1. Strategic Opportunities for Improving Pregnancy Outcomes in Guilford County Marie Lynn Miranda, PhD Sharon Edwards, MS 31 August 2009

2. 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

3. PPO are a Significant Problem in GC 2003-2007 #% Total births29,973 IM 264 0.9 PTB 3,46111.6 VPTB 1,085 3.6 LBW 2,809 9.4 VLBW 616 2.1 Any adverse outcome 4,23114.1

4. 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 1993-19971998-20022003-2007 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

5. 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# admissions Total days Total charges Mean # of days Mean charge Premature birth7269,08616,983,9781323,394 Problem birth/full term 1,1194,2266,445,32645,760 Normal newborn4,5389,9024,315,1942951 Total6,38323,21427,744,498

6. 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 (%) AreaAllNHWNHBH AllNHWNHBH United States12.811.718.512.28.37.314.07.0 NC13.611.919.012.09.17.814.26.2 Guilford Co13.312.015.99.9 9.37.213.34.6 HP 2010 goal7.65.0

7. Timing Level Individual Community PrenatalPreconceptionPostnatal Opportunities for Intervention

8. Timing Level Current interventions in Guilford Co. PreconceptionPrenatalPostnatal Individual  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

9. 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 % PTB11.5 4.8 % VPTB 3.6 0.6 % LBW 9.5 4.3 % VLBW 2.1 0.4

10. Current Intervention: Nurse Family Partnership Nationally replicated program Provides home visitation to low-income first time moms through the infant’s 2 nd 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

11. 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

12. 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

13. 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

14. 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

15. Questions?