1. Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes Lilian Peake, MD, MPH Charlottesville-Albemarle Health Department October 22, 2008

2. Infant Mortality Albemarle, Charlottesville and Virginia 1995-2006

3. Infant Mortality by Race Albemarle and Charlottesville 1995-2005

4. Infant Mortality Among Black Infants TJHD, Virginia, U.S. 1998-2004

5. Top 5 Causes of Infant Mortality TJHD, 2002-2006 Source: Division of Womens and Infants Health, Virginia Department of Health

6. Congenital Malformations (Birth Defects) Source: Division of Womens and Infants Health, Virginia Department of Health

7. What are the most common birth defects? Down Syndrome Heart defects Neural tube defects Metabolic disorders - –e.g. Tay-Sachs disease Musculoskeletal defects Gastrointestinal defects

8. What causes birth defects? Genetics Alcohol Certain drugs - e.g., Accutane, cocaine Certain Infections - e.g., syphilis Certain chemicals Insufficient amounts of folate Multifactorial Causes of 70% are unknown

9. How can women reduce their risk of having a baby with a birth defect? Have a preconception visit with healthcare provider –Health history/genetic counseling Take folate vitamin (all women of child bearing age) Avoid drinking alcohol, smoking and using drugs Avoid medications without first checking with healthcare provider Avoid changing cats litter box and eating raw and undercooked meats (infection with toxoplasmosis)

10. Low Birth Weight Source: Division of Womens and Infants Health, Virginia Department of Health

11. Percent of Low Weight (<2500g) Births Albemarle, Charlottesville, Virginia 1997-2004

12. Percent of Low Weight Births for Black Infants Charlottesville-Albemarle, Virginia, U.S. 1997-2004

13. What causes low birth weight? Birth defects Mom has chronic health problems –e.g., high blood pressure, diabetes Mom smokes while pregnant Mom drinks alcohol or uses illicit drugs while pregnant Infections in mom or fetus –Rubella, chickenpox, toxoplasmosis Socioeconomic factors –Income, moms education

14. How can women reduce their risk of having a baby that has a low birth weight? Have a preconception check-up –Folate; treat chronic medical conditions; health history Receive early and regular prenatal care Get help to stop smoking Do not drink alcohol or use illegal drugs Learn about signs and symptoms of preterm labor and call healthcare provider if develop them

15. % of Infant Deaths by Number of Prenatal Visits TJHD, 2002-2006 Source: Division of Womens and Infants Health, Virginia Department of Health

16. Percent of Births With >10 Prenatal Visits Albemarle and Charlottesville,1999-2004

17. Local Barriers to Prenatal Care Study of Medicaid-eligible moms who delivered at UVA between Dec. 2007 and Feb. 2008 Phone survey Only able to reach 32 of the 125 moms –Mean age = 25 (18-38) –50% graduated from high school –78% had not planned pregnancy –97% received some prenatal care (4-20 visits) –78% not married

18. Local Barriers to Prenatal Care Difficulty making appointments –Long lag time in getting first appointment –Multiple steps –Mailed appointment time (in English) rather than scheduling by phone Transportation problems Problems communicating with healthcare providers Feeling too sick to go to appointment

19. No 1 st Trimester Prenatal Care and Low Birth Weight City of Charlottesville, 1990-2006 The Meadows North Downtown Rose Hill 10 th & Page Locust Grove Greenbrier Barracks Rugby Barracks Road Lewis Mountain Venable Belmont Woolen Mills Martha Jefferson Ridge St. Fifeville Johnson Village Frys Spring Jefferson Park Ave. Starr Hill

20. Births To Mothers With Less Than 12 th Grade Education, Albemarle, Charlottesville, and Virginia 2002-2005

21. Frys Spring Ridge St. Belmont Barracks/ Rugby Greenbrier 10 th & Page Venable Locust Grove Ridge St. Belmont 10 th & Page Greenbrier Barracks/ Rugby

22. Black Mothers Education Less than 12 Years South Barracks/Rugby 54% (26) Ridge St./North area 51% (399) 10th and Page 44.36% (266) Central Frys Spring 44% (25) Southwest Belmont 42% (19) Ridge St./South 42% (236) Southeast Venable 40% (75)

23. Teen Pregnancy Rate Albemarle, Charlottesville, and Virginia 3-Year Rolling Averages, 1997-2005

24. SIDS Source: Division of Womens and Infants Health, Virginia Department of Health

25. What is SIDS? Sudden, unexplained infant deaths –Cause of death is unknown –Not due to a chronic disease or illness After the cause of death has been determined, infant deaths that were initially classified as sudden, unexplained infant death can be referred to as sudden, unexpected infant deaths (SUID)

26. Causes of SUID Accidental suffocation or strangulation Accidental poisoning Obstruction of respiratory tract Accidental falls Neglect, abandonment and other maltreatment syndromes Assault and homicide Other symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified - unknown cause, or unexplained heart or breathing failure

27. How can families reduce the risk of SIDS? Put your baby on her back to sleep Dont put baby on soft sleep surfaces and avoid loose bedding –Waterbed, couch, sofa, or pillows, or sleeping with stuffed toys Dont let your baby become overheated while sleeping Dont smoke during pregnancy and dont let anyone smoke around your baby Dont let the baby sleep in your bed

28. Questions?

29. Neonatal Death Rate (<28 Days) Albemarle, Charlottesville and Virginia 1995-2005