what you do to prevent preterm birth in cleveland and cuyahoga county carol gilbert, ms health data...
TRANSCRIPT
![Page 1: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/1.jpg)
1
WHAT YOU DO TO PREVENT PRETERM BIRTHIN CLEVELAND AND CUYAHOGA COUNTY
Carol Gilbert, MS
Health Data Analyst, CityMatCH
![Page 2: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/2.jpg)
2
Your Programs
• MomsFirst, • Help Me Grow, • Lead Safe, • Creating Healthy
Communities, • Produce Perks, • Breast for Success, • Place Matters, • Baby Basics, and • CFHS
Your Expertise
• Nursing• Perinatal health• Counseling• Health Systems• Education Systems• Housing Systems• Law enforcement• Justice system• Knowledge of your
clients
![Page 3: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/3.jpg)
3
….AND YOU KNOW CLEVELAND AND CUYAHOGA COUNTY
Neighborhoods
History
Values
Traditions
![Page 4: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/4.jpg)
4
Services you provide
Health education• Health literacy• Prenatal care• Breastfeeding• Family planning• Interconception
care• Parenting• Smoking Cessation• Child Health and
Development
Case management• Obtaining medical
insurance• Obtaining
transportation to medical appointments
• Screening and referral for perinatal depression
• Connect parents to social supports, medical home
Health promotion• Assess and
improve environmental, systems and policies to promote health
• Lead abatement grants
• Extra value for food stamp cards when used at farmers markets
• Breastfeeding support
![Page 5: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/5.jpg)
5
Black birth outcomes (2010-2012 birth records)
• Teen pregnancy 17%• Short birth spacing 36% (similar to reference group)• Late or no prenatal care 14% (none in the reference
group)• Very preterm birth 5% (vs 1% for reference group)• Infant mortality rate
![Page 6: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/6.jpg)
6
In Cuyahoga County, the Black infant mortality rate is 2.5 times the White rate (2006-2010)
Ohio Cuyahoga County
5.93.7
14.0
9.2
1-WHITE_NH 2-BLACK_NH
![Page 7: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/7.jpg)
Infant mortality is complex
• Health care system• Built Environment
7
Important time periods• Preconception health• Prenatal• Neonatal• Post-neonatal
Goes beyond obstetrics• Chronic disease• Mental Health• Social determinants
• Life course• Inter-generational
…and is an important indicator of population health
![Page 8: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/8.jpg)
What is the Perinatal Periods of Risk approach, or PPOR?An approach for helping cities and large communities to use their own data to investigate the reasons for their high infant mortality rates and disparities
Uses Vital Records Data (birth and death records)Everyone is includedAvailable at local level 8
![Page 9: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/9.jpg)
What’s different about the PPOR analytic approach?
1. Four periods of risk
2. Uses fetal death data
3. Uses a reference group
4. Tailored to every community
9
![Page 10: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/10.jpg)
The PPOR “map” of fetal and infant mortality. Perinatal Periods of Risk are named to suggest the preventive areas
500-1499 g
1500+ g
Fetal Deaths
(>=24 wks)
9 10 11 12
13 14 15 16
Maternal Health / Prematurity
Maternal Care
Newborn Care
Infant Health
Neonatal Deaths
(Birth – 27 days)
Postneonatal Deaths
(28 – 364 days)
age
weight
![Page 11: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/11.jpg)
4.1
1.8 1.2 2.0
PPOR “maps” for Cuyahoga County*
11
All 2006-2010
* PPOR Fetal and infant deaths per 1000 live births and fetal deaths
7.3
2.7 1.3 2.9
NH Black 2006-2010
9.1 14.3
![Page 12: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/12.jpg)
But . . . What rates can we expect to see in each Period of Risk?”
PPOR answers this question using a reference group, a real population of mothers that experience best outcomes:
low fetal and infant mortality rates
12
![Page 13: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/13.jpg)
Ohio State Reference GroupPPOR MAP, 2006-2010
1.8
1.2 1.0 0.7
Reference Group Characteristics:
• 20+ years of age• 16+ years of education• Non-Hispanic White• Resident of Ohio at the
time of baby’s birth 13
Ohio State Reference Group Overall Rate = 4.7
* per 1000 live births and fetal deaths
![Page 14: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/14.jpg)
By using the reference group, PPOR helps measure “Inequity”Remember: Inequity is a disparity that is unnecessary and unfair
Unnecessary deaths are those that could be prevented
In PPOR, preventability is estimated on a population basis by comparing the community’s outcomes to the outcomes of a real “reference group” 14
![Page 15: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/15.jpg)
7.3
2.7 1.3 2.9
PPOR for Cuyahoga County
15
Black 2006-2010
* per 1000 live births and fetal deaths
1.8
1.2 1.0 0.7
Ref2 2006-2010
5.5
1.6 0.4 2.2
Excess Mortality
14.3 4.7 9.6
![Page 16: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/16.jpg)
169
48 11 67
PPOR for Cuyahoga CountyEstimated excess deaths
2006-2010
16
Black NH
* per 1000 live births and fetal deaths
11
5 6 36
All others
295 59
![Page 17: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/17.jpg)
Cuyahoga County (2006-2010)
17
Black VLBW48%
Other VLBW3%
Black MC14%
Other MC1%
Black NC3%
Other NC2%
Black IH19%
Other IH10%
Excess (preventable) Fetal and Infant Deaths By Race and Period of Risk
From Kitagawa, 92% of the blue pie slice is due to too many babies born too small; County-wide, 44% of excess mortality is due to Black prematurity
![Page 18: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/18.jpg)
Impact on Target Populati
on
Appropriate
Interventions
Capacity
Infant Mortality
PPOR says:
Prematurity Prevention
Clear Focus
Identifying Priorities
Next Step: Determine which risk factors are most important for Cuyahoga County Black births
End of today
Some of you saw this part of PPOR analysis before
![Page 19: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/19.jpg)
Risk Factors for Prematurity
PREMATURITY
<37 weeks_________
32-36 weeks
________
<32 weeks
Previous spontaneous preterm
Smoking
Preconception Health
Stress
During pregnancy
Over the life course
Chronic Disease
Obesity**
Hypertension
Diabetes
Short inter-pregnancy interval
Congenital Anomalies Environmental exposure
Maternal age and diet
Twins, triplets etc.Heredity
Assisted Reproductive Technology
![Page 20: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/20.jpg)
20
Potential impact of addressing …Maternal stress during pregnancy—pooled RR=1.50—prematurity defined as less than 37 weeks (Ding)
Short cervix—RR=6.19 (lengths at or below the 10th percentile—prematurity defined as less than 35 weeks (Iams , 1996)
Previous preterm birth—RR=1.5-2.0—prematurity defined as less than 32 weeks (Iams)
Diabetes (GDM)—RR=1.47—prematurity defined as less than 3.7 weeks (Hedderson)
Inter-pregnancy interval—pooled adjusted RR=1.07-1.40 (<6 to 12-17mo)—preterm defined as less than 37 weeks (Conde-Agudelo)
![Page 21: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/21.jpg)
Prematurity is dangerous! Ohio (2006-2010) It causes death…
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 420.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
White Black
Gestational age at delivery
Per
cen
t o
f b
abie
s w
ho
die
![Page 22: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/22.jpg)
…prematurity also causes perinatal morbidity, and adverse childhood outcomes
Source: Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003;101:178-93. Reproduced with permission from Lippincott Williams & Wilkins.
![Page 23: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/23.jpg)
23
Risk factors for prematurity that we can’t measure from birth certificate data• Maternal stress during pregnancy and over the life course
• Alcohol, prescription drugs, other drugs (even smoking is under-reported)
• Many congenital anomalies are not detected at birth
• Environmental and occupational exposures (even strenuous work)
• Periodontal disease
• Generational effects (the grandparents’ health, the mother’s health at her own birth etc.)
![Page 24: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/24.jpg)
24
Risk factors on birth certificate
Not married at time of baby’s birth (SES, social support)Teen mom age<20High school or less education (indicator for SES)Medicaid paid for delivery (indicator for SES)Received WIC during pregnancyTwins, triplets etc.Previous preterm birthBirth spacing shorter than 18 monthsHypertension before or during pregnancy (includes eclampsia)Overweight or obese prior to pregnancyDiabetes before or during pregnancySmoking before or during pregnancyLate or no prenatal care (13 weeks or later)STD (Syphilis, Chlamydia, or Gonorrhea)
![Page 25: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/25.jpg)
Determining importance of risk factors (PPOR Phase 2 analysis, continued):
1. Is the risk factor more prevalent (more common) among Black mothers compared with the reference population?
2. Among Black mothers, does the factor have a high relative risk, i.e. is a woman more likely to have very preterm birth if she had the risk factor, compared to if she doesn’t?
3. If we could ELIMINATE the risk factor from this population, how much would the very preterm birth rate be reduced? Population Attributable Risk Percent is a simple descriptive measure of potential impact. It takes into account both “strength” (relative risk) and prevalence of the risk factor. Interaction or overlap among factors is not addressed.
![Page 26: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/26.jpg)
26
Rare among Black Cuyahoga County Births
Not married at time of baby’s birth (SES, social support)Teen mom age<20High school or less education (indicator for SES)Medicaid paid for delivery (indicator for SES)Received WIC during pregnancy (protective)Twins, triplets etc.Previous preterm birthBirth spacing shorter than 18 monthsHypertension before or during pregnancy (includes eclampsia)Overweight or obese prior to pregnancyDiabetes before or during pregnancySmoking before or during pregnancyLate or no prenatal care (13 weeks or later)STD (Syphilis, Chlamydia, or Gonorrhea)
![Page 27: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/27.jpg)
27
Low RR for VPTB among Black CC
Not married at time of baby’s birth (SES, social support)Teen mom age<20High school or less education (indicator for SES)Medicaid paid for delivery (indicator for SES)Received WIC during pregnancy (protective)Twins, triplets etc.Previous preterm birthBirth spacing shorter than 18 monthsHypertension before or during pregnancy (includes eclampsia)Overweight or obese prior to pregnancyDiabetes before or during pregnancySmoking before or during pregnancyLate or no prenatal care (13 weeks or later) [but underreporting]STD (Syphilis, Chlamydia, or Gonorrhea)
![Page 28: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/28.jpg)
28
Little impact on Black prematurity in CC
Not married at time of baby’s birth (SES, social support)Teen mom age<20High school or less education (indicator for SES)Medicaid paid for delivery (indicator for SES)Received WIC during pregnancy (protective)Twins, triplets etc.Previous preterm birthBirth spacing shorter than 18 monthsHypertension before or during pregnancy (includes eclampsia)Overweight or obese prior to pregnancyDiabetes before or during pregnancySmoking before or during pregnancyLate or no prenatal care (13 weeks or later)STD (Syphilis, Chlamydia, or Gonorrhea)
![Page 29: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/29.jpg)
29
And the winners are:
Not married at time of baby’s birth (SES, social support)Teen mom age<20High school or less education (indicator for SES)Medicaid paid for delivery (indicator for SES)Received WIC during pregnancy (protective)Twins, triplets etc.Previous preterm birthBirth spacing shorter than 18 monthsHypertension before or during pregnancy (includes eclampsia)Overweight or obese prior to pregnancyDiabetes before or during pregnancySmoking before or during pregnancyLate or no prenatal care (13 weeks or later)STD (Syphilis, Chlamydia, or Gonorrhea)
![Page 30: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/30.jpg)
30
Most important contributors to prematurity among Cuyahoga County Black mothers
Black % with factor
Ref % with factor
RR for VPTB among Black
PAR for VPTB among Black
Not married at time of baby’s birth (SES, social support)
89 6 1.4 25%
Birth spacing shorter than 18 months 36 34 1.4 13%
High school or less education (SES) 58 N.A. 1.3 13%
Previous Preterm Birth* 8 2 3.0 13%
*not preventable, but predictive
![Page 31: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/31.jpg)
31
What you can do to prevent prematurity
Strongest opportunities (based on birth certificate) :
• SES – mitigating the effects of low SES,
– reducing prevalence of low SES• Social support, strengthening families• Increasing birth spacing
![Page 32: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/32.jpg)
WIC 43%
Poverty is prevalent among Ohio mothers!
High school or less education 44%
Medicaid for Delivery 39%
ALL THREE indicators– 20% of births
AT LEAST ONE of the three indicators of poverty apply to 61% of births
Ohio births 2006-2010
![Page 33: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/33.jpg)
WIC 43%
Poverty is MORE prevalent among BLACK Ohio mothers!
High school or less education 58%
Medicaid for Delivery 64%
ALL THREE – 34%
AT LEAST ONE– 88%
Ohio births 2006-2010
![Page 34: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/34.jpg)
34
Approximate distribution of conditions leading to preterm birth
Spontaneous preterm labor
50%Spontaneous PROM25%
Indicated (needed to
happen)25%
March of Dimes, J Iams, Yonekura
Screening to identify women at risk of spontaneous preterm labor:• Previous preterm• Short Cervix
10% muti-fetal pregnancy (twins, triplets)contribute to all three parts
![Page 35: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/35.jpg)
35
One more potential direction
• Having a previous preterm birthBlack % with factor
Ref % with factor
RR for VPTB among Black
PAR for VPTB among Black
Previous Preterm Birth 8% 2% 3.0 13%
This is an easily identified high-risk population that could potentially be treated with progesterone or 17p during pregnancy. In a population with history of spontaneous preterm birth, weekly injections of 17p reduced preterm birth by 33% (Petrini 2005) Depending on current 17p use, we could expect up to 4% decrease in prematurity if all these women received appropriate treatment. If other high risk women could be identified, progesterone/17p could have more impact.
![Page 36: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/36.jpg)
36
Black% Ref% diff RR PARNot Married-Yes 83.80% 5.57% 78.23% 1.4 25%Teen Mom-Yes 17.40% 1.0 0%High School or Less-Yes 58.35% 1.3 13%Medicaid-Yes 68.98% 4.15% 64.83% 1.2 12%WIC-Yes 72.34% 5.35% 66.99% 0.7 -28%Plurality-Yes 3.63% 5.07% -1.44% 5.3 14%PPB-Yes 7.82% 2.47% 5.35% 3.0 13%Birth spacing <18 months 36.46% 34.34% 2.13% 1.4 13%Hypertension-Yes 13.93% 6.11% 7.82% 1.6 7%Overwt/Obese-Yes 63.59% 42.60% 20.99% 1.1 7%Diabetes-Yes 5.66% 5.46% 0.20% 1.4 2%Smoke any-Yes 16.44% 4.66% 11.78% 1.3 4%No/late Prenatal Care-Yes 14.27% 3.27% 11.00% 1.1 2%STD-Yes 11.92% 0.26% 11.66% 1.0 1%
![Page 37: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/37.jpg)
GROUP PRENATAL CARE AND CENTERING EVIDENCE
![Page 38: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/38.jpg)
38
Centering Healthcare™: The Evidence
• Yale University randomized control trial • 1,047 women in public clinics • Randomized to traditional or group care• 33% reduction in preterm birth for women in Centering groups• Other outcomes
• Increased satisfaction with care • Increased breast-feeding rates, and • Improved knowledge and readiness for birth and parenting
• University of Kentucky Centering Pregnancy Smiles program• Reduction in preterm births from 13.7% to 6.6%• Saved ~$2.1 million in 2 years
![Page 39: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/39.jpg)
39
Centering delivers results:• Less likely to delivery prematurely: to deliver
prematurely (9.8 vs. 13.8 percent). • More likely to receive adequate prenatal care:
CenteringPregnancy participants were less likely than those enrolled in usual care to receive inadequate prenatal care (26.6 percent of program participants received inadequate care, compared with 33 percent of those getting usual care)
• Higher satisfaction with prenatal care
![Page 40: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/40.jpg)
Centering delivers results• Increased use of postpartum family planning• Hale N, Picklesimer AH, Billings DL, et al. The impact of
Centering Pregnancy Group Prenatal Care on postpartum family planning. Am J Obstet Gynecol 2014;210:50.e1-7.
• Utilization of postpartum family-planning services was higher among women participating in GPNC than among women receiving IPNC (29% vs 20% at 12 months postpartum, p<.05)
![Page 41: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/41.jpg)
41
Home Visitation: The Evidence
• Program dependent• http://homvee.acf.hhs.gov/programs.aspx• http://
homvee.acf.hhs.gov/EvidenceOverview.aspx
![Page 42: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/42.jpg)
42
Home visiting delivers resultsEvery Child Succeeds (ECS), an established, regional home visiting program in southwest Ohio from 2007 to 2010
Healthy Families America model of home visiting; program goals are to
(1) improve pregnancy outcomes through nutrition education and substance use reduction,
(2) support parents in providing children with a safe, nurturing,
and stimulating home environment,
(3) optimize child health and development,
(4) link families to health care and other services, and
(5) promote economic self-sufficiency. for at-risk, first-time mothers.
![Page 43: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/43.jpg)
43
Home visiting delivers results
Pediatrics. 2013 Dosage effect of prenatal home visiting on pregnancy outcomes in at-risk, first-time mothers.
Goyal NK1 et. al
Evaluated the effect of home visiting dosage on preterm birth … in women in southwest Ohio. Home visits are provided by social workers, child development specialists, nurses, or paraprofessionals
Results: ≥8 completed visits by 26 weeks reduced odds of preterm birth by about 2/3 (compared with <3 visits)
![Page 44: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/44.jpg)
Cuyahoga County (2006-2010)
44
Black VLBW48%
Other VLBW3%
Black MC14%
Other MC1%
Black NC3%
Other NC2%
Black IH19%
Other IH10%
Excess (preventable) Fetal and Infant Deaths
By Race and Period of Risk
From Underlying Cause of Death, 62% of the green pie slice is due to sleep related deaths; (Black Cleveland 2008-2010)
SUID rate was 2.2, should be <.5
![Page 45: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/45.jpg)
45
Causes of Sleep-related deathSUID is:SIDS
Ill-DefinedAccidental Suffocation
Sleep Position Side or Prone (OR 2.3-13.1)Bed-sharing
(OR 2.88)Smoker Parent (OR 2.3-17.7)
Infant <3 months (OR 4.7-10.4)
Soft surfaces like couch, armchair (OR 5.1-66.9)
Multiple bedsharers (OR 5.4)Parent consumed alcohol, drugs, or is
overtired (OR 1.66)Prenatal drug and alcohol use
(OR varies, > 3.0)Use of soft bedding
(OR 5.0)Prone with soft bedding (OR 21.0)Smoke Exposure: prenatalPost-natal
Nicotine Metabolism
Source: Rachel Moon’s CDC Grand Rounds Presentation October 2012
![Page 46: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/46.jpg)
46
• Back to sleep for every sleep • Use a firm sleep surface • Room-sharing without bed-sharing is recommended • Keep soft objects and loose bedding out of the crib • Pregnant women should receive regular prenatal care • Avoid smoke exposure during pregnancy and after birth • Avoid alcohol and illicit drug use during pregnancy and
after birth • Breastfeeding is recommended• Pacifier for sleep• Avoid overheating
Source: Rachel Moon’s CDC Grand Rounds Presentation October 2012
Based on good and consistent scientific evidence
![Page 47: WHAT YOU DO TO PREVENT PRETERM BIRTH IN CLEVELAND AND CUYAHOGA COUNTY Carol Gilbert, MS Health Data Analyst, CityMatCH 1](https://reader038.vdocument.in/reader038/viewer/2022110206/56649cf95503460f949cb043/html5/thumbnails/47.jpg)
47
Relevant national initiatives
• Cribs for Kids• >300 partners nationally• Provide low-cost portable cribs to organizations, who then provide
them free or at cost to parents who cannot afford a crib
• ABCs• Alone, on your Back, in a Crib• Baltimore City Health Department and others
• Safe to Sleep• NICHD-led public awareness campaign• Expands focus from back sleeping only to ALL of the components
of a safe sleep environment (position, bedding, bedsharing, sleep surface, etc.)