Strategic Opportunities for Improving Pregnancy Outcomes in Guilford County

Marie Lynn Miranda, PhD

Sharon Edwards, MS

31 August 2009

Poor Pregnancy Outcomes

Very preterm birth (VPTB): <34

weeks

Preterm birth (PTB): <37 weeks

Low birthweight (LBW): <2500

grams (<5 lbs 8 oz ) Very low

birthweight (VLBW): <1500

grams (<3 lbs 5 oz)

Infant mortality (IM): live birth with death before 12 months

PPO are a Significant Problem in GC

  2003-2007  # %Total births 29,973

IM 264 0.9PTB 3,461 11.6VPTB 1,085 3.6LBW 2,809 9.4VLBW 616 2.1Any adverse outcome 4,231 14.1

Impact of PPO in GC

Significant impact on morbidity and mortality• US data: Accounts for 1/5 children with mental retardation; 1/3 children with vision impairment; ½ children with

cerebral palsy• Leading cause of neonatal mortality; in Guilford County

• Increased risk for myocardial infarction, stroke, hypertension, diabetes in adulthood

  1993-1997 1998-2002 2003-2007

Total deaths 231 236 264

% PTB 76.2 75.9 78.8% VPTB 68.8 67.8 75.4% LBW 75.8 77.1 80.4% VLBW 64.1 65.4 74.2

Impact of PPO in GC

Significant impact on short and long term costs• Neonatal hospitalization costs

• Average medical costs in first year of life are ~$4,500 for full-term babies and ~$50,000 for PTB/LBW babies• Additional costs to health, education, and social service systems throughout childhood and into adulthood

Outcome # admissio

ns

Total days

Total charges

Mean # of days

Mean charg

e

Premature birth

726 9,086 16,983,978

13 23,394

Problem birth/full term

1,119 4,226 6,445,326

4 5,760

Normal newborn

4,538 9,902 4,315,194

2 951

Total 6,383 23,214

27,744,498

Significant Disparities in PPO

• Disparities in outcomes by race

• Those lacking social and financial resources, as well as those who engage in risky behaviors, are also at especially high risk

  Rate of Preterm Birth (%)  Rate of Low Birthweight

(%)

Area All NHW NHB H   All NHW NHB H

United States 12.8 11.7 18.5 12.2 8.3 7.3 14.0 7.0

NC 13.6 11.9 19.0 12.0 9.1 7.8 14.2 6.2

Guilford Co 13.3 12.0 15.9 9.9   9.3 7.2 13.3 4.6

HP 2010 goal 7.6 5.0

TimingLevel

Ind

ivid

ual

Com

mu

nit

y

PrenatalPreconception

Postnatal

Opportunities for Intervention

TimingLevel

Current interventions in Guilford Co.

Preconception Prenatal PostnatalIndividual G/HP Pregnancy Care

Center Nurse Family

Partnership Peaceful Beginnings Adopt-A-Mom Improving Prenatal Care Baby Love Plus YWCA Doula

Universal Newborn Home Visits

Kid Konnection

Combined Guilford Coalition on Adolescent Pregnancy Prevention

Maternity Care Coordination

WIC Planned Parenthood Youth Focus:

Transitional Living Program

Community Women’s Resource Center of Greensboro

Fit for Two Boot Camp for New

Dads Teen Parent Mentor

Program at G-YWCA Big brother/Big Sister Community Action for

Healthy Babies Centering Program

Baby and Me Breastfeeding Basics and

Beyond La Leche League Good Beginnings for

Teen Parents Adolescent Parenting

Program at HP-YMCA

Current Intervention: Adopt-A-Mom

• Nationally recognized best practice program• Provides prenatal care for medicaid-ineligible, uninsured

women• Over 3,700 women over 17 years• Outcomes among 2005-2007 participants

• Equates to $738,000 savings in hospitalization costs alone

 Guilford County

AAM participants

% PTB 11.5 4.8% VPTB 3.6 0.6% LBW 9.5 4.3% VLBW 2.1 0.4

Current Intervention: Nurse Family Partnership

• Nationally replicated program• Provides home visitation to low-income first time moms

through the infant’s 2nd birthday; 2005-2007 outcomes:

• Equates to $78,000 savings in hospitalization costs alone (clear underestimate – additional gains)

• National data: NFP costs $4,500/family/year with benefits of ~$34,000/high-risk family; costs recovered by time child turns 4

 Guilford County

Guilford County teens

NFP participants

% PTB 10.9 11.0 8.2% VPTB 3.5 4.1 2.7% LBW 10.0 11.0 10.9% VLBW 2.2 2.3 1.8

Strategic Opportunities

• Lead the public health dialogue on poor pregnancy outcomes

• Support best practice programs with demonstrated success in improving maternal and child health

• Implement formal evaluations to determine the effectiveness of current interventions in Guilford County directed at pregnancy outcomes

Strategic Opportunities

Lead the public health dialogue on poor pregnancy outcomes • Recast the emphasis from infant mortality to poor

pregnancy outcomes• Acknowledge current risk factors and anticipate changing

characteristics among women of child-bearing age

Very preterm birth

Preterm birth

Low birthweight

Very low birthweight

Infant mortality

Strategic Opportunities

Support best practice programs with demonstrated success in improving maternal and child health

• Continue funding of programs like the Nurse Family Partnership and the Adopt-a-Mom programs

• Support programs delivering contraceptive services

• Support preconception and internatal care programs

• Create a clearinghouse for service delivery

Strategic Opportunities

Implement formal evaluations to determine the effectiveness of current interventions in Guilford County directed at pregnancy outcomes

• Formally evaluate existing countywide services• Build evaluation requirements into project design

Questions?