1. Healthy Pregnancy Monica Riccomini, RN, MSN Lisa Lottritz RN, BSN

2. Outline of Today’s Topics Preconception Health Prenatal Health Fetal Infant Mortality Review Case Study Discussion Closing

3. Components of a Healthy Pregnancy Preconception Health Prenatal Health Interconception Health

4. National Objective Healthy People 2000 set a goal of 60% of primary care physicians will provide age-appropriate preconception care Estimated 1 in 4 providers currently provide preconception care

5. Preconception Preconception Health Defined as a women’s health status prior to becoming pregnant Preconception Care Interventions that aim to identify and modify risks to a women’s health or pregnancy outcome through prevention and management

6. Preconception Risk Factors Chronic Health Conditions Obesity Substance Use Smoking Sexual Transmitted Infections Teratogenic Drugs Vaccinations Folic Acid

7. Preconception Interventions Smoking Cessation Folic Acid Supplementation Medication Adjustments Pre-pregnancy Check Up Obesity Control

8. Prenatal Health Prenatal Care Healthy Behaviors Community Resources

9. National Objectives Healthy People 2010 Objective Increase the proportion of pregnant women who receive early and adequate prenatal care to 90% of live births

10. Nevada Data, 2004

11. Pregnancy Weight Gain..\Healthy Pregnancy\INSTITUTE OF MEDICINEappendix.doc

12. Evaluating Interventions Data Pregnancy Risk Assessment Monitoring System (PRAMS) Perinatal Periods of Risk (PPOR) Fetal Infant Mortality Review (FIMR)

13. National Objectives Healthy People 2010 Objective Less than 5 percent of the babies born will be low birth weight and less than 0.9 percent of the babies born will be VLBW

14. Nevada Data, 2004

15. National Objective Healthy People 2010 Objective Reduce fetal deaths to 4.1 per 1,000 live births plus fetal deaths Reduce all infant deaths to 4.5 per 1,000 live births

16. Nevada Data, 2004

17. Fetal Infant Mortality Review FIMR is a process that looks at community level factors related to individual cases of fetal and infant deaths The objective of FIMR is to improve community resources and health delivery systems for women, infants, and families

18. Case Review Team Medical Records Death Certificate Home Interview Community Action Team FIMR

19. Case Study 19 year old African American female Fetal demise at 27 weeks gestation Second pregnancy, living child is 9 months old Pre-pregnancy weight is 192#, height is 5 foot 4 inches Quit smoking when she found out she was pregnant

20. Case Study Started prenatal care at 17 weeks Has been taking multi-vitamin daily since she was 6 weeks pregnant She had gestational diabetes with both pregnancies She had 3 prenatal appointments

21. Case Review Additional information needed Preconception risks Prenatal risks Recommendations

22. Nevada Data, 2004

23. Community Action Team Interventions/Actions

24. Health Care Costs The IOM report estimates preterm birth cost the US more than $26.2 billion in 2005 The average hospital charge for the most severe (premature) babies was $77,000 per stay, compared to $1,700 for an uncomplicated newborn stay

25. Conclusion