Perinatal Health: From a women’s health lifespan

perspective

Diana Cheng, M.D.

Medical Director, Women’s HealthCenter for Maternal and Child Health

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Routine Prenatal Care

Nutrition, fitness, smoking cessation, substance use, medical screen, folic acid, immunization, toxic exposures, health coverage

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Routine Prenatal Care

Nutrition, fitness, smoking cessation, substance use, medical screen, folic acid, immunization, toxic exposures, health coverage

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“Preconception” Women’s Health

Nutrition, fitness, smoking cessation, substance use, medical screen, folic acid, immunization, depression, toxic exposures, health coverage, plan pregnancy

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What is the most common known cause of infant low birth weight?

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Prenatal Cigarette Smoking Maryland 2004-2008

Source: Maryland PRAMS 2004-20086

Smoking Before, During and After Pregnancy, Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 7

Smoking Before, During and After Pregnancy, Maryland 2004-2008

BRFSS 2006 18%

Source: Maryland PRAMS 2004-2008 8

Preconception Cigarette Smoking

Source: Maryland PRAMS 2004-20089

What is the most common known preventable cause of mental retardation?

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Prenatal Binge Drinking Maryland 2004-2008

Source: Maryland PRAMS 2004-200811

Prenatal Alcohol Use Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 12

Alcohol Use Before and During Pregnancy, Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 13

Preconception Alcohol UseMaryland 2004-2008

Source: Maryland PRAMS 2004-2008 14

Preconception Binge Drinking Maryland 2004-2008

Source: Maryland PRAMS 2004-200815

What is the leading cause of non-obstetric hospitalization for females aged 18-44?

Source: Maryland HSCRC 2006-2007 16

Postpartum Depression Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 17

What is the leading cause of death during pregnancy and postpartum?

Source: Maryland Vital Statistics Administration 1993-200818

Prenatal Physical Abuse Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 19

Preconception Physical Abuse Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 20

What is the most common chronic medical disorder during pregnancy?

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Preconception AsthmaMaryland 2004-2008

Source: Maryland PRAMS 2004-2008 22

Preconception Diabetes Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 23

Preconception Hypertension Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 24

Preconception BMI >25 Maryland 2004-2008

Source: Maryland PRAMS 2004-2008

41 41

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42 43 45

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Preconception BMI <18.5 Maryland, 2004-2008

Source: Maryland PRAMS 2004-2008 26

Preconception Risk FactorsMaryland 2004-2008

All: race/ethnicity Black Non-Hispanic

Source: Maryland PRAMS 2004-2008 27

Preconception Risk FactorsMaryland 2004-2008

All ages Age 20-24

Source: Maryland PRAMS 2004-2008 28

Private Insurance: Preconception, Prenatal, Delivery, Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 29

Preconception: No Private Health Insurance, Maryland 2004-2008

Source: Maryland PRAMS 2004-2008 30

No Preconception and Prenatal Routine Dental Cleaning, Maryland 2004-2007

Source: Maryland PRAMS 2004-2007 31

Unintended PregnancyMaryland 2004-2008

Source: Maryland PRAMS 2004-2008 32

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Summary• Risk factors prevalent among young women

– Chronic medical disorders– Obesity– Substance abuse and cigarette smoking– Depression– Abuse– Unintended pregnancy– Access to care, including oral health – Co morbidities

• Women’s health/preconception/interconception– Prenatal care gap

• Always misses 1st month of pregnancy • Not enough time to impact many health behaviors

– Start young– Include boys, men, families, communities

Priorities Identified by Stakeholder Survey: Women’s and Perinatal Health

• Unintended pregnancy and need for family planning/reproductive health services• Lack of health insurance coverage for women of childbearing age and pregnant

women• Access to early and adequate prenatal care• Infant mortality and related factors (prematurity, low birth weight, disparities,

SIDS/SUDIs)• Early identification of pregnant women and infants at risk (home visiting)• Mental health services, increasing need to services, access to screening, treatment

services for women of childbearing age and pregnant women; depression, including postpartum)

• Breastfeeding—increasing initiation and continuation; disparities; workplace support• Substance use/abuse among women of childbearing age and during pregnancy—

cigarettes, alcohol, illegal drugs; affects on newborns; access to treatment and services; increasing prescription drug addiction

• Women’s wellness —Access to primary, preconception, and inter-conception care, including oral health services; life course perspective

• More male involvement and fatherhood initiatives needed; greater recognition of the importance of fathers

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