-Weight (VLBW) infants, i.e with a birth weight under 1,500g. When birth weight under 2,500g ranges from 4% to 9% of live births (see ECHI 28) among EU countries, the percentage of VLBW babies ranges from 0.7% to 1.4% (source Euro-Peristat 2013 report).
Evenly, the Euro-Peristat project has also defined a core indicator on distribution of gestational age including the concept of Very-Low-Gestational-Age (VLGA) infants, i.e babies born preterm, before 37 completed weeks of gestation. In Europe the preterm birth rate for live births varies from about 5% to 10% (source Euro-Peristat 2013 report).
In addition, the Euro-Peristat project has developed an indicator on the percentage of very preterm babies delivered in units without a neonatal intensive care unit (NICU) but absence of common definition hampers the full implementation of the recommended indicator.
Perinatal condition specific registries
The Euro-Peristat project has also monitored indicators on perinatal health developed by other European networks. For instance, EUROCAT (European Surveillance of Congenital Anomalies) registries cover affected live births, fetal deaths from 20 weeks of gestation (including stillbirths), and terminations of pregnancy for a fetal anomaly (TOPFA) following prenatal diagnosis (whether before or after 20 weeks of gestation). Another important network is the SCPE (Surveillance of Cerebral Palsy) which has developed a database of children with cerebral palsy (CP).
Rare diseases are life-threatening or chronically debilitating diseases with a low prevalence and a high level of complexity. Most of them are genetic diseases resulting from environmental exposures during pregnancy or later in life, often in combination with genetic susceptibility, the others being rare cancers, auto-immune diseases, congenital malformations, toxic and infectious diseases among other categories. There is also a great diversity in the age at which the first symptoms occur but half of rare diseases can appear at birth or during childhood. The European Commission is supporting some specific networks on pediatric rare diseases.