Healthy Babies are Worth the Wait: Preventable Preterm Births

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Healthy Babies are Worth the WaitPreventable
Preterm Births
Katrina Thompson, Karla Damus, Dr. Diane
Ashton, Dr. Ruth Ann Shepherd
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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
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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
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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

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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

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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

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Healthy Babies are Worth the Wait Hospital
Sites
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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

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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

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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

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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.

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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

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RESULTSBaseline consumer surveys
English 91.8 Spanish 8.2
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Demographic CharacteristicsHBWW Consumer Survey
Respondents
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Obstetrical-Related FactorsHBWW Consumer Survey
Respondents
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.
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Prematurity KAB

• 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)

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Periconceptional Vitamin Use by Women of
Childbearing Age
Percent
HBWW Consumer Survey 2007
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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
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Other Risk Factors for Preterm Birth
Percent
HBWW Consumer Survey, 2007
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Cesarean Delivery KAB
30
35
33
Percent
HBWW Consumer Survey, 2007
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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

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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
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www.prematurityprevention.org
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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.

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• 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