pregnant women and infants

www.kdheks.gov

Our Vision – Healthy Kansans living in safe and sustainable environments.


Pregnant Women Pregnant Women and Infantsand Infants

Jamie S. KimJamie S. Kim

November 6, 2009November 6, 2009

MCH 2015 Needs MCH 2015 Needs AssessmentAssessment

www.integrativehealthinstitute.ca


Target Target PopulationPopulation

All pregnant women and infants All pregnant women and infants

in Kansasin Kansas InfantInfant: A child under one year of age.: A child under one year of age. Pregnant womanPregnant woman: A female from the : A female from the

time that she conceives to 60 days after time that she conceives to 60 days after birth, delivery, or expulsion of fetus. birth, delivery, or expulsion of fetus. However, many states also include the However, many states also include the preconceptional health of a women in her preconceptional health of a women in her reproductive years (e.g., 15-44 years).reproductive years (e.g., 15-44 years).


GoalGoal

To enhance the health of To enhance the health of Kansas women and infants in Kansas women and infants in partnership with families and partnership with families and communities.communities.

ccstockton.net


MCH2010 Priority Needs MCH2010 Priority Needs are:are:

Increase early and comprehensive Increase early and comprehensive health care before, during and after health care before, during and after pregnancy.pregnancy.

Reduce premature births and low Reduce premature births and low birth weightbirth weight

Increase breastfeedingIncrease breastfeeding


Increase early and Increase early and comprehensive comprehensive

health care before, health care before, during and after during and after

pregnancypregnancy


HP2010 16-6b. Percent of pregnant women who HP2010 16-6b. Percent of pregnant women who receive early and adequate prenatal care (APNCU)receive early and adequate prenatal care (APNCU)

79.1 78.4 77.3 77.6

68.6 69.3

0

20

40

60

80

100

2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US

Healthy People 2010 (90%)

Desired Direction=Above Line

Data Source: Bureau of Public Health Informatics; National Center for Health Statistics

nativeremedies.com


NPM18. Percent of infants born to pregnant women NPM18. Percent of infants born to pregnant women receiving prenatal care receiving prenatal care

beginning in the first trimesterbeginning in the first trimester

76.0 75.0 72.4 73.1

69.070.2

0

20

40

60

80

100

2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US



NPM: National Performance Measure Data Source: Bureau of Public Health Informatics; National Center for Health Statistics

preconception.com


Reduce Premature Reduce Premature BirthsBirths


HP2010 16-11a. Percent of total preterm births HP2010 16-11a. Percent of total preterm births (<37 weeks)(<37 weeks)

8.79.4 9.6 9.6 9.4 9.2 9.3

12.5 12.7 12.8 12.712.1 12.3

0

5

10

15

20

25

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US

Healthy People 2010

(7.6%)

Desired Direction=Below Line

www.marchofdimes.com

Data Source: Bureau of Public Health Informatics; National Center for Health Statistics Note: U.S. data for 2007 is preliminary.


HP2010 16-11a. Percent of live births at 32 to 36 HP2010 16-11a. Percent of live births at 32 to 36 weeks of gestation weeks of gestation

(moderately premature and late preterm)(moderately premature and late preterm)

7.67 7.67

10.49 10.80 10.70

7.928.078.118.107.25

10.12 10.37

0

5

10

15

20

25

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US

Healthy People 2010

(6.4%)



ok.gov


Percent of live births at 34 to 36 weeks of Percent of live births at 34 to 36 weeks of gestation (late preterm)gestation (late preterm)

6.656.576.276.817.047.026.99

9.159.098.908.80

0

5

10

15

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KSUS


cincinnatichildrens.org


HP2010 16-11a. Percent of live births at less than 32 HP2010 16-11a. Percent of live births at less than 32 weeks of gestation (very premature)weeks of gestation (very premature)

1.58 1.612.01 2.03 2.05

1.44 1.34 1.50 1.54 1.46

1.971.96

0

1

2

3

4

5

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US

Healthy People 2010

(1.1%)



Extremely preterm infant born at 26 weeks' gestation

archive.student.bmj.com


All resident live birthsCesarean delivery rates by gestational age

Kansas, 1997-2008

0%

10%

20%

30%

40%

50%

60%

70%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Pe

rce

nt

Very premature (1-31 wks) Late preterm (34-36 wks) Preterm (<37 wks) Total C-section Normal (37-41 wks)


All resident live birthsInduction of labor rates by gestational age

Kansas, 1997-2008

0%

5%

10%

15%

20%

25%

30%

35%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Per

cen

t

Very premature (1-31 wks) Late preterm (34-36 wks) Preterm (<37 wks) Total lnduction labor Normal (37-41 wks)


All resident live birthsSmoking during pregnancy rates by gestational age

Kansas, 1997-2008

0%

5%

10%

15%

20%

25%

1997 1998 1999 2000 2001 2002 2003 2004 // 2005 2006 2007 2008

Year

Per

cen

t

Very premature (1-31 wks) Late preterm (34-36 wks) Preterm (<37 wks) Total smoking Normal (37-41 wks)


Reduce Low Reduce Low BirthweightBirthweight


HSI1A. Percent of live births weighing less HSI1A. Percent of live births weighing less than 2,500 grams (LBW).than 2,500 grams (LBW).

7.218.1 8.2 8.3 8.2

7.197.187.317.377.01 7.117.8 7.9

0

5

10

15

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US

Healthy People 2010

(5.0%)


HSI: Health Status IndicatorData Source: Bureau of Public Health Informatics; National Center for Health Statistics U.S. data for 2007 is preliminary.

www.askamum.co.uk


HSI1B. Percent of live HSI1B. Percent of live singleton birthssingleton births weighing less than 2,500 grams (LBW).weighing less than 2,500 grams (LBW).

5.51

6.31 6.41 6.49

5.525.315.74 5.58 5.51 5.72

6.26.12

0

5

10

15

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KSUS

HSI: Health Status IndicatorData Source: Bureau of Public Health Informatics; National Center for Health Statistics

archive.student.bmj.com


HSI2A. Percent of live births weighing HSI2A. Percent of live births weighing less than 1,500 grams (VLBW).less than 1,500 grams (VLBW).

1.37 1.371.48 1.49 1.49

1.311.14

1.38 1.35 1.291.451.46

0

1

2

3

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US

Healthy People 2010

(0.9%)



tobaccolabels.ca


HSI2B. Percent of live HSI2B. Percent of live singleton birthssingleton births weighing less than 1,500 grams (VLBW).weighing less than 1,500 grams (VLBW).

1.04

1.12 1.14 1.14

1.000.981.010.860.94

1.04

1.11 1.11

0

1

2

3

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KSUS


jillstanek.com


Increase Increase BreastfeedingBreastfeeding


HP2010 16-19a. Percent of mothers who breastfeed HP2010 16-19a. Percent of mothers who breastfeed their infants in early postpartum period (at hospital their infants in early postpartum period (at hospital

discharge).discharge).

80.4

75.0 75.3

79.4

70.9 71.6 71.4 72.6 73.1 74.2

72.872.3

60

80

100

2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

Liv

e B

irth

s

KS US



Data Source: National Immunization Survey (birth year)


NPM 11, SPM3, HP2010 16-19b. Percent of mothers NPM 11, SPM3, HP2010 16-19b. Percent of mothers who breastfeed their infants at 6 months.who breastfeed their infants at 6 months.

34.737.4 38.2 37.8

34.2 36.9 37.6 39.1 42.1 43.1

42.3 43.4

0

20

40

60

80

2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

Liv

e B

irth

s

KS US



NPM: National Performance Measure; SPM: State Performance Measure


dsf.health.state.pa.us


NPM 11, SPM3, HP2010 16-19b. Percent of mothers NPM 11, SPM3, HP2010 16-19b. Percent of mothers who breastfeed their infants at 1 year.who breastfeed their infants at 1 year.

15.718.2 19 19.6 21.4 21.4

13.415.8

17.320.3

19.121.2

0

10

20

30

40

2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

Liv

e B

irth

s

KS US





babble.com


Percent of mothers participating in WIC who Percent of mothers participating in WIC who breastfeed their infants in early postpartum period breastfeed their infants in early postpartum period

(at hospital discharge).(at hospital discharge).

63.0 61.764.5

67.3 68.0

52.5 55.1 56.1 58.5 60.1 59.8 62.0

63.966.0

40

60

80

100

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US



Data Source: Pediatric Nutrition Surveillance System (PedNSS)


Percent of mothers participating in WIC Percent of mothers participating in WIC who breastfeed their infants at 6 months.who breastfeed their infants at 6 months.

20.724.4 22.5

20.7 23.4 23.3 24.3 25.2 25.4 26.9

20.619.6 22.2 21.6

0

20

40

60

80

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US





Percent of mothers participating in WIC Percent of mothers participating in WIC who breastfeed their infants at 1 year.who breastfeed their infants at 1 year.

12.317.3 17.5 17.7 18.1 17.5 19.1

12.213.3 13.6 12.813.7

11.8 12.2

0

10

20

30

40

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KS US





NPM 11, SPM3, HP2010 16-19b. Percent of mothers NPM 11, SPM3, HP2010 16-19b. Percent of mothers who breastfeed their infants at 6 months.who breastfeed their infants at 6 months.

0

10

20

30

40

50

60

70

Perc

en

t o

f L

ive B

irth

s

KS 34.7 37.4 38.2 37.8 42.3 43.4

US 34.2 36.9 37.6 39.1 42.1 43.1

HP2010 50 50 50 50 50 50 50 50

WIC KS 23.4 20.6 20.7 19.6 24.4 22.5 22.2 21.6

WIC US 19.7 21.5 20.7 23.4 23.3 24.3 25.2 25.4

2000 2001 2002 2003 2004 2005 2006 2007




Data Source: National Immunization Survey (birth year); Pediatric Nutrition Surveillance System (PedNSS)


Kansas Pregnant Women Kansas Pregnant Women and Infants Selected and Infants Selected

Characteristics/IndicatorCharacteristics/Indicatorss


Population Population CharacteristicsCharacteristics

coolest-homemade-costumes.com


Population Composition by MCH Population Composition by MCH groupings, Kansas and U.S., 2008groupings, Kansas and U.S., 2008

Population GroupPopulation Group Age Age

in in YearsYears

KSKS

Population Population EstimateEstimate

KSKS

%%

US US

Population Population EstimateEstimate

USUS

%%

InfantsInfants

ChildrenChildren

ChildrenChildren

AdolescentsAdolescents

Women of Childbearing AgeWomen of Childbearing Age

Teen WomenTeen Women

Adult WomenAdult Women

<1<1

1-41-4

5-95-9

10-1410-14

15-4415-44

15-1915-19

20-4420-44

42,42542,425

160,104160,104

192,365192,365

187,678187,678

553,481553,481

96,53196,531

456,950456,950

1.5%1.5%

5.7%5.7%

6.9%6.9%

6.7%6.7%

19.8%19.8%

3.4%3.4%

16.3%16.3%

4,313,1324,313,132

16,692,72016,692,720

20,065,24920,065,249

20,054,62720,054,627

61,918,94661,918,946

10,487,09410,487,094

51,431,85251,431,852

1.4%1.4%

5.5%5.5%

6.6%6.6%

6.6%6.6%

20.4%20.4%

3.4%3.4%

16.9%16.9%

Total MCH PopulationTotal MCH Population

OthersOthers

1,136,0531,136,053

1,6660811,666081

40.5%40.5%

59.5%59.5%

123,044,674123,044,674

181,015,050181,015,050

40.5%40.5%

59.5%59.5%

Total PopulationTotal Population 2,802,1342,802,134 100.0%100.0% 304,059,724304,059,724 100%100%

Data Source: U.S. Census Bureau


MCH Populations as a Percent of Total MCH Populations as a Percent of Total Population, Kansas and U.S., 2008Population, Kansas and U.S., 2008

1.5%

5.7%

6.9%

6.7%

3.4%

16.3%59.5%

Infants <1

Children 1-4

Children 5-9

Adolescents 10-14

Teen Women 15-19

Adult Women 20-44

Other

1.4%

5.5%

6.6%

6.6%

3.4%

16.9%59.5%

Infants <1Children 1-4Children 5-9Adolescents 10-14Teen Women 15-19Adult Women 20-44Other

Kansas U. S.

Data Source: U.S. Census Bureau


Women (ages 15-44) by Race and Women (ages 15-44) by Race and Ethnicity, Kansas and U.S., 2008Ethnicity, Kansas and U.S., 2008

78.1%

6.4%

1.0%

2.9%

1.6%

10.0%

White NHBlack NHNat. Am. NHAsian/PI NHMultiple Race NHHispanic

Kansas U. S.

61.5%14.0%

0.9%

5.2%

1.5%

17.0%

White NHBlack NHNat. Am NHAsian/PI NHMultiple Race NHHispanic

Data Source: U.S. Census BureauNote: The percentage distribution of U.S. Black NH, Nat. Am. NH, Asian/PI NH, and Multiple Race NH are approximations.


Percent of Percent of prepregnancyprepregnancy overweight and overweight and obesity, Kansas and U.S., 2003-2007obesity, Kansas and U.S., 2003-2007

43.6 45.6 44.8 45.3

43.0 44.1 43.6 44.5

0

20

40

60

80

100

2003 2004 2005 2006 2007

Pe

rce

nt

KS US

Data Source: Pregnancy Nutrition Surveillance (PNSS)


Percent of women (ages 18-44) Percent of women (ages 18-44) withoutwithout health care coveragehealth care coverage

Kansas and U.S., 2002-2007 Kansas and U.S., 2002-2007

19.8 19.9 20.3 19.6

19.718.2

16.918

14.6

17.3

18.319.3

0

10

20

30

2002 2003 2004 2005 2006 2007

Pe

rce

nt

KSUS

Data Source: Behavioral Risk Factor Surveillance System


Percent of women (ages 18-44) Percent of women (ages 18-44) withoutwithout health care coveragehealth care coverageKansas, 2002-2007 Kansas, 2002-2007

0

20

40

60

80

100P

erc

en

t

White NH 11.9 16.4 13.3 14.1 15.0 12.4

Black NH 27.3 23.8 24.7 12.0 16.5 25.8

Hispanic 35.9 30.7 41.4 50.0 52.0 52.9

2002 2003 2004 2005 2006 2007

Data Source: Behavioral Risk Factor Surveillance System


Pregnancy OutcomesPregnancy Outcomes

theonion.com


Crude Birth Rate Crude Birth Rate Kansas and U.S., 2002-2008Kansas and U.S., 2002-2008

0

5

10

15

20

25R

ate

per

1,0

00 t

ota

l p

op

ula

tio

n

KS 14.5 14.4 14.5 14.5 14.8 15.1 14.9

US 13.9 14.1 14.0 14.0 14.2 14.3

KS LB 39,338 39,353 39,553 39,701 40,896 41,951 41,815

2002 2003 2004 2005 2006 2007 2008

Data Source: Bureau of Public Health Informatics (residence data); National Center for Health Statistics Note: U.S. birth rate for 2007 is preliminary.LB: Number of live births


Crude Birth Rate by Race/EthnicityCrude Birth Rate by Race/EthnicityKansas and U.S., 2007Kansas and U.S., 2007

15.113.5

17.7

27.3

14.3

11.5

16.4

23.3

0

20

40

Total White NH Black NH Hispanic

Ra

te p

er

1,0

00

po

pu

lati

on

KS US



Percent of Births to Percent of Births to UnmarriedUnmarried Women WomenKansas and U.S., 2002-2008Kansas and U.S., 2002-2008

37.734.0 34.6 35.8 36.9

38.5 39.7

36.4

30.8 31.4 32.6 34.0 35.2

0

10

20

30

40

50

2002 2003 2004 2005 2006 2007 2008

Pe

rce

nt

of

Liv

e B

irth

s

KSUS



Teen Teen BirthBirth Rate (ages 15-17) Rate (ages 15-17)Kansas and U.S., 2002-2008Kansas and U.S., 2002-2008

22.0

23.2 22.4 22.1 21.4 22.0 22.2

21.721.2 20.0 20.4 19.6 19.5

0

20

40

60

80

100

2002 2003 2004 2005 2006 2007 2008

Ra

te p

er

1,0

00

liv

e b

irth

s

KSUS



Teen Teen PregnancyPregnancy Rate (ages Rate (ages 15-1715-17))Kansas and U.S., 2002-2008Kansas and U.S., 2002-2008

27.1

42.7 44.1

26.828.3 26.6 25.8 25.7 25.5

41.540.2

0

20

40

60

80

100

2002 2003 2004 2005 2006 2007 2008

Ra

te p

er

1,0

00

wo

me

n 1

5-1

7 y

ea

rs

KSUS

Data Source: Bureau of Public Health Informatics; National Center for Health Statistics Note: Teen pregnancy include the sum of live births, stillbirths and abortions.


Teen Teen PregnancyPregnancy Rate (ages Rate (ages 15-1915-19))Kansas and U.S., 2002-2008Kansas and U.S., 2002-2008

55.0

72.2 70.6

53.254.751.3 50.3 50.8 52.2

73.776.0

0

20

40

60

80

100

2002 2003 2004 2005 2006 2007 2008

Rate

per

1,0

00 w

om

en

15-1

9 y

ears

KSUS

Data Source: Bureau of Public Health Informatics; National Center for Health Statistics Note: Teen pregnancy include the sum of live births, stillbirths and abortions.


Infant Mortality RatesInfant Mortality RatesKansas and U.S., 2002-2008Kansas and U.S., 2002-2008

7.25

6.97 6.85 6.79 6.87 6.69 6.77

7.947.17

6.667.18 7.48 7.16

0

5

10

15

2002 2003 2004 2005 2006 2007 2008

Ra

te p

er

1,0

00

liv

e b

irth

s

KSUS



Infant Mortality RatesInfant Mortality Ratesby Race/Ethnicityby Race/EthnicityKansas, 2002-2008Kansas, 2002-2008

0

10

20

30

Ra

te p

er

1,0

00

liv

e b

irth

s

White NH 6.27 5.83 6.75 6.26 6.16 6.79 6.16

Black NH 15.47 14.65 16.53 16.85 17.49 19.61 13.28

Hispanic 7.99 8.31 5.13 8.56 6.24 8.39 8.41

2002 2003 2004 2005 2006 2007 2008

Data Source: Bureau of Public Health Informatics


Infant Mortality RatesInfant Mortality Ratesby Race/Ethnicity and by Race/Ethnicity and RatioRatio

Kansas, 2002-2008Kansas, 2002-2008

0

10

20

30

Ra

te p

er

1,0

00

liv

e b

irth

s

White NH 6.27 5.83 6.75 6.26 6.16 6.79 6.16

Black NH 15.47 14.65 16.53 16.85 17.49 19.61 13.28

Ratio 2.47 2.51 2.45 2.69 2.84 2.89 2.16

2002 2003 2004 2005 2006 2007 2008

Data Source: Bureau of Public Health Informatics


Based on the most recent years of Based on the most recent years of available dataavailable data

http://www.datacounts.net/mch2015/

Kansas Pregnant Kansas Pregnant Women Women

and Infants Highlightsand Infants Highlights


HighlightHighlightss

In 2008, Women of childbearing age (15-In 2008, Women of childbearing age (15-44) and infants comprise 21.3% of Kansas 44) and infants comprise 21.3% of Kansas population.population.

In 2008, 41,815 live births occurred to In 2008, 41,815 live births occurred to Kansas residents, representing a birth Kansas residents, representing a birth rate of 14.9 per 1,000 population. rate of 14.9 per 1,000 population.

In 2008, Geary (25.8), Seward (24.4), and In 2008, Geary (25.8), Seward (24.4), and Ford (21.7) counties had the highest Ford (21.7) counties had the highest county birth rates per 1,000 population. county birth rates per 1,000 population.


HighlightsHighlights

In 2006, birth rates (14.8) in Kansas are among In 2006, birth rates (14.8) in Kansas are among the highest (ranked 14the highest (ranked 14thth) in the nation (US ) in the nation (US 14.2).14.2).

In 2006, Kansas teen (ages 15-19) birthrate In 2006, Kansas teen (ages 15-19) birthrate (42.0) is about the same as the national (42.0) is about the same as the national average (41.9) – Ranked 17average (41.9) – Ranked 17thth. .

In 2008, Kansas non-Hispanic black In 2008, Kansas non-Hispanic black (97.6/1,000) and Hispanic(121.1) teenagers (97.6/1,000) and Hispanic(121.1) teenagers (ages 15-19) are over twice and three times, (ages 15-19) are over twice and three times, respectively, as likely to get pregnant as non-respectively, as likely to get pregnant as non-Hispanic white teens (42.2).Hispanic white teens (42.2).


HighlightsHighlights According to the 2003-2004 Kansas According to the 2003-2004 Kansas

Women’s Health Survey, 36.6% of Kansas Women’s Health Survey, 36.6% of Kansas pregnancies that result in a live birth are pregnancies that result in a live birth are unintended.unintended.

In 2008, 25.6% of Kansas women who In 2008, 25.6% of Kansas women who deliver a live birth use Medicaid as a deliver a live birth use Medicaid as a source of payment for prenatal care.source of payment for prenatal care.

In 2008, 73.1% of Kansas mothers receive In 2008, 73.1% of Kansas mothers receive prenatal care during the first trimester, prenatal care during the first trimester, and 77.6% receive adequate care or better and 77.6% receive adequate care or better during their pregnancy.during their pregnancy.


In 2008, 16.1% of Kansas women In 2008, 16.1% of Kansas women smoke cigarettes during pregnancy smoke cigarettes during pregnancy (US 13.2% in 2006) and 0.2% report (US 13.2% in 2006) and 0.2% report alcohol use.alcohol use.

According to the 2007 CDC National According to the 2007 CDC National Immunization Survey, 79.4% of Immunization Survey, 79.4% of Kansas mothers initiate breastfeeding Kansas mothers initiate breastfeeding after delivery and 43.4% continue after delivery and 43.4% continue breastfeeding for at least 6 months.breastfeeding for at least 6 months.




In 2008, 9.3% (3,873) of Kansas infants are In 2008, 9.3% (3,873) of Kansas infants are born preterm.born preterm.

Each year, an average of 300 Kansas infants Each year, an average of 300 Kansas infants die before reaching their first birthday.die before reaching their first birthday.

About 2-3% of Kansas infants are born with About 2-3% of Kansas infants are born with one or more congenital anomalies, accounting one or more congenital anomalies, accounting for more than 20% of all infant deaths.for more than 20% of all infant deaths.

20% of U.S. mothers report experiencing 20% of U.S. mothers report experiencing physical abuse by their husband or partner physical abuse by their husband or partner during pregnancy.during pregnancy.


Thank you!Thank you!

currentworldnews.netcurrentworldnews.net


Jamie S. Kim, MPHJamie S. Kim, MPHMCH EpidemiologistMCH Epidemiologist

Bureau of Family HealthBureau of Family HealthKansas Department of Health and Kansas Department of Health and

[email protected]@kdheks.gov

785-296-6467785-296-6467

http://www.kdheks.gov/c-f/index.htmlhttp://www.kdheks.gov/c-f/index.html

www.kdheks.gov


pregnant women and infants

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