Transcript here - UNC Center for Maternal & Infant Health

Preconception Health in NC
Think Tank Meeting #3
August 16, 2007
What’s UP?
 NC Women’s Health Report Card Released
 National Preconception Clinical Curriculum to
be housed on mombaby.org
 NC Featured on National Webcast – National
Association of City and County Health Officials
 National Summit on Preconception Health
 October 29-31 in Oakland, CA
 5 presentations/posters from NC
Planning Steps
March 2007 Think Tank Meeting #1
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To initiate a focused, collaborative, comprehensive
process to create a state Preconception Action Plan
May 2007 Think Tank Meeting #2
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To collect diverse ideas and understand how
preconception fits into existing work
August 2007 Think Tank Meeting #3
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To develop the components of the plan
Guiding Principles
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Focus on the whole woman – not only her
reproductive capacity.
Consider the woman’s health needs and related
wellness recommendations within the context of
her family and community.
Be careful that messages don’t imply that certain
groups of women should not become mothers.
Be cognizant of health disparities and prioritize
programs with potential to close the gaps.
Work should address…
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Clinical practice – continuity of care
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Evaluation & research
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Integrating new messages into
current campaigns
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Policy & advocacy
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Holistic view of health
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Social marketing
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Interconception health
Themes
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Include men & families
Start early / young
Use existing programs
to carry messages
Build on public health
outreach into worksites,
private practice, and
communities
Master tool kit – clear
and consistent messages
Potential Target Audiences
Age (teens, 20s, 30s, 40s)
• Contemplators / NonContemplators
• Race/Ethnicity
• Gender
• Income
• Education
• Mothers
• Geography (13 counties
have most of the excess
infant death)
•
Families / Couples
• Women w/health conditions
• Communities
• Health care providers (OBs,
Pediatrics, Family Medicine,
Internal Medicine, etc)
• Public health leaders
• State opinion leaders
• Media
• Insurers / Funders
• Researchers
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The chasm
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There is a gap between knowing and
doing.
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We need to use education and resources
– knowledge and mechanisms to narrow
that gap and enable women to make
positive changes.
Qualitative Data
Data Sources
What New Mothers Say: Personal Comments from the North Carolina
PRAMS Survey,
NC DHHS SCHS, May 2007
Latina Infant Mortality Awareness Project,
NC Healthy Start Foundation, April 2007
Women’s Health: Attitudes and Practices in North Carolina – Focus
Group Research,
NC SIM Collaborative/NC Healthy Start Foundation, June 2005
Uncovering Community Voices: A Catalog of Qualitative Data
Regarding Women’s Health in North Carolina 1995 – 2005,
UNC MCH 315 Spring 2005 Class with Supervision from UNC Sheps
Center and UNC Center for Maternal and Infant Health
What women say…
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Behavior Change: Awareness not enough to
change behaviors. Knowledge of family
history, family support and healthcare options
can lead to change.
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Stress: Emotional, physical and financial
stress negatively influence health. Need more
social support and networking.
What women say…
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Mental health issues, especially depression,
are significant. Lack of resources in
communities.
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Barriers to Health Care: Cost. Racism.
Lack of – insurance, access, trust/respect,
childcare, and transportation.
What women say…
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Approach to Healthcare: Prefer holistic approach.
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Substance Use: Many women reported they knew
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Most pregnancies are unplanned. Women are
someone struggling with drug addiction. Reported as coping
mechanism for extreme stress.
concerned about becoming pregnant but don’t use
contraception. Inconvenient clinic hours and quality of care
problems with family planning services.
Quantitative Data
Obesity and Related Conditions
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25% of NC Women aged 18 – 44 y.o. are
obese BRFSS 2005
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Obesity increases risk for hypertension (13%)
and diabetes (2%) BRFSS 2005
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62% of NC women do not meet minimum
recommendations for physical activity
NC Women’s Health Report Card, 2007
DIABETES PREVALANCE
NC 2000 - 2006
YEAR
ESTIMATED
POPULATION
PERCENT
2000
379,000
6.4%
2001
418,000
6.7%
2002
449,000
7.2%
2003
518,000
8.1%
2004
609,000
9.6%
2005
547,000
8.5%
2006
600,000
9.1%
Source: State Center for Health Statistics, North Carolina
Gestational Diabetes
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Occurs only during pregnancy and affects 24% of all pregnant women.
Obesity is a risk factor for the development of
gestational diabetes.
Women who develop gestational diabetes are
at higher risk of developing type 2 diabetes.
Source: ADA. Clinical Practice Recommendations 2005. Diabetes Care 28 (Sup 1): S38. (17)
Complications Associated with Obesity
 Obesity is a risk factor in the higher perinatal
mortality and morbidity rate found in type 2 diabetes,
including congenital malformation and macrosomia.
Complications include:
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Hypertension
Obstructive sleep apnea
Preeclampsia
Increased urinary tract infections
Higher rates of cesarean and difficult deliveries in the
mother
Source: Diabetes Care. 1992; 15:1640-57
Impact on Infants
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Major congenital malformations remain the
leading cause of mortality and serious
morbidity in infants of mothers with type 1
and type 2 diabetes.
Observational studies indicate that the risk of
malformations increases continuously with
maternal glycemia during the first 6-8 weeks
of gestation (1st trimester).
Source: ADA. Clinical Practice Recommendations 2005. Diabetes Care 28 (Sup 1): S38. (17)
Substance Use
NC Women Aged 18 – 44 years old
24% Use Tobacco
8% Engage in Binge Drinking
7% Engage in Illicit Drug Use*
NC BRFSS 2005
*NC Adults aged 12 and older, SAMHSA, National Survey on Drug Abuse and Health, 2005
Substance Use
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Lack of outpatient and inpatient services
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Need for provider training and screening
tools
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Need for more NC-specific research
NC Women & Factors Affecting
Pregnancy Outcomes
45% of pregnancies are unintended
NC PRAMS 1997 - 2000
62% do not take folic acid daily
NC BRFSS 2006
19% may not be rubella immune
NC State Lab, prenatal clients, 2006
NC Women and Sickle Cell
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Nationally one in every 12 African
Americans has sickle cell trait
NIH NHLBI, 2007
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3,908 newborns born in NC with sickle
cell trait in 2006
NC State Lab
STIs/HIV Case Rate
NC Women Aged 18 – 44 years old
1320.3/100,000 Chlamydia Case Rate
432.5/100,000 Gonorrhea Case Rate
312.4/100,000 living with HIV/AIDS
8.1/100,000 Syphilis Case Rate (PSEL)
NC DPH, HIV/STD Prevention and Care Branch 2006
Mental Health
NC Women Aged 18 – 44 years old
23% Report 1- 8 days of poor mental health
during the past month NC BRFSS, 2005
20% Report being moderately or very
depressed in the months after
delivery NC PRAMS 2000, 2003
Barriers to Healthcare
NC Women - Aged 18 – 44 years old
24% Uninsured
27% No dental visit in the past year
NC BRFSS 2005
Criteria for Areas of Focus
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Impact women’s and/or infant health
Consistent with CDC Recommendations
Based on best available scientific evidence, including
NC data highlighting disparities and needs/gaps
Reflect issues that women have highlighted as
important to them
Reflect priorities of participants in previous meetings
Offer concrete opportunities for action
BONUS: Impact chronic disease in the future
What Bubbles to the Top?
1) Pregnancy Intendedness
2) Substance Use
3) Obesity and Related Conditions
4) Mental Health
5) Barriers to Healthcare
Questions?
Structure
• Leadership Team
• Topic Area Groups (Workgroups)
• Collaborate around agreed-upon areas of focus
• Will have Chairperson and develop agenda
• Collaborate on existing programs, funding
opportunities, develop new programs/advocacy
plans, measurement of progress
• Use expertise of researchers and messaging
experts as needed
• Preconception Collaborators (project-specific)
Leadership Structure
Preconception Leadership Team
Mental
Health
Barriers to
Healthcare
Preconception
Collaborators
Substanc
e Use
Obesity
/
Related
Issues
Pregnancy
Intendedness
Other?
The Website
www.mombaby.org
Resources
• National News
• Minutes
• Feedback
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Please join us!
Sign up for the Leadership Team, a
workgroup(s), or to provide other support
• Workgroups will meet in Fall 2007
• Progress reports from workgroups to be given
at next large-group meeting on December 4
(save the date!)
• NC Preconception Conference: January 23,
2008 (Greenville)
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