Epidemiology of Reproductive and Early Years Our Healthy Future? Epidemiology of Reproductive and Early Years Insert name of presentation on Master Slide Dr Shantini Paranjothy

Overview Teenage pregnancy Risks to a healthy future Birth outcomes Early years (0 – 2) Our Healthy Future?

Teenage pregnancy Pre-term birth OR 1.2 – 1.9 Low birth weight Baby at increased risk of Pre-term birth OR 1.2 – 1.9 Low birth weight OR 1.2 – 1.8 Neonatal mortality OR 1.3 – 2.7 Harm, illness, injuries Behavioural and emotional complications 2 X more likely to have a teen birth Source: Paranjothy et al Arch Dis Child 2009 94: 239-245

Conception rates E & W Source: ONS

Public Health Wales Observatory

Complex social factors Risks to a healthy future Complex social factors Alcohol Illegal drugs Environment Obesity Smoking

Obesity Pre-eclampsia RR 3 Gest diabetes RR 3 Thromboembolism OR 2.6 Baby Mother Pre-eclampsia RR 3 Gest diabetes RR 3 Thromboembolism OR 2.6 Post partum haemorhage RR 4 Stillbirth RR 2 Preterm birth RR 1.2 Intensive care RR 1.5 Large for gestational age RR 2 Source: CEMACE

Obesity

Cigarette smoking Miscarriage OR 1.5 Stillbirth OR 2.O Infant mortality OR 1.8 Prematurity RR 1.3

Cigarette smoking Source: Infant Feeding Survey (2005)

Smoking data in Wales Powys 150 97% 19% Cwm Taf 3,982 96% 21% BCU Health Board Total births Data completeness (%) Smoking prevalence (%) Powys 150 97% 19% Cwm Taf 3,982 96% 21% BCU 6,858 89% 17% Hywel Dda 3,254 86% 11% ABMU 6,050 27% 2% CVU 6,031 5% 98% AB 5,928 0.5% 13% Source: NCCHD 2009

Alcohol Source: Infant Feeding Survey (2005) Outcomes: Miscarriage, chromosomal abnormalities, disordered fetal growth, perinatal death and susceptibility to disease in later life

Birth Outcomes Our Healthy Future?

Stillbirth Our Healthy Future?

Cause of stillbirth (AWPS 2005-09) Antepartum haemorrhage (8.5%) Congenital anomaly (15.2%) Maternal disorder (6.1%) Mechanical (4.8%) Pre-eclamspia (3.0%) Unexplained (57.4%) Our Healthy Future?

Preterm birth <36 weeks Source: AWPS and NCCHD Our Healthy Future?

Inequalities in preterm birth <36 weeks Source: AWPS and NCCHD Our Healthy Future?

Low birth weight <2500g Source: AWPS and NCCHD Our Healthy Future?

Birth weight > 4000g Source: AWPS and NCCHD Our Healthy Future?

Infant mortality Our Healthy Future?

Public Health Wales Observatory

Causes of infant mortality Preterm birth (35%) Congenital anomaly (21%) Sudden unexplained death in infancy (11%) Infection (11%) Intrapartum events (9%) Our Healthy Future?

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Early Years (0-2) Our Healthy Future?

Breastfeeding Our Healthy Future?

Complex social factors Illegal drug use Benefits Unemployment Homeless Domestic violence Our Healthy Future?

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Insert name of presentation on Master Slide

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Conclusion Inequalities persist Some risk factors and outcomes not e-captured What should be done? How will we know its making a difference? Can surveillence make a difference?

Is my future bright?