Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health
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Invited Commentary: Analysis of Gestational-Age-specific Mortality—On What Biologic Foundations?
1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC.
2 Biometry Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC.
Received for publication February 5, 2004; accepted for publication March 29, 2004.
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Birth is a dangerous event. Of all infant deaths in the first year, one third happen on the first day and 10 percent in the first hour (1). There is a similar pattern among fetal deaths, with the highest risk just prior to delivery. Given this cluster of deaths around birth, epidemiologists have commonly combined stillbirths and deaths in the newborn period into a category called perinatal mortality. This grouping avoids the practical difficulty of distinguishing between a stillbirth and a death soon after birth (2). It also implicitly assumes that the causes of death are not different for the two. While this may be true for the peak of deaths around delivery, it is probably less true for the fetal deaths that occur well before labor and the neonatal deaths that occur days or weeks after birth.
The gap between the causes of stillbirths and
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