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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

Perinatal Health in Oregon: Data and Program Development

Ken Rosenberg, MD, MPH

MCH Epidemiologist

Office of Family Health

November 28, 2007

perinatal data book
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
strength of evidence
Strength of Evidence
  • My own personal summary of the strength of the evidence:
    • Very strong
    • Strong
    • Moderate
    • Weak
    • Very Weak
infant mortality preterm birth pages 10 19
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
periconceptional folic acid pages 22 23
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)
perinatal data book exercise text and appendix
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%
exercise perinatal data book appendix
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%
prepregnancy obesity pages 24 25
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)
prenatal care pages 26 31
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)
maternal smoking during 3 rd trimester of pregnancy pages 32 35
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
maternal alcohol use during 3 rd trimester of pregnancy pages 36 39
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)
unintended childbearing pages 40 41
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)
postpartum depression pages 44 45
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)
breastfeeding pages 46 49
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)
infant sleep position pages 50 51
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)
other topics preconception care
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
other topics gestational diabetes18
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
other topics oral health
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
other topics domestic violence
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)
contact information
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