Epidemiological trends of infant mortality related to premature rupture of membranes: U.S. 1999–2023

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Introduction: Premature rupture of membranes (PROM) complicates 8% of pregnancies and accounts for nearly one-third of preterm labor. While prior studies have examined clinical management and maternal risk factors, national data on PROM-related infant mortality remains scarce. This study investigates demographic trends in PROM-related infant mortality in the U.S. from 1999 to 2023. Methods: The CDC WONDER database was utilized to identify U.S. crude mortality rates of newborns affected by PROM (ICD-10 code P01.1). Demographic variables were analyzed through the CDC Joinpoint Regression program to evaluate temporal trends. This study used publicly available, de-identified data and is IRB-exempt. Results: A total of 27,184 PROM-related infant deaths were identified from 1999 to 2023. Mortality rates rose significantly from 1999 to 2002 (APC = 5.09), increased modestly through 2013 (APC = 0.69), then declined through 2023 (APC = -3.66). Black or African American infants consistently had higher mortality across gender and region. In urban areas, mortality increased significantly in large central metros (APC = 2.32) and fringe metros (APC = 1.45) until 2012, then declined through 2023 (APC = -2.93; -1.45). Rural areas showed a gradual decline from 1999 to 2021 (APC = -1.35). Conclusion: While PROM-related infant mortality has declined since the early 2000s, disparities persist across race and geography. Black or African American infants continue to experience higher mortality rates, mirroring broader obstetric disparities. Urban and rural centers also demonstrated distinct temporal patterns. Further research is needed to clarify these trends and risk factors between these sub-populations.

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