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Perinatal Health in Oregon: Data and Program Development PowerPoint PPT Presentation

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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Perinatal health in oregon data and program development l.jpg

Perinatal Health in Oregon: Data and Program Development

Ken Rosenberg, MD, MPH

MCH Epidemiologist

Office of Family Health

November 28, 2007


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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


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Strength of Evidence

  • My own personal summary of the strength of the evidence:

    • Very strong

    • Strong

    • Moderate

    • Weak

    • Very Weak


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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


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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)


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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%


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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%


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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)


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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)


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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


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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)


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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)


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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)


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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)


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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)


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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


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Other topics: Gestational diabetes


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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


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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


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    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)


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    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: [email protected]


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