reducing preterm births - ohio department of health...
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Reducing Preterm Births in Ohio
Celeste Smith MA, PC
Toledo Lucas County Health Department
Local Office on Minority Health
Lauren Henderson MPH
March of Dimes
Maternal and Child Health Director Northeast Ohio
• March of Dimes mission and
purpose
• Priority Areas for Ohio
• Strategies and impact on
preterm birth
• Health equity
Today’s
Presentation
March of Dimes Mission
The mission of the March of Dimes is to improve the
health of babies by preventing premature birth, birth
defects, and infant mortality.
A FIGHTING CHANCE FOR EVERY BABY
Why Prematurity?
• 1 in 10 babies
• Leading cause of newborn death
• Significant health problems
• Premature birth costs a lot of money
Preterm Birth and Infant Mortality
Leading cause of Infant Mortality (2015)
Based on in-depth Child Fatality Reviews (CFRs) from 2012-2015
Retrieved from: https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/OEI/2015-
Ohio-Infant-Mortality-Report-FINAL.pdf?la=en
2016 PREMATURE BIRTH REPORT CARD
marchofdimes.org/reportcard
Gestational age is based on obstetric estimate. Source: National Center for Health Statistics, 2015 natality data..
PRETERM BIRTH RATES AND GRADES BY STATE
Preterm Birth Rates
*2015 data are preliminary. LMP=gestational age based on date of mother’s last menstrual periodOE=gestational age based on obstetric estimate.2020 and 2030 goals based on OE gestational age.Preterm is less than 37 weeks gestation. Source: National Center for Health Statistics, 1990-2014 final and 2015 preliminary natality data.Prepared by March of Dimes Perinatal Data Center, June 2016.
United States, 1990, 1995, 2000, 2005-2015*
*2015 data are preliminary.
Gestational age based on obstetric estimate.
Preterm is less than 37 weeks gestation.
Source: National Center for Health Statistics, 2014 final and 2015 preliminary natality data.
Prepared by March of Dimes Perinatal Data Center, June 2016.
9.57
9.62
9.00
9.25
9.50
9.75
2014 2015*
Perc
en
tag
e o
f li
ve b
irth
s
For the first time in 8
years, the US preterm
birth rate increased
slightly between 2014
and 2015.
Preterm Birth RatesUnited States, 2014 & 2015*
*2015 data are preliminary.
Gestational age based on obstetric estimate.
Preterm is less than 37 weeks gestation.
Costs per infant include all employer payments for newborn medical care during the first year of life.
Source: National Center for Health Statistics, 2014 final and 2015 preliminary natality data. Institute of Medicine, CostS of
Preterm Birth.
Prepared by March of Dimes Perinatal Data Center, June 2016.
If the US preterm birth rate had not
increased from 2014 to 2015…
Approximately 2,000 fewer babies would have been born preterm.
More than $100 million in medical and societal costs could have been avoided.
*2015 data are preliminary. Gestational age based on obstetric estimate. Preterm is less than 37 weeks gestation. Data shown only for select race/ethnicity categories. Race categories exclude Hispanics.Source: National Center for Health Statistics, 2014 final and 2015 preliminary natality data.Prepared by March of Dimes Perinatal Data Center, June 2016.
0.0%
+1.1%
+1.5%
-2.0%
-1.5%
-1.0%
-0.5%
0.0%
0.5%
1.0%
1.5%
2.0%
White Hispanic Black
Note: 2016 Report Card disparities data will use 2012-2014 average rates. This chart shows the change from 2014 to 2015
Percent change in preterm birth rates by maternal
race/ethnicity
United States, 2014 and 2015*
2016 PREMATURE BIRTH REPORT CARD
marchofdimes.org/reportcard
Rate and Grade
are unchanged
from 2015
Report CardThe preterm birth
rate among Black
women is 45%
higher than the
rate among all
other women.
2016 PREMATURE BIRTH REPORT CARD
COUNTIES IN OHIO
marchofdimes.org/reportcard
Counties with the greatest number of births are graded based on their 2014 preterm birth rates.
Counties Preterm birth rate Grade
Cuyahoga 11.8% F
Franklin 10.4% D
Hamilton 10.8% D
Lucas 11.6% F
Montgomery 11.0% D
Summit 10.4% D
Gestational age is based on obstetric estimate. Source: National Center for Health Statistics, 2014 natality data.
Prematurity in Ohio Cities
Goal of 8.1%
• Cleveland 98th
• Cincinnati 87th
• Columbus 86th
• Toledo 67th
The March of Dimes carries out this mission through
community services, advocacy, research, education and
support.
What are Preterm Birth Contributors
• Previous preterm birth
• Late/no prenatal care
• Smoking
• Drug use
• Poor nutrition
• Chronic health problems
• Stress
• Short pregnancy spacing
• Short cervix
Other Considerations:
• Biological
• Genetics
• Environment
• Geographies
Social determinants of
health including:
• Poverty
• Racism
• Crime
• Access to care
• Living conditions
Strategies that May Impact
Alignment
Collaboration
New Partners
Investment
Prevention
Place based strategies
Focus on the social determinants
Determinants of Health
Long before we need medical care, our foundation
for health begins in our homes, schools and
neighborhoods. Robert Wood Johnson Foundation
Graphic retrieved from the Institute of Public Health: http://www.publichealth.ie/healthinequalities/healthinequalities
Determinants of Health
March of Dimes Prematurity
Campaign
8.1% 2020 preterm birth rate goal for the U.S.
5.5% 2030 preterm birth rate goal for the US
New focus on high volume and high burden areas
and populations in Report Cards
Prematurity Campaign Roadmap
Roadmap Interventions
Birth spacing and interconception care
Elimination of non-medically indicated early elective
deliveries
Smoking Cessation
Group Prenatal Care
Access to progesterone shots for women with a previous
preterm birth
Low dose aspirin to prevent preeclampsia
Vaginal progesterone and cerclage for short cervix
Reduce multiple births conceived through Assisted
Reproductive TechnologyTarget geographies and/or racial and ethnic groups with high rates
and/or high birth volume.
Roadmap: Targeting 16 States /
Territories Accelerate change in 16 high burden and high birth volume
states/territories.
Consistent with fundamental public health principles and
strategies – services based on burden and volume.
Continue activities in all states/territories.
Target 16 States/Territories
•Phase I: 6 states/territories in 2017Alabama, Louisiana, Mississippi, Puerto Rico -
Highest rates.
Florida, Texas - Most populous high rate
states.
•Phase II: 10 additional states with births
>100,000 California, Georgia, Illinois, Michigan, New
Jersey, New York, North Carolina, Ohio,
Pennsylvania, Virginia.
Prematurity Campaign Roadmap
The Prematurity Campaign
Roadmap sets out our plan for
achieving the new 2020 and 2030
goals. To achieve them, we
must:
Optimize existing
interventions
Engage stakeholders.
Identify new treatments
based on translation of
discovery research.
March of Dimes investment in
the Prematurity Research
Centers is essential to
achieving 5.5% by 2030
5.5% by 2030
Ohio Strategies
1. Reduce the rate of women in the six targeted areas
or focus populations who have inter-pregnancy
intervals less than 18 months.
2. Provide progesterone therapy to women with a
previous preterm birth in the six targeted areas
3. Expand group prenatal care in targeted counties
and focused Ohio populations
4. Maintain an early elective delivery rate without
medical indication at or below 5% for Ohio
hospitals
Expand group prenatal care in targeted counties and
focused Ohio populations
Centering Pregnancy® and March of Dimes
Nationally
• MOD has strongly supported the spread of CP beginning in 2005
• 2012-2014 – In partnership with Anthem, MOD expanded CP to 13
states – 8,000 women participated, PTB rate was 7.4% (12% US)
• In 2014, 1,800 providers and 24,000 women benefited
Ohio
• $878,400 invested since 2007 (32 awards)
• 2013 - $102,400 – 8 grants – 750 – 1000 women
• 2014 - $83,121 – 3 grants – 500 – 750 women
• 2015 - $95,000 – 3 grants – 750 – 800 women
• 2016 - $150,000 – 7 grants – 1000 women
Centering Pregnancy® and
March of Dimes 2014-2016
Ohio Data Trends 2014-2016 2014 Percentage 2015 Percentage 2016 YTD Percentage
Total women participating 228 100 421 100 299 100
Women attending 8 or more
sessions29 23.6 109 32.3 58 31.4
Women attending CP <17 weeks 48 41.7 71 46.1 113 39.8
Women under 20 years of age 30 25.2 83 29.1 51 33.1
Black participation 64 55.7 278 90.8 144 91.7
Preterm births <37 weeks 6 5.8 22 8.2 7 4.9
Centering Pregnancy® and
March of Dimes 2017
• Program expansion
• Target Black participation
• Increase sessions attended
Reduce the rate of women in the six targeted areas
or focus populations who have inter-pregnancy
intervals less than 18 months.
• Focus inter-pregnancy intervals
• Developing baseline data for Ohio and targeted
counties
• Increase awareness
• Partnership building
• LARC
Maintain an early elective delivery rate without
medical indication at or below 5%
Healthy Babies are Worth the Wait
Provide progesterone therapy to women
with a previous preterm birth
• Increase consumer awareness
• Increase provider utilization
Prematurity Campaign Results
Since 2007 the prematurity rate has decreased
to 9.6%
• Fewer babies are now counted as preterm due to a
change in measurement by the National Center for
Health Statistics (NCHS).
• Progress has been made in reducing preterm birth
rates.
Progress is not victory
• Despite progress, the U.S. preterm birth rate ranks
poorly among Very High Human Development Index
(VHHDI) countries.
Preterm Birth Rates for Very High Human
Development Index Countries*
*Preterm birth rates per 100 live births in 2010 (baseline) for 39 countries with VHHDI.
Chang, H., Larson, J., Biencowe, H., et al. (2013). Preventing preterm births: Analysis of trends and potential reductions with interventions in 39 countries with very high human development
index. The Lancet, 381(9862), 223-234.
Results
With Roadmap activities:
1.3 million fewer babies will be born preterm
between 2014 and 2030 when we meet the 5.5%
2030 goal.
• 210,000 fewer babies will be born preterm from
2014-2020, when we meet the 8.1% 2020 goal.
• 1.1 million fewer babies will be born preterm from
2021-2030, when we meet the 5.5% 2030 goal.
March of Dimes Perinatal Data Center. Projected estimates each year based on 2014 live births and incremental declines between
9.6% in 2014 and 5.5% in 2030.
Gestational age determined using obstetric estimate of gestation.
Thank you