Botto LD, Krikov S, Carmichael SL, Munger RG, Shaw GM, Feldkamp ML Lower rate of selected congenital heart defects with better maternal diet quality: a population-based study. Arch Dis Child Fetal Neonatal Ed. 2015;

Crabbe K, Hemingway A Public health and wellbeing: A matter for the midwife?. British Journal of Midwifery. 2014; 22:(9)634-40

Health and Social Care Information Centre. Statistics on Women's Smoking Status and Time of Delivery, England—Quarter 4, 2014–15. 2015. (accessed 19 August 2015)

Office for National Statistics. Statistical Bulleting: Unexplained Deaths in Infancy: England and Wales, 2013. 2015. (accessed 19 August 2015)

Additions to the public health evidence-base

02 September 2015
Volume 23 · Issue 9

Public health is a fundamental aspect of the midwife's role. Regular contact with women and their families during pregnancy and the immediate postnatal period offers a crucial opportunity to maximise health and wellbeing by delivering health promotion messages. Public health interventions during pregnancy may be universal, such as breastfeeding promotion, or tailored to the needs of individual women, such as smoking cessation advice or support with domestic abuse (Crabbe and Hemingway, 2014).

Two recent publications have highlighted the importance of promoting public health messages antenatally. The first was a report of data from the Office for National Statistics (ONS, 2015) revealing that, for the first time since 2008, there was an increase in unexplained infant deaths in England and Wales in 2013. The rate of unexplained deaths increased from 0.32 per 1000 live births in 2012, to 0.36 per 1000 in 2013—a figure which is likely to actually be slightly higher, as the 2013 numbers are provisional. Of these deaths, 65% were recorded as sudden infant deaths (SIDS) while 35% were recorded as ‘unascertained’, meaning they did not meet the criteria to be classed as SIDS. Unexplained deaths accounted for 9% of all infant deaths in England and Wales in 2013, up from 8% in 2012. More than a quarter (27.2%) of unexplained infant deaths in 2013 occurred between the ages of 28 days and 2 months.

Known risk factors for unexplained infant death include overheating and an unsafe sleeping environment (such as the baby's head being covered), both of which are more likely to occur during winter. The ONS figures show that, in 2013, the month with the highest number of unexplained infant deaths (28) was February, while the lowest number (16) occurred in June. This suggests some parents may be unaware that they are covering their infants in an unsafe manner while trying to keep them warm. Another major risk factor for unexplained infant death is smoking—both in terms of maternal smoking during pregnancy and postnatal exposure to tobacco smoke. In 2014–15, 11.4% of women were recorded as smokers at the time of giving birth in England (Health and Social Care Information Centre, 2015). This is clearly a public health priority, not only because of the risk of SIDS but also the numerous other poor health outcomes associated with maternal smoking, such as low birth weight—which is, in itself, a risk factor for unexplained infant death.

Meanwhile, a population-based study published in August has linked a healthy maternal diet—both before and during pregnancy—with a lower risk of heart problems in infants (Botto et al, 2015). The study of 19 000 women in the US found that those in the top quartile of maternal diet quality had a lower risk of having a baby with certain heart defects than those in the bottom quartile, even after accounting for other factors, such as smoking or maternal intake of folic acid.

Midwives offer essential support to women and their partners in preparing for parenthood. These recent reports offer yet more evidence to add to the midwife's armoury in delivering key health promotion messages.