Emerging Issues in MCH

Incorporating Preconception Health into MCH Services

Debra Bara MA

PPOR

Perinatal Periods of Risk Practice Collaborative

Sponsored by CityMatCH, UNMC Partners included  National Offices of March of Dimes  Centers for Disease Control and Prevention

Practice Collaborative Members

Teams from 16 cities that included:  Policy Representative  Data Representative  Community Representative  Met to “refine the practice” of PPOR and adapt for use in urban cities in industrialized country.

OVERVIEW

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Perinatal Periods of Risk

Both a DATA ANALYSIS TOOL and an APPROACH to identify critical gaps in the maternal and child health system that lead to infant mortality.

OVERVIEW

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PPOR Differs from conventional analysis

 In addition to AGE AT DEATH , PPOR takes into account the BIRTH WEIGHT , an equally important predictor of survivability.

OVERVIEW

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PPOR differs from conventional analysis:

 Utilizes LINKED birth and death records, which allows investigators to sort and study variables on the birth certificates, which is generally more complete that death certificate records alone.

OVERVIEW

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PPOR differs from conventional analysis

 Combines fetal and infant deaths in a “feto-infant” death rate.  Includes fetal deaths as over 24 weeks , live births greater than 500 grams , (excluding spontaneous and induced abortions)  Ensures comparability group) of data (reference

OVERVIEW

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Feto-infant mortality rates are “mapped” according to the time of death and weight

Age at death

Fetal 24+ wks.

Neonatal Postneonatal Maternal Health

Birth Weight

Maternal Care Newborn Care Infant Health

DATA LEADS TO ACTION !

Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health

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Preconception Health

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Health Behaviors

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Perinatal Care

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Prenatal Care

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High Risk OB Referrals

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Insurance Coverage

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Perinatal Management

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Neonatal Care

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Pediatric Surgery

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Sleep Position

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Breast Feeding

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Injury Prevention

Maternal Health Risk Factors

Infection Stress and Work General state of health prior to pregnancy Injuries and abuse Family planning Nutrition Tobacco/alcohol/drug use Previous pregnancy outcomes

Maternal Care Risk Factors

Nutrition during pregnancy Late/inadequate PNC Treatment of infection Poor weight gain Tobacco/alcohol/drug use during pregnancy Lack of recognition of problems needing care Recognition/manageme nt of early labor Obesity

Newborn Care Risk

Factors

Availability of neonatal intensive care Prevention of infection Recognition of emergency situation Obstetric expertise Pediatric expertise Regular newborn care including feeding/well baby care.

Infant Health Risk Factors

Prevention & treatment of infection Recognition of birth defects/developmenta l anomalies Prevention/treatment of injuries Recognition of signs & symptoms of illness Failure to obtain well child care or follow-up for illness SIDS prevention

What it tells us

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Opportunity gaps

 Uses a “comparison group” model to quantify the specific opportunity to improve  United States “reference group” is white women, 13+ years of education, over 20 years of age, married.

Common Finding across Cities

Maternal Health was greatest opportunity for improvement Infant Health was most frequent second opportunity Often documented racial disparity issues as occurring in Maternal Health Cell

National PPOR Rates by Race/Ethnicity, by Period of Risk Components, for Resident Mothers 20+ years age, 13+ years of education in US, 1998-2000 (Table 6.3) 14 12 10 8 6 4 2 0 2 1.4

2.5

1 1.1

1.5

2.2

6.4

White non Hispanic Black non Hispanic 1 1 1.8

2.8

Hispanic Infant Health Newborn Care Maternal Care Maternal Heath/ Prematurity

Implications Changes in Practice Program & Policy

PRACTICE

EXAMPLES-Integrating pre and interconceptional care into existing services  Family Planning Clinics  Home Visitation services  Developing risk screening process for non pregnant population of women

Program- EXAMPLE Healthy Start Home Visitation Services

Risk assessment  Women’s Health questionnaire-25 questions      Access to Health Care, Maternal Infections, Baby Spacing Nutrition & Physical Activity Chronic Health Issues Stress & Mental Health Environmental Health Interventions  Home Visitation Staff linking non-pregnant patients to:  Smoking cessation services  Domestic violence prevention, MH services, including drug treatment  Health Care

Policy

Answer questions “who do we serve & how?” What programs need to be organizationally connected for optimum service to women throughout the life span?

Funding Implications Research Implications