1. Healthy Babies are Worth the Wait ®: Preventable Preterm Births Katrina Thompson, BS, MSW State Director Of Program Services March of Dimes Kentucky Chapter Kadams-thompson@marchofdimes.com

2. A Collaborative Partnership The “Prematurity Prevention Partnership”: –March of Dimes –Johnson & Johnson Pediatric Institute –Kentucky Department for Public Health Kentucky Chapter Professional Organizations (ACOG, AAP, AWHONN) Kentucky Perinatal Leaders

3. Healthy Babies are Worth the Wait ® Prevent “preventable” preterm births in target areas of Kentucky Three-year Initiative (2007-2009) in partnership with Johnson & Johnson Pediatric Institute and Kentucky Department for Public Health Evidence-based interventions -clinical -public health Focus on late preterm birth (34-36 weeks) Targets both perinatal providers and childbearing women System of collaboration between clinical and public health leadership

4. Healthy Babies are Worth the Wait ® Hospital Sites

5. Interventions “Bundled” Evidence-Based Interventions Linked elements of clinical care, public health and consumer education: –Consumer Awareness and Education Health literacy in context of prenatal care Community outreach –Professional Continuing Education Grand Rounds & Training –Public Health Intervention Augmenting existing services for case management, screening & referral –Clinical Intervention in Prenatal Period Standard clinical guidelines (folic acid, smoking cessation, progesterone) Patient safety

6. What Pregnant Women Can Do to Help Prevent Preterm Birth What Pregnant Women Can Do to Help Prevent Preterm Birth Messages for pregnant women (and women of childbearing age) Some preterm births—especially late preterm—could be prevented if all pregnant women: –Get early, regular prenatal care –Quit smoking or at least cut back and avoid secondhand smoke –Avoid all alcohol –Take folic acid daily before, during and between pregnancies –Pay careful attention to good nutrition and eat a balanced diet with lots of fruits and vegetables –Gain only the weight recommended by your health care provider –Receive timely and appropriate treatment for existing medical conditions such as diabetes, high blood pressure, thyroid disease, addictions, and all infections including STIs –Take good care of their teeth--brush, floss, and visit a dentist regularly –Try to avoid stress and ask for help from their health care provider or support person to manage stressful situations in your life –Question the reason to schedule any delivery before 39 weeks unless there are medical reasons for an early delivery –Avoid elective induction or elective cesarean delivery including cesarean delivery on maternal request before 39 weeks –Talk to their doctor if you have a history of spontaneous preterm labor or birth and are carrying a single baby about possible receiving progesterone to help prevent another preterm delivery

7. What Communities Can Do to Help Prevent Preterm Birth What Communities Can Do to Help Prevent Preterm Birth Messages for the community Preterm birth has consequences for many facets of our communities, including school systems, employers and insurers Make preventing preterm birth a priority in each community, as it will result in healthier babies, children, future parents and less chronic disease in all residents Visit and use materials from the Healthy Babies Are Worth the Wait website www.prematurityprevention.orgwww.prematurityprevention.org Do not smoke around pregnant women, babies or children Host a Healthy Babies Are Wroth the Wait Prematurity Prevention awareness session where participants learn about preterm birth and how they can help to make a difference in their community Raise awareness of services and resources available to pregnant women and their families from the local clinical sites and the health department Work together on this leading public health problem as everyone can make a difference for the health of families in Kentucky

8. Barriers (due to dynamic conditions contributing to preterm birth) high rates of high risk factors (such as smoking, abuse of pain medication/oxycodone, illicit drug use, stress, infections, obesity) significant changes in the culture of childbearing by pregnant women (scheduling deliveries, CDMR) significant changes in obstetrical management with more inductions, cesareans and other procedures contributing to higher rates of iatrogenic late preterm birth changes in health care delivery systems, reimbursement structures and a litigious environment for obstetrical care These barriers are being overcome by successful implementation of the components of HBWW and with the close collaboration and guidance of key leadership in clinical, public health and communications/media. A focus on patient safety protocols is being implemented in year 2.

9. Consumer Survey: Methodology Snapshot KAB (knowledge, attitudes, beliefs/reported behaviors) survey –39-item core questionnaire –14-item optional supplement Questions from PRAMS, BRFSS, and MOD surveys Original questions specific to needs of HBWW interventions Focus groups and pilot testing Anonymous, voluntary, convenience sampling Analysis done in SPSS® WHO?Pregnant women presenting for prenatal care WHAT?Questions assessing KAB regarding pregnancy and childbirth WHEREIntervention and comparison sites (clinics, centering classes, private offices) WHEN? January-May, 2007

10. SiteCoreSupplemental Int. Site 1289278 Int. Site 2337101 Int. Site 313923 Comp. Site 19388 Comp. Site 215163 Comp. Site 35748 Total1066601 English: 91.8% Spanish: 8.2% RESULTS Baseline consumer surveys

11. Demographic Characteristics HBWW Consumer Survey Respondents Maternal Age <20 years14% 20-34 years77% 35+ years6% mean +/- sd 25.3 +/- 5.401 range 14-45 Race White80% Black9% Hispanic Ethnicity Yes9% Marital Status Married54% Single/partner20% Single22% Maternal Education <HS18% HS26% Some College38% Bachelors14% Payor Medicaid50% Private35% Self3%

12. Of women in their 3 rd trimester, 66% reported that their hcp had discussed the signs and symptoms of preterm labor with them. Of the 24% of pregnant women who had a previous preterm birth, 13% reported that their providers had discussed progesterone with them in their current pregnancy. Obstetrical-Related Factors HBWW Consumer Survey Respondents Previous C/S None63% 121% 27% 3+2% range0-4 Inductions None42% 138% 2+10% range 0-6 Trimester 1st9% 2nd28% 3rd59% Planned Preg39% Previous Births None41% 131% 216% 3+11% mean +/- sd1.02 +/- 1.129 range 0-6 Previous Preterm None71% 117% 2+7% mean +/- sd0.35 +/- 0.709 range0-5 Multiple Birth2.5%

13. Prematurity KAB 79% could give an acceptable answer on how to explain prematurity to a friend Causes of preterm birth? High risk conditions (38%) High risk behaviors (25%) Stress (9%) How serious is preterm birth in your community? Very serious14% Somewhat serious23% Not at all7% Not sure54% How serious if your baby is born 3 weeks early? Very serious2% Serious11% Somewhat serious41% Not really42%

14. Percent Periconceptional Vitamin Use by Women of Childbearing Age HBWW Consumer Survey 2007

15. www.marchofdimes.com/peristats Percent Behavioral Risk Factors: Smoking by Women of Childbearing Age HBWW Survey 38% of respondents reported that at least 1 smoker lived in their home

16. Percent Other Risk Factors for Preterm Birth HBWW Consumer Survey, 2007

17. Percent Cesarean Delivery KAB HBWW Consumer Survey, 2007 30 35 33

18. Reduction of singleton LPTB rate Reduction in elective inductions and sections conducted prior to 39 weeks gestation Increase in baby’s average days of gestational age and birth weight Reduction in neonate’s length of hospital stay Reduction in hospital cost / charges associated with preterm births Positive change in consumer and provider knowledge, attitudes, and behaviors regarding PTB More information: www.prematurityprevention.org Goal: reduction of singleton PTB rate by 15% in Intervention Sites

19. Source: KY Dept pf Health Prepared by the March of Dimes Perinatal Data Center, 2007 Singleton Preterm Birth Rates by Hospital of Delivery, Kentucky, 2004

20. www.prematurityprevention.org

22. Take Home Message- You Can Prevent Some Preterm Births The overall message is that despite years of research and programs to attempt to reduce preterm birth, the rates continue to rise reaching an all time high of 12.7% for the US and 15% for KY in 2005. However, since most of this increase is due to the rising rates of late preterm birth (34-36 weeks) a thorough understanding of contributing modifiable risk factors and an innovative program to address local issues driven by timely local information can begin to reduce these seemingly run away rates and in doing improve health by decreasing morbidity and mortality for infants, children and ultimately adults.

23. “Because this is a real-world model, and focuses on education and enhancing existing systems of care, we anticipate that it will be feasible to implement the lessons learned statewide. We are confident this initiative will improve the lives of mothers and babies.” Dr. Ruth Ann Shepherd Director, Adult and Child Health Improvement Kentucky Department for Public Health

24. March of Dimes Late Preterm Resources Consumer Brochure Why the Last Weeks of Pregnancy Count Provider Brochures Late-preterm Brain Development Card Describes a baby’s growth and development and tells women why it’s important not to schedule an induction or c-section before 39 wks of pregnancy Buy 2 packages of Why the Last Weeks of Pregnancy Count (#37-2209-07) and get 1 free package of the Late-preterm Brain Development Card (#37-2229-07). The promotion expires on 12/31/08 and the promotion code is NACHWEB08. Call 1-800-367-6630 Teaching tool for providers to use with pregnant women. Illustrates the differences in brain development at 35 and 40 weeks of pregnancy