Transcript Slide 1

March of Dimes
NYS Premature Birth
Report Card
Diane M. Ashton, MD, MPH
Deputy Medical Director
March of Dimes National Office
[email protected]
Regional Perinatal Forum
November 12, 2008
Preterm Birth
(<37 completed weeks of gestation)
• Has increased 10% in the last decade and
over 30% in the last 20 years
• #1 Perinatal Health Challenge
• Leading cause of infant mortality
• Leading cause of cerebral palsy, blindness,
deafness, and retardation
Preterm Birth Rates
United States, 1983, 1993, 2003, 2006
15
12.3
12.8
11.0
10
> 1 out of 8 births or
~540,000 babies were
born preterm in 2006
9.6
Percent
7.6
5
0
1983
1993
2003
>30% Increase
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, 2008
2006
HP 2010
Objective
3
Preterm Births, United States,
1983, 1993, 2003, 2006
Percent
14
12.3
11.0
12
10
12.8
9.6
7.6
8
6
4
2
0
1983
1993
2003
30 Percent Increase
2006
2010
Healthy
People
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, 2006
Preterm Births, US, 2000-2006
550,000
543,000*
540,000
530,000
520,000
520,000
508,356
510,000
499,008
500,000
490,000
476,250
480,000
470,000
480,812
467,201
460,000
450,000
2000
2001
2002
2003
2004
*2006 preliminary birth data provided by the National Center for
Health Statistics; Source: National Center for Health Statistics
2005
2006
Preterm Birth Rates, US, 2005
US PTB 12.7%
NYS 12.1%
www.marchofdimes.com/peristats
Premature Birth Report Card
• The March of Dimes is issuing a national
and individual state Report Cards, giving
the nation and each state a letter grade by
comparing its preterm birth rate to the
Healthy People 2010 goals
National Report Card Release
NATION GETS A “D”
MARCH OF DIMES RELEASES PREMATURITY REPORT CARD
18 States, Puerto Rico and DC Failed
NOV. 12, 2008, WHITE PLAINS, NY – The United States hasn’t
quite failed preterm infants, but it came close, according to the
March of Dimes.
In the first of what will be an annual report card on preterm birth,
the nation received a “D” and not a single state earned an “A,” when
March of Dimes investigators compared actual preterm birth rates
to the national Healthy People 2010 goal.
Premature Birth Report Card
Grades - Methodology
Based on distance from Healthy People 2010 goal – measured in
standard deviations.
A Less than or equal to 7.6%
B Between 7.6% and 1 standard deviation above
C Greater than 1, but less than 2 standard deviations above
7.6%
D Greater than 2, but less than 3 standard deviations above
7.6%
F 3 or more standard deviations above 7.6%
Preterm Birth Rates Compared to
HP2010 Objective and 2005 US Rate
HP2010 Objective PTB 7.6%
2005 US PTB 12.7%
www.marchofdimes.com/peristats
Report Card Key Messages
A – None.
B – Vermont leads the nation, but can still do more to prevent
premature birth. (1)
C – These states do better than most in preventing prematurity
but still have a long way to go to reach the Healthy People
goals. (8)
D – These states lag behind in preventing premature birth – action
is urgently needed to prevent more deaths and disabilities.
(23)
F – These states face a crisis level of premature births that is
driving up health care costs and special education budgets.
We must act now to help moms go full term. (20)
NYS Preterm Birth Rates
1995-2005
•National Center for Health Statistics, final natality
data.•Retrieved November 11, 2008, from
www.marchofdimes.com/peristats.
3 Major Factors Affecting Preterm Birth Rates:
Late Preterm Births, Smoking, and Uninsured
Women of Childbearing Age,
Late preterm: US, 2005
US 9.1%
NY 8.5%
Smoking among women of
childbearing age, US, 2007
US 21.2%
Uninsured women:
US, 2005-2007 Avg
US 20.1%
NYS Preterm Birth Rate by
Race/Ethnicity 2003-2005 average
•National Center for Health Statistics, final natality data
.•Retrieved November 11, 2008, from www.marchofdimes.com/peristats.
Preterm Births by Week of Gestation
United States, 2004
16%
<32 weeks
37%
5%
32 weeks
33 weeks
Late preterm
71%
8%
34 weeks
35 weeks
36 weeks
13%
21%
Source: National Center for Health Statistics, 2004 final natality data
Prepared by March of Dimes Perinatal Data Center, 2007
Preterm Births by Gestational Age Category
United States, 1990, 1995, 2000, 2005
14
12
10
%8
6
4
2
0
12.7
10.6
11.6
11.0
7.3
7.7
8.2
9.1
3.3
3.3
3.4
3.6
1990
1995
2000
2005
Preterm
Year
less than 34 weeks
71% Late
Late Preterm (34-36 6/7 weeks)
Consequences of Late Preterm Delivery
•
•
•
•
•
•
•
Temperature instability
Hypoglycemia
Breathing difficulties
Feeding difficulties
Jaundice
Sepsis
3 times as likely to die in first year
of life vs. term
• Increased NICU use and readmission
• Increased cost
• Long term outcomes – data suggest
problems
Human Brain Growth by Gestation
Kinney, 2006
Recent Studies
Clinical Outcomes:
Chyi, LJ, et al. School Outcomes of Late Preterm Infants:
Special Needs and Challenges for Infants Born at 32-36
Weeks Gestation. Journal of Pediatrics, July, 2008
Lindstrom, K, et al.. Preterm Infants as Young Adults: a
Swedish National Cohort Study. Pediatrics, July, 2007
Recent Studies
Findings:
U.S.: 970 prematures compared to 13,671 full term infants
– Late preterm (34-36 wks.) are poorer readers with less
math skills in early school years,
– With 1.6-2.1 times elevated risk for special education
Sweden: 522,310 infants born 1973-1979 (23-29 y.o.)
– “Moderate” preterm (33-36 wks.) have lower chance of
completing college, lower net salary, and increased risk
for disability
Relevance:
Late preterm infants have significant long term deficits
including learning problems, disability,
and lower salaries
Infant Mortality among Singletons
by Gestational Age, United States, 1995 - 2002
Rate per 1,000 live births
10
9.5
8.9
8.7
8.3
8
7.8
8.1
7.6
7.9
6
4
3.0
2.9
2.8
2.7
2.6
2.6
2.5
2.4
1995
1996
1997
1998
1999
2000
2001
2002
2
0
Late-Preterm Infants
Term Infants
Late preterm is between 34 and 36 weeks gestation
Source: National Center for Health Statistics, period linked birth/infant death data
Prepared by March of Dimes Perinatal Data Center, 2007
ACOG Committee Opinion # 404
Late Preterm Infants
April 2008
•Late preterm infants often are mistakenly believed to be as
physiologically and metabolically mature as term infants. However,
compared with term infants, late–preterm infants are at higher risk
than term infants of developing medical complications, resulting in
higher rates of infant mortality, higher rates of morbidity before initial
hospital discharge, and higher rates of hospital readmission in the first
months of life.
•Preterm delivery should occur only when an accepted
maternal or fetal indication for delivery exists.
•Collaborative counseling by both obstetric and neonatal
clinicians about the outcomes of late–preterm births is
warranted unless precluded by emergent conditions.
Statement developed jointly with AAP Committee on Fetus & Newborn
ACOG Evidence Based Guidelines
No elective induction or elective cesarean
delivery before 39 weeks unless evidence of
fetal lung maturity
To assess fetal lung maturity an amniocentesis is
usually done to collect amniotic fluid for
testing
– as for any invasive procedure there are
potential risks
ACOG Practice Bulletin No. 10, November, 1999.
www.commonwealthfund.org/innovations/innovations_show.htm?doc_id=250148
As a result of these and other improvements,
total maternal and neonatal variable costs
decreased from $1,622 per case in January 2003
to $1,480 in the first half of 2004 (for
uncomplicated deliveries resulting in normal
newborns). This result was $300 better than
expected based on historical trends, adjusted for
producer price inflation.
Clark SL, et al. AJOG, 2008;199:105.e1-105.e7.
•For the first time in many years, the primary cesarean delivery rate in our system in 2006 fell
significantly (Fig 5, P .001), despite the tolerance of a liberal general approach to operative delivery
•Appears to be attributable to fewer cesareans for oxytocin-induced fetal heart rate abnormalities
associated with the universal implementation in 2006 of a uniform, checklist-based system for
oxytocin administration.
•In our large system, this translates annually into the avoidance of tens of thousands of primary and
future repeat cesarean deliveries.
Clark SL, et al. AJOG, 2008;199:105.e1-105.e7.
Work Policies That Support Maternal &
Infant Health
• Provide preconception and pregnancy preparedness
information to prospective parents, through classes,
brochures, a library, e-mail or directed website(s)
• Provide information about healthy pregnancy and
childbirth, that encourages early and continuing prenatal
care and information about preterm birth prevention
• Ensure time off for prenatal appointments
• Provide extra physical accommodation for pregnant
employees, such as a place where they can rest with their
feet up, preferred parking in the last trimester, etc
• Engage other employees in creating a positive working
environment for pregnant colleagues such as a smoke-,
drug-, and toxin-free environment
Work Policies That Support Maternal &
Infant Health (con’t)
• Ensure time off for pediatric appointments during first year of
infancy
• Provide a private area where lactating women can pump and
store breast milk
• Provide health insurance coverage that includes comprehensive
preconception, prenatal, childbirth, and postnatal care,
including immunizations or facilitate through a liaison the
application for insurance through state or private agencies
• Access to flextime
• Access to work from home/telecommuting
• Access to Job Sharing
• Offer an Employee Assistance Program
• Offer discounts to gyms or fitness resources
• Job protection for maternity leave that extends beyond FMLA
www.marchofdimes.com/petition
Petition for Preemies
1. We urge the federal government to increase support
for prematurity-related research and data collection
as recommended by the Institute of Medicine and the
Surgeon General’s Conference on the Prevention of
Preterm Birth, to:
(a) Identify the causes of premature birth;
(b) Test strategies for prevention;
(c) Improve the care, treatment and outcomes of
preterm infants;
(d) Better define and track the problem of
premature birth
Petition for Preemies
2. We urge federal and state policymakers to expand
access to health coverage for women of childbearing
age and to support smoking cessation programs as
part of maternity care
3. We call on hospitals and health care professionals to
voluntarily assess c-sections and inductions that
occur prior to 39 weeks gestation to ensure
consistency with professional guidelines
4. We call on businesses to create workplaces
that support maternal and infant health
Petition – Advocacy Elements
• A bipartisan effort to elevate the problem of
preterm birth onto the health care agenda of
our new President and Congress
• Inform legislators and regulators about the
serious issue of preterm birth in order to
drive policy changes at federal and state
levels
We Need Your Support!
Please visit marchofdimes.com
and sign the Petition for Preemies
Goals of the Report Card
To create an awareness of the increase in incidence of preterm
births as a nation and as individual states
To addresses issues related to prematurity including :
- Access to quality healthcare
– Research into the causes and factor related to prematurity
– Prevention of preterm births in pregnant women, through
knowledge and intervention
– Advocate for work policies that accommodate pregnancy
Report Card – Advocacy Elements
• Access to health coverage for women of childbearing age
– Maximize Medicaid & SCHIP eligibility
– Medicaid targeted case management (TCM)
– Family planning waiver
• Tobacco related initiatives
–
–
–
–
–
Medicaid coverage for smoking cessation
Funding for 5”As” provider education
Smoke-free initiatives
Tobacco tax
Health warning signs
Report Cards 2009 & Beyond
• Report cards will be issued annually for at least
the next 3 years
• Future report cards will highlight improvement or
decline in rates from the previous year
• Work has begun on a global report on preterm
birth rates – goal is to release on Oct. 4, 2009 in
New Delhi
• Exploratory conversations have been held with
U.K. organizations about a global Prematurity
Awareness Day
Support stronger, healthier babies
…born in a nation and state that makes
the grade and gets an “A”
for preventing preterm birth
Questions?
Comments?