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Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes

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Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes . Lilian Peake, MD, MPH Charlottesville-Albemarle Health Department October 22, 2008. Infant Mortality Albemarle, Charlottesville and Virginia 1995-2006.

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Health and Wellness in Charlottesville: At a Crossroads

Reducing African-American Infant Mortality

and Improving Pregnancy Outcomes

Lilian Peake, MD, MPH

Charlottesville-Albemarle Health Department

October 22, 2008

infant mortality by race albemarle and charlottesville 1995 2005
Infant Mortality by RaceAlbemarle and Charlottesville1995-2005
top 5 causes of infant mortality tjhd 2002 2006
Top 5 Causes of Infant MortalityTJHD, 2002-2006

Source: Division of Women’s and Infant’s Health, Virginia Department of Health

congenital malformations birth defects
Congenital Malformations (Birth Defects)

Source: Division of Women’s and Infant’s Health, Virginia Department of Health

what are the most common birth defects
What are the most common birth defects?
  • Down Syndrome
  • Heart defects
  • Neural tube defects
  • Metabolic disorders -
    • e.g. Tay-Sachs disease
  • Musculoskeletal defects
  • Gastrointestinal defects
what causes birth defects
What causes birth defects?
  • Genetics
  • Alcohol
  • Certain drugs - e.g., Accutane, cocaine
  • Certain Infections - e.g., syphilis
  • Certain chemicals
  • Insufficient amounts of folate
  • Multifactorial
  • Causes of 70% are unknown
how can women reduce their risk of having a baby with a birth defect
How can women reduce their risk of having a baby with a birth defect?
  • Have a preconception visit with healthcare provider
    • Health history/genetic counseling
  • Take folate vitamin (all women of child bearing age)
  • Avoid drinking alcohol, smoking and using drugs
  • Avoid medications without first checking with healthcare provider
  • Avoid changing cat’s litter box and eating raw and undercooked meats (infection with toxoplasmosis)
low birth weight
Low Birth Weight

Source: Division of Women’s and Infant’s Health, Virginia Department of Health

percent of low weight 2500g births albemarle charlottesville virginia 1997 2004
Percent of Low Weight (<2500g) Births Albemarle, Charlottesville, Virginia 1997-2004
percent of low weight births for black infants charlottesville albemarle virginia u s 1997 2004
Percent of Low Weight Births for Black Infants Charlottesville-Albemarle, Virginia, U.S. 1997-2004
what causes low birth weight
What causes low birth weight?
  • Birth defects
  • Mom has chronic health problems
    • e.g., high blood pressure, diabetes
  • Mom smokes while pregnant
  • Mom drinks alcohol or uses illicit drugs while pregnant
  • Infections in mom or fetus
    • Rubella, chickenpox, toxoplasmosis
  • Socioeconomic factors
    • Income, mom’s education
how can women reduce their risk of having a baby that has a low birth weight
How can women reduce their risk of having a baby that has a low birth weight?
  • Have a preconception check-up
    • Folate; treat chronic medical conditions; health history
  • Receive early and regular prenatal care
  • Get help to stop smoking
  • Do not drink alcohol or use illegal drugs
  • Learn about signs and symptoms of preterm labor and call healthcare provider if develop them
of infant deaths by number of prenatal visits tjhd 2002 2006
% of Infant Deaths by Number of Prenatal VisitsTJHD, 2002-2006

Source: Division of Women’s and Infant’s Health, Virginia Department of Health

local barriers to prenatal care
Study of Medicaid-eligible moms who delivered at UVA between Dec. 2007 and Feb. 2008

Phone survey

Only able to reach 32 of the 125 moms

Mean age = 25 (18-38)

50% graduated from high school

78% had not planned pregnancy

97% received some prenatal care (4-20 visits)

78% not married

Local Barriers to Prenatal Care
local barriers to prenatal care18
Local Barriers to Prenatal Care

Difficulty making appointments

Long lag time in getting first appointment

Multiple steps

Mailed appointment time (in English) rather than scheduling by phone

Transportation problems

Problems communicating with healthcare providers

Feeling too sick to go to appointment

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No 1st Trimester Prenatal Care and Low Birth Weight

City of Charlottesville, 1990-2006

The Meadows

Greenbrier

Barracks Road

Barracks Rugby

Venable

Locust Grove

Lewis Mountain

Rose Hill

North Downtown

10th &Page

Starr Hill

Martha Jefferson

Jefferson Park Ave.

Fifeville

Woolen Mills

Ridge St.

Johnson Village

Belmont

Fry’s Spring

slide20
Births To Mothers With Less Than 12th Grade Education, Albemarle, Charlottesville, and Virginia 2002-2005
slide21

Barracks/

Rugby

Greenbrier

Greenbrier

Barracks/

Rugby

Venable

10th & Page

10th & Page

Locust

Grove

Belmont

Belmont

Ridge St.

Ridge

St.

Fry’s

Spring

black mothers education less than 12 years
Black Mothers’ Education Less than 12 Years
  • South Barracks/Rugby 54% (26)
  • Ridge St./North area 51% (399)
  • 10th and Page 44. 36% (266)
  • Central Fry’s Spring 44% (25)
  • Southwest Belmont 42% (19)
  • Ridge St./South 42% (236)
  • Southeast Venable 40% (75)
teen pregnancy rate albemarle charlottesville and virginia 3 year rolling averages 1997 2005
Teen Pregnancy RateAlbemarle, Charlottesville, and Virginia3-Year Rolling Averages, 1997-2005
slide24
SIDS

Source: Division of Women’s and Infant’s Health, Virginia Department of Health

what is sids
What is SIDS?
  • Sudden, unexplained infant deaths
    • Cause of death is unknown
    • Not due to a chronic disease or illness
  • After the cause of death has been determined, infant deaths that were initially classified as sudden, unexplained infant death can be referred to as sudden, unexpected infant deaths (SUID)
causes of suid
Causes of SUID
  • Accidental suffocation or strangulation
  • Accidental poisoning
  • Obstruction of respiratory tract
  • Accidental falls
  • Neglect, abandonment and other maltreatment syndromes
  • Assault and homicide
  • Other symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified - unknown cause, or unexplained heart or breathing failure
how can families reduce the risk of sids
How can families reduce the risk of SIDS?
  • Put your baby on her back to sleep
  • Don’t put baby on soft sleep surfaces and avoid loose bedding
    • Waterbed, couch, sofa, or pillows, or sleeping with stuffed toys
  • Don’t let your baby become overheated while sleeping
  • Don’t smoke during pregnancy and don’t let anyone smoke around your baby
  • Don’t let the baby sleep in your bed
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