1. Perinatal Health: From a women’s health lifespan perspective Diana Cheng, M.D. Medical Director, Women’s Health Center for Maternal and Child Health 1

2. Routine Prenatal Care Nutrition, fitness, smoking cessation, substance use, medical screen, folic acid, immunization, toxic exposures, health coverage 2

3. Routine Prenatal Care Nutrition, fitness, smoking cessation, substance use, medical screen, folic acid, immunization, toxic exposures, health coverage 3

4. “Preconception” Women’s Health Nutrition, fitness, smoking cessation, substance use, medical screen, folic acid, immunization, depression, toxic exposures, health coverage, plan pregnancy 4

5. What is the most common known cause of infant low birth weight? 5

6. Prenatal Cigarette Smoking Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 6

7. Smoking Before, During and After Pregnancy, Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 7

8. Smoking Before, During and After Pregnancy, Maryland 2004-2008 BRFSS 2006 18% Source: Maryland PRAMS 2004-2008 8

9. Preconception Cigarette Smoking Source: Maryland PRAMS 2004-2008 9

10. What is the most common known preventable cause of mental retardation? 10

11. Prenatal Binge Drinking Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 11

12. Prenatal Alcohol Use Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 12

13. Alcohol Use Before and During Pregnancy, Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 13

14. Preconception Alcohol Use Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 14

15. Preconception Binge Drinking Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 15

16. What is the leading cause of non- obstetric hospitalization for females aged 18-44? Source: Maryland HSCRC 2006-2007 16

17. Postpartum Depression Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 17

18. What is the leading cause of death during pregnancy and postpartum? Source: Maryland Vital Statistics Administration 1993-2008 18

19. Prenatal Physical Abuse Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 19

20. Preconception Physical Abuse Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 20

21. What is the most common chronic medical disorder during pregnancy? 21

22. Preconception Asthma Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 22

23. Preconception Diabetes Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 23

24. Preconception Hypertension Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 24

25. Preconception BMI >25 Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 41 32 4243 45 25

26. Preconception BMI <18.5 Maryland, 2004-2008 Source: Maryland PRAMS 2004-2008 26

27. Preconception Risk Factors Maryland 2004-2008 All: race/ethnicityBlack Non-Hispanic Source: Maryland PRAMS 2004-2008 27

28. Preconception Risk Factors Maryland 2004-2008 All agesAge 20-24 Source: Maryland PRAMS 2004-2008 28

29. Private Insurance: Preconception, Prenatal, Delivery, Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 29

30. Preconception: No Private Health Insurance, Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 30

31. No Preconception and Prenatal Routine Dental Cleaning, Maryland 2004-2007 Source: Maryland PRAMS 2004-2007 31

32. Unintended Pregnancy Maryland 2004-2008 Source: Maryland PRAMS 2004-2008 32

33. 33 Summary Risk factors prevalent among young women – Chronic medical disorders – Obesity – Substance abuse and cigarette smoking – Depression – Abuse – Unintended pregnancy – Access to care, including oral health – Co morbidities Women’s health/preconception/interconception – Prenatal care gap Always misses 1 st month of pregnancy Not enough time to impact many health behaviors – Start young – Include boys, men, families, communities

34. Priorities Identified by Stakeholder Survey: Women’s and Perinatal Health Unintended pregnancy and need for family planning/reproductive health services Lack of health insurance coverage for women of childbearing age and pregnant women Access to early and adequate prenatal care Infant mortality and related factors (prematurity, low birth weight, disparities, SIDS/SUDIs) Early identification of pregnant women and infants at risk (home visiting) Mental health services, increasing need to services, access to screening, treatment services for women of childbearing age and pregnant women; depression, including postpartum) Breastfeeding—increasing initiation and continuation; disparities; workplace support Substance use/abuse among women of childbearing age and during pregnancy— cigarettes, alcohol, illegal drugs; affects on newborns; access to treatment and services; increasing prescription drug addiction Women’s wellness —Access to primary, preconception, and inter-conception care, including oral health services; life course perspective More male involvement and fatherhood initiatives needed; greater recognition of the importance of fathers 34