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Healthy Babies are Worth the Wait

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Healthy Babies are Worth the Wait : Preventable Preterm Births Katrina Thompson, Karla Damus, Dr. Diane Ashton, Dr. Ruth Ann Shepherd – PowerPoint PPT presentation

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Title: Healthy Babies are Worth the Wait


1
Healthy Babies are Worth the WaitPreventable
Preterm Births
Katrina Thompson, Karla Damus, Dr. Diane
Ashton, Dr. Ruth Ann Shepherd
2
Preterm Birth RatesUnited States, 1983, 1993,
2003, 2006
gt 1 out of 8 births or 520,000 babies born
preterm in 2005
Percent
gt30 Increase
HP 2010 Objective
Preterm is less than 37 completed weeks
gestation. Source National Center for Health
Statistics, final natality data Prepared by March
of Dimes Perinatal Data Center, 2005
3
Focus on Late PTBPercentage Distribution of
Preterm Births by Gestational Age, US, 2004
(lt28 wks)
Late preterm infants are more likely than term
infants to have -Depression at birth (low
Apgar scores) -Respiratory distress,
respiratory failure -Hypoglycemia -Fee
ding problems -Temperature Instability -Apnea -
Hyperbilirubinemia -SIDS -ADHD -Behavior problems
(28-31 wks)
(36 wks)
(32 wks)
(33 wks)
(34 wks)
(35 wks)
Source NCHS, 2004 natality file Prepared by the
March of Dimes Perinatal Data Center
4
Development of the Human Brain through Gestation
  • Lower functions mature first
  • Cortex is last to develop
  • Brain at 35 wks weighs only 2/3 what it will
    weigh at term

5
A Collaborative Partnership
  • The Prematurity Prevention Partnership
  • March of Dimes
  • Johnson Johnson Pediatric Institute
  • Kentucky Department for Public Health
  • Kentucky Chapter
  • Professional Organizations (ACOG, AAP, AWHONN)
  • Kentucky Perinatal Leaders

6
Healthy Babies are Worth the Wait
  • Prevent preventable preterm births in target
    areas of Kentucky
  • Three-year Initiative (2007-2009) in partnership
    with Johnson Johnson Pediatric Institute and
    Kentucky Department for Public Health
  • Evidence-based interventions
  • -clinical
  • -public health
  • Focus on late preterm birth (34-36 weeks)
  • Targets both perinatal providers and childbearing
    women
  • System of collaboration between clinical and
    public health leadership

7
Healthy Babies are Worth the Wait Hospital
Sites
8
Interventions
  • Bundled Evidence-Based Interventions
  • Linked elements of clinical care, public health
    and consumer education
  • Consumer Awareness and Education
  • Health literacy in context of prenatal care
  • Community outreach
  • Professional Continuing Education
  • Grand Rounds Training
  • Public Health Intervention
  • Augmenting existing services for case management,
    screening referral
  • Clinical Intervention in Prenatal Period
  • Standard clinical guidelines (folic acid, smoking
    cessation, progesterone)
  • Patient safety

9
What Pregnant Women Can Do to Help Prevent
Preterm BirthMessages for pregnant women (and
women of childbearing age)
  • Some preterm birthsespecially late pretermcould
    be prevented if all pregnant women
  • Get early, regular prenatal care
  • Quit smoking or at least cut back and avoid
    secondhand smoke
  • Avoid all alcohol
  • Take folic acid daily before, during and between
    pregnancies
  • Pay careful attention to good nutrition and eat a
    balanced diet with lots of fruits and vegetables
  • Gain only the weight recommended by your health
    care provider
  • Receive timely and appropriate treatment for
    existing medical conditions such as diabetes,
    high blood pressure, thyroid disease, addictions,
    and all infections including STIs
  • Take good care of their teeth--brush, floss, and
    visit a dentist regularly
  • Try to avoid stress and ask for help from their
    health care provider or support person to manage
    stressful situations in your life
  • Question the reason to schedule any delivery
    before 39 weeks unless there are medical reasons
    for an early delivery
  • Avoid elective induction or elective cesarean
    delivery including cesarean delivery on maternal
    request before 39 weeks
  • Talk to their doctor if you have a history of
    spontaneous preterm labor or birth and are
    carrying a single baby about possible receiving
    progesterone to help prevent another preterm
    delivery

10
What Communities Can Do to Help Prevent Preterm
Birth Messages for the community
  • Preterm birth has consequences for many facets of
    our communities, including school systems,
    employers and insurers
  • Make preventing preterm birth a priority in each
    community, as it will result in healthier babies,
    children, future parents and less chronic disease
    in all residents
  • Visit and use materials from the Healthy Babies
    Are Worth the Wait website www.prematuritypreventi
    on.org
  • Do not smoke around pregnant women, babies or
    children
  • Host a Healthy Babies Are Wroth the Wait
    Prematurity Prevention awareness session where
    participants learn about preterm birth and how
    they can help to make a difference in their
    community
  • Raise awareness of services and resources
    available to pregnant women and their families
    from the local clinical sites and the health
    department
  • Work together on this leading public health
    problem as everyone can make a difference for the
    health of families in Kentucky

11
Barriers (due to dynamic conditions contributing
to preterm birth)
  • high rates of high risk factors (such as smoking,
    abuse of pain medication/oxycodone, illicit drug
    use, stress, infections, obesity)
  • significant changes in the culture of
    childbearing by pregnant women (scheduling
    deliveries, CDMR)
  • significant changes in obstetrical management
    with more inductions, cesareans and other
    procedures contributing to higher rates of
    iatrogenic late preterm birth
  • changes in health care delivery systems,
    reimbursement structures and a litigious
    environment for obstetrical care
  • These barriers are being overcome by successful
    implementation of the components of HBWW and with
    the close collaboration and guidance of key
    leadership in clinical, public health and
    communications/media. A focus on patient safety
    protocols is being implemented in year 2.

12
Consumer Survey Methodology Snapshot
  • KAB (knowledge, attitudes, beliefs/reported
    behaviors) survey
  • 39-item core questionnaire
  • 14-item optional supplement
  • Questions from PRAMS, BRFSS, and MOD surveys
  • Original questions specific to needs of HBWW
    interventions
  • Focus groups and pilot testing
  • Anonymous, voluntary, convenience sampling
  • Analysis done in SPSS
  • WHO? Pregnant women presenting for prenatal care
  • WHAT? Questions assessing KAB regarding
    pregnancy and childbirth
  • WHERE Intervention and comparison sites
    (clinics, centering classes, private offices)
  • WHEN? January-May, 2007

13
RESULTSBaseline consumer surveys
Site Core Supplemental
Int. Site 1 289 278
Int. Site 2 337 101
Int. Site 3 139 23
Comp. Site 1 93 88
Comp. Site 2 151 63
Comp. Site 3 57 48
Total 1066 601
English 91.8 Spanish 8.2
14
Demographic CharacteristicsHBWW Consumer Survey
Respondents
Marital Status Marital Status
Married 54
Single/partner 20
Single 22
Maternal Education Maternal Education
ltHS 18
HS 26
Some College 38
Bachelors 14
Payor Payor
Medicaid 50
Private 35
Self 3
Maternal Age Maternal Age
lt20 years 14
20-34 years 77
35 years 6
mean /- sd 25.3 /- 5.401
range 14-45 
Race Race
White 80
Black 9
Hispanic Ethnicity Hispanic Ethnicity
Yes 9
15
Obstetrical-Related FactorsHBWW Consumer Survey
Respondents
Previous C/S Previous C/S
None 63 
1 21
2 7
3 2
range 0-4 
Inductions Inductions
None 42
1 38
2 10
range  0-6
Trimester Trimester
1st 9
2nd 28
3rd 59
Planned Preg 39
Previous Births Previous Births
None 41
1 31
2 16
3 11
mean /- sd 1.02 /- 1.129
range  0-6
Previous Preterm Previous Preterm
None 71
1 17
2 7
mean /- sd 0.35 /- 0.709 
range 0-5 
Multiple Birth 2.5
Of the 24 of pregnant women who had a previous
preterm birth, 13 reported that their providers
had discussed progesterone with them in their
current pregnancy.
Of women in their 3rd trimester, 66 reported
that their hcp had discussed the signs and
symptoms of preterm labor with them.
16
Prematurity KAB
How serious is preterm birth in your community? How serious is preterm birth in your community?
Very serious 14
Somewhat serious 23
Not at all 7
Not sure 54
How serious if your baby is born 3 weeks early? How serious if your baby is born 3 weeks early?
Very serious 2
Serious 11
Somewhat serious 41
Not really 42
  • 79 could give an acceptable answer on how to
    explain prematurity to a friend
  • Causes of preterm birth?
  • High risk conditions (38)
  • High risk behaviors (25)
  • Stress (9)

17
Periconceptional Vitamin Use by Women of
Childbearing Age
Percent
HBWW Consumer Survey 2007
18
Behavioral Risk FactorsSmoking by Women of
Childbearing Age
Percent
38 of respondents reported that at least 1
smoker lived in their home
HBWW Survey
www.marchofdimes.com/peristats
19
Other Risk Factors for Preterm Birth
Percent
HBWW Consumer Survey, 2007
20
Cesarean Delivery KAB
30
35
33
Percent
HBWW Consumer Survey, 2007
21
Goal reduction of singleton PTB rate by 15 in
Intervention Sites
  • Reduction of singleton LPTB rate
  • Reduction in elective inductions and sections
    conducted prior to 39 weeks gestation
  • Increase in babys average days of gestational
    age and birth weight
  • Reduction in neonates length of hospital stay
  • Reduction in hospital cost / charges associated
    with preterm births
  • Positive change in consumer and provider
    knowledge, attitudes, and behaviors regarding PTB
  • More information www.prematurityprevention.org

22
Singleton Preterm Birth Rates by
Hospital of Delivery, Kentucky, 2004
Source KY Dept pf Health Prepared by the March
of Dimes Perinatal Data Center, 2007
23
www.prematurityprevention.org
24
(No Transcript)
25
Take Home Message-You Can Prevent Some Preterm
Births
  • The overall message is that despite years of
    research and programs to attempt to reduce
    preterm birth, the rates continue to rise
    reaching an all time high of 12.7 for the US and
    15 for KY in 2005.
  • However, since most of this increase is due
    to the rising rates of late preterm birth (34-36
    weeks) a thorough understanding of contributing
    modifiable risk factors and an innovative program
    to address local issues driven by timely local
    information can begin to reduce these seemingly
    run away rates and in doing improve health by
    decreasing morbidity and mortality for infants,
    children and ultimately adults.

26
  • Because this is a real-world model, and focuses
    on education and enhancing existing systems of
    care, we anticipate that it will be feasible to
    implement the lessons learned statewide. We are
    confident this initiative will improve the lives
    of mothers and babies.

Dr. Ruth Ann Shepherd Director, Adult and Child
Health Improvement Kentucky Department for Public
Health
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