1 / 21

Perinatal Health in Oregon: Data and Program Development

Perinatal Health in Oregon: Data and Program Development Ken Rosenberg, MD, MPH MCH Epidemiologist Office of Family Health November 28, 2007 Perinatal Data Book Topics include: Infant mortality & preterm birth Periconceptional folic acid Prepregnancy obesity Prenatal care Tobacco use

albert
Download Presentation

Perinatal Health in Oregon: Data and Program Development

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Perinatal Health in Oregon: Data and Program Development Ken Rosenberg, MD, MPH MCH Epidemiologist Office of Family Health November 28, 2007

  2. Perinatal Data Book • Topics include: • Infant mortality & preterm birth • Periconceptional folic acid • Prepregnancy obesity • Prenatal care • Tobacco use • Alcohol use • Pregnancy intendedness • Postpartum depression • Breastfeeding • Infant sleep position

  3. Strength of Evidence • My own personal summary of the strength of the evidence: • Very strong • Strong • Moderate • Weak • Very Weak

  4. Infant Mortality / Preterm Birth (pages 10-19) • Infant Mortality Rate (IMR) & Preterm Birth (PTB) are lower in Oregon than the U.S. • IMR has decreased past 100 years • PTB has increased slightly past 10 years • Increased assisted reproduction • Increased cesarean deliveries • Increased elective induction of labor • Strength of evidence that it is important to decrease IMR/PTB: very strong • Strength of evidence that we have any interventions to decrease IMR/PTB: very weak despite many attempts

  5. Periconceptional Folic Acid (pages 22-23) • 400 micrograms per day • Multivitamin or fortified cereal • Racial/ethnic disparities in Oregon • 24.6% of American Indian mothers • 30.3% of African American mothers • 32.1% of Hispanic mothers • 38.6% of White mothers • Strength of evidence that folic acid can prevent birth defects: very strong • Strength of evidence that we can increase women taking folic acid: moderate (hard to get more than 50% of any population of fertile women to take folic acid)

  6. Perinatal Data Book Exercise: Text and Appendix • Two versions: pages 23 & 81: • Women who took a multivitamin 4 or more days a week in the month before they got pregnant: • 0 times a week: 53.2% • 1-3 times a week: 9.4% • 4-6 times a week: 6.4% • Every day of the week: 31.0%

  7. Exercise: Perinatal Data Book: Appendix • Page 81: • Women who took a multivitamin 4 or more days a week in the month before they got pregnant: • White: 38.6% • African American: 30.3% • American Indian: 24.6% • Asian/Pacific Islander: 31.0% • Hispanic: 32.1%

  8. Prepregnancy Obesity (pages 24-25) • Obese women have increased risk of • Gestational diabetes and diabetes • Infants with birth defects • 22% of Oregon women who gave birth were obese before getting pregnant • Strength of evidence that obesity increases the risk of bad pregnancy outcomes: moderate (strong association in cross sectional studies; no way to do randomized trials) • Strength of evidence that we have interventions to decrease obesity: weak (intensive diet and exercise has modest impact)

  9. Prenatal Care (pages 26-31) • First trimester initiation: • Oregon (80%) worse than U.S. (84%) • Adequacy of prenatal care: • Oregon (70%) worse than U.S. (75%) • Insurance for prenatal care: • Varies by maternal race/ethnicity: graph page 31 • 8% had no insurance (68% of those without insurance were Hispanic): pie chart page 31 • Strength of evidence that adequate prenatal care leads to less infant mortality and less preterm birth: weak (e.g., many studies on prenatal care and low birthweight) • Strength of evidence that adequate prenatal care leads to better long-term outcomes for mother and child: weak (few studies; expensive and hard to do)

  10. Maternal smoking during 3rd trimester of pregnancy (pages 32-35) • Pregnant Oregon women smoke at about U.S. average: 13% • Most likely to smoke: American Indian and White • Among smokers: 46% quit, 61% of the quitters stayed quit (at average of 14 weeks) • Smoke Free Mothers and Babies increased prenatal providers using The 5 A’s • Strength of evidence that quitting smoking is important, especially to decrease low birthweight and SIDS risk: very strong • Strength of evidence that The 5 A’s can decrease smoking: strong

  11. Maternal alcohol use during 3rd trimester of pregnancy (pages 36-39) • Alcohol use during pregnancy: Oregon women (8%) more than U.S. (6%) • Alcohol use during pregnancy leads to low birthweight, birth defects (including FAS) and child neurological problems • Strength of evidence that stopping drinking will lead to healthier children: moderate (underlying studies of drinking and child outcomes were never done) • Strength of evidence that there are interventions that will decrease drinking among fertile women: weak (alcohol rehab and intensive motivational interviewing yield modest results; nothing else is effective)

  12. Unintended Childbearing (pages 40-41) • Oregon (37%) is lower than U.S. (43%) • Young women are more likely to have unintended births • Women with unintended births are less ready to be a parent. They are more likely to smoke and drink during pregnancy and less likely to have taken folic acid. • Strength of evidence that increasing pregnancy intendedness will improve long-term birth outcomes: weak (few studies to date) • Strength of evidence that increasing independent decision-making skills of young women can prevent unintended pregnancies: moderate (few studies to date)

  13. Postpartum Depression (pages 44-45) • 9% of Oregon women said that they had been always/often depressed since their baby was born. • Postpartum depression affects mothers, infants, children and families • This topic is ripe for pilot interventions such as educating obstetricians and pediatricians to screen new mothers. • Recent popular literature is starting to reach new mothers. • Strength of evidence that it is important to decrease postpartum depression: moderate (need more long-term follow-up) • Strength of evidence that we can decrease postpartum depression: weak (proposed interventions are just being formulated; not yet tested)

  14. Breastfeeding (pages 46-49) • Breastfeeding: women exclusively breastfeed for at least 6 months: in Oregon (22%) more than U.S. (14%) [WE’RE NUMBER ONE!] • Breastfeeding leads to less infant infection, better maternal-infant bonding and less childhood obesity • Strength of evidence that increased breastfeeding leads to better infant health outcomes: very strong (observational but consistent for many outcomes) • Strength of evidence that changes in birthing hospital can increase BF: strong (especially rooming-in, breastfeeding on demand, education and new protocols)

  15. Infant Sleep Position (pages 50-51) • Infant back sleeping: Oregon (75%) is better than U.S. (65%) • Infant back sleeping reduces infant’s risk of SIDS by 50% • Back to Sleep has done a good job of educating people about infant sleep position. • But 10% of Oregon mothers still put their babies to sleep on their stomach. • Strength of evidence that it is important to decrease stomach sleeping: very strong (many nations, many studies) • Strength of evidence that education decreases stomach sleeping: strong (Back to Sleep decreased SIDS)

  16. Other topics: Preconception care • New awareness that long-term pregnancy outcomes need to be addressed before conception [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm] • Preconception care (like prenatal care) is a collection of many separate interventions – each of which will need to be evaluated independently • Narrowly: include preconception (or interconception) provider visits for: tobacco, alcohol, folic acid, obesity • More broadly: improved preadolescent nutrition, adolescent smoking and improved overall health

  17. Other topics: Gestational diabetes

  18. Other topics: Gestational diabetes • 4.3% of Oregon women have gestational diabetes during their pregnancy • Women with gestational diabetes have increased risk of developing diabetes later • Strength of evidence that gestational diabetes is harmful for mothers and their children: strong • Strength of evidence that case management for gestational diabetics can delay onset of type 2 diabetes: not yet tested

  19. Other topics: Oral health • Good maternal oral health may improve child’s oral health • Prenatal care: oral health screening questions should be part of prenatal care: • Have you seen a dentist in the past year? • Any pain in your mouth? • Do you brush regularly with a fluoride toothpaste? • All women (including pregnant women) need to have a dental home • Strength of evidence: interventions have not been evaluated

  20. Other topics: Domestic violence • Physical abuse (pregnant & non-pregnant women) in the past 12 months: • Age 18-24: 25% • Age 25-34: 19% • Before pregnancy (4%); during pregnancy (3%) • Assess adequacy of existing programs? • Strength of evidence that women are negatively affected by domestic violence: very strong • Strength of evidence that public health interventions can decrease domestic violence: weak (has not been adequately studied)

  21. Contact Information Kenneth D. Rosenberg, MD, MPH Maternal & Child Health Epidemiologist Oregon Public Health Division Office of Family Health 800 NE Oregon Street, Suite 850 Portland, OR 97232 Telephone: (971) 673-0237 e-mail: ken.d.rosenberg@state.or.us

More Related