Emerging Issues in MCH Incorporating Preconception Health into MCH Services Debra Bara MA PPOR
Perinatal Periods of Risk Practice Collaborative • Sponsored by CityMatCH, UNMC • Partners included • National Offices of March of Dimes • Centers for Disease Control and Prevention
Practice Collaborative Members • Teams from 16 cities that included: • Policy Representative • Data Representative • Community Representative • Met to “refine the practice” of PPOR and adapt for use in urban cities in industrialized country.
OVERVIEW • Perinatal Periods of Risk • Both a DATA ANALYSIS TOOL and an APPROACH to identify critical gaps in the maternal and child health system that lead to infant mortality.
OVERVIEW • PPOR Differs from conventional analysis • In addition to AGE AT DEATH, PPOR takes into account the BIRTH WEIGHT, an equally important predictor of survivability.
OVERVIEW • PPOR differs from conventional analysis: • Utilizes LINKED birth and death records, which allows investigators to sort and study variables on the birth certificates, which is generally more complete that death certificate records alone.
OVERVIEW • PPOR differs from conventional analysis • Combines fetal and infant deaths in a “feto-infant” death rate. • Includes fetal deaths as over 24 weeks, live births greater than 500 grams, (excluding spontaneous and induced abortions) • Ensures comparability of data (reference group)
OVERVIEW • Feto-infant mortality rates are “mapped” according to the time of death and weight Age at death Fetal 24+ wks. Neonatal Postneonatal Birth Weight Maternal Health Maternal Care Newborn Care Infant Health
DATA LEADS TO ACTION ! Maternal Health/ Prematurity • Preconception Health • Health Behaviors • Perinatal Care • Prenatal Care • High Risk OB Referrals • Insurance Coverage Maternal Care • Perinatal Management • Neonatal Care • Pediatric Surgery Newborn Care • Sleep Position • Breast Feeding • Injury Prevention Infant Health
Infection Stress and Work General state of health prior to pregnancy Injuries and abuse Family planning Nutrition Tobacco/alcohol/drug use Previous pregnancyoutcomes Maternal HealthRisk Factors
Nutrition during pregnancy Late/inadequate PNC Treatment of infection Poor weightgain Tobacco/alcohol/drug use during pregnancy Lack of recognition of problems needing care Recognition/management of early labor Obesity Maternal CareRisk Factors
Availability of neonatal intensive care Prevention of infection Recognition of emergencysituation Obstetric expertise Pediatric expertise Regular newborn care including feeding/well baby care. Newborn CareRisk Factors
Prevention & treatment of infection Recognition of birth defects/developmental anomalies Prevention/treatment of injuries Recognition of signs & symptoms of illness Failure to obtain well-child care or follow-up for illness SIDS prevention Infant HealthRisk Factors
What it tells us • Opportunity gaps • Uses a “comparison group” model to quantify the specific opportunity to improve • United States “reference group” is white women, 13+ years of education, over 20 years of age, married.
Common Finding across Cities • Maternal Health was greatest opportunity for improvement • Infant Health was most frequent second opportunity • Often documented racial disparity issues as occurring in Maternal Health Cell
National PPOR Rates by Race/Ethnicity,by Period of Risk Components, for Resident Mothers 20+ years age, 13+ years of education in US, 1998-2000 (Table 6.3)
Implications Changes in Practice Program & Policy
PRACTICE • EXAMPLES-Integrating pre and interconceptional care into existing services • Family Planning Clinics • Home Visitation services • Developing risk screening process for non-pregnant population of women
Risk assessment Women’s Health questionnaire-25 questions Access to Health Care, Maternal Infections, Baby Spacing Nutrition & Physical Activity Chronic Health Issues Stress & Mental Health Environmental Health Interventions Home Visitation Staff linking non-pregnant patients to: Smoking cessation services Domestic violence prevention, MH services, including drug treatment Health Care Program- EXAMPLEHealthy Start Home Visitation Services
Policy • Answer questions “who do we serve & how?” • What programs need to be organizationally connected for optimum service to women throughout the life span? • Funding Implications • Research Implications