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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

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Perinatal Health in Oregon: Data and Program Development

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  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

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