1. Incorporating Preconception Health into MCH Services
Emerging Issues in MCH
Debra Bara MA
Incorporating Preconception Health into MCH Services
PPOR

2. Perinatal Periods of Risk Practice Collaborative
Sponsored by CityMatCH, UNMC
Partners included
National Offices of
March of Dimes
Centers for Disease
Control and Prevention

3. Practice Collaborative Members
Teams from 16 cities that included:
Policy Representative
Data Representative
Community Representative
Met to “refine the practice” of PPOR and adapt for use in urban cities in industrialized country.

4. OVERVIEW Perinatal Periods of Risk
Both a DATA ANALYSIS TOOL and an APPROACH to identify critical gaps in the maternal and child health system that lead to infant mortality.

5. OVERVIEW PPOR Differs from conventional analysis
In addition to AGE AT DEATH, PPOR takes into account the BIRTH WEIGHT, an equally important predictor of survivability.

6. OVERVIEW PPOR differs from conventional analysis:
Utilizes LINKED birth and death records, which allows investigators to sort and study variables on the birth certificates, which is generally more complete that death certificate records alone.

7. OVERVIEW PPOR differs from conventional analysis
Combines fetal and infant deaths in a “feto-infant” death rate.
Includes fetal deaths as over 24 weeks, live births greater than 500 grams, (excluding spontaneous and induced abortions)
Ensures comparability of data (reference group)

8. OVERVIEW
Feto-infant mortality rates are “mapped” according to the time of death and weight
Age at death
Fetal 24+ wks.
Neonatal
Postneonatal
Birth
Weight
Maternal Health
Maternal
Care
Newborn
Care
Infant
Health

9. Maternal Health/ Prematurity
DATA LEADS TO ACTION !
Maternal Health/ Prematurity
Preconception Health
Health Behaviors
Perinatal Care
Prenatal Care
High Risk OB Referrals
Insurance Coverage
Maternal Care
Perinatal Management
Neonatal Care
Pediatric Surgery
These labels suggest preventive action. For Maternal Health and Prematurity, prevention may need to focus on preconceptional health, unintended pregnancy, smoking, drug abuse, and specialized perinatal care. For Maternal Care, prevention may need to focus on early continuous prenatal care, referral of high risk pregnancies and good medical management of diabetes, seizures, post maturity or other medical problems. For newborn care, the focus may need to be advanced neonatal care and treatment of congenital anomalies. And for infant health, communities may need to focus on SIDS prevention like sleep position or breast feeding, access to a medical home and injury prevention.
Newborn Care
Sleep Position
Breast Feeding
Injury Prevention
Infant Health

10. Maternal Health Risk Factors
Infection
Stress and Work
General state of health prior to pregnancy
Injuries and abuse
Family planning
Nutrition
Tobacco/alcohol/drug use
Previous pregnancy outcomes

11. Maternal Care Risk Factors
Tobacco/alcohol/drug use during pregnancy
Lack of recognition of problems needing care
Recognition/management of early labor
Obesity
Nutrition during pregnancy
Late/inadequate PNC
Treatment of infection
Poor weight gain

12. Newborn Care Risk Factors
Availability of neonatal intensive care
Prevention of infection
Recognition of emergency situation
Obstetric expertise
Pediatric expertise
Regular newborn care including feeding/well baby care.

13. Infant Health Risk Factors
Prevention & treatment of infection
Recognition of birth defects/developmental anomalies
Prevention/treatment of injuries
Recognition of signs & symptoms of illness
Failure to obtain well-child care or follow-up for illness
SIDS prevention

14. What it tells us Opportunity gaps
Uses a “comparison group” model to quantify the specific opportunity to improve
United States “reference group” is white women, 13+ years of education, over 20 years of age, married.

15. Common Finding across Cities
Maternal Health was greatest opportunity for improvement
Infant Health was most frequent second opportunity
Often documented racial disparity issues as occurring in Maternal Health Cell
Maternal care in some area, newborn care in

16. National PPOR Rates by Race/Ethnicity, by Period of Risk Components, for Resident Mothers 20+ years age, 13+ years of education in US, (Table 6.3)

17. Implications
Changes in Practice Program & Policy

18. PRACTICE
EXAMPLES-Integrating pre and interconceptional care into existing services
Family Planning Clinics
Home Visitation services
Developing risk screening process for non-pregnant population of women
Incorporating physical health assessment, screening for diabetes, high blood pressure

19. Program- EXAMPLE Healthy Start Home Visitation Services
Risk assessment
Women’s Health questionnaire-25 questions
Access to Health Care, Maternal Infections, Baby Spacing
Nutrition & Physical Activity
Chronic Health Issues
Stress & Mental Health
Environmental Health
Interventions
Home Visitation Staff linking non-pregnant patients to:
Smoking cessation services
Domestic violence prevention, MH services, including drug treatment
Health Care

20. Policy Answer questions “who do we serve & how?”
What programs need to be organizationally connected for optimum service to women throughout the life span?
Funding Implications
Research Implications