healthy pregnancy

Healthy Pregnancy

Monica Riccomini, RN, MSNLisa Lottritz RN, BSN

Outline of Today’s Topics

Preconception HealthPrenatal HealthFetal Infant Mortality ReviewCase StudyDiscussionClosing

Components of a Healthy Pregnancy

Preconception Health

Prenatal Health

Interconception Health

National Objective

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

Preconception

Preconception HealthDefined as a women’s health status prior to becoming pregnant

Preconception CareInterventions that aim to identify and modify risks to a women’s health or pregnancy outcome through prevention and management

Preconception Risk Factors

Chronic Health ConditionsObesitySubstance UseSmokingSexual Transmitted InfectionsTeratogenic DrugsVaccinationsFolic Acid

Preconception Interventions

Smoking Cessation Folic Acid SupplementationMedication AdjustmentsPre-pregnancy Check UpObesity Control

Prenatal Health

Prenatal Care

Healthy Behaviors

Community Resources

National Objectives

Healthy People 2010 ObjectiveIncrease the proportion of pregnant women who receive early and adequate prenatal care to 90% of live births

Nevada Data, 2004

Early and Adequate Prenatal Care, 2004

67.4 66.1 67.158.6 56.8

90.073.3

70.253.8

0.0

20.0

40.0

60.0

80.0

100.0

HP 2010 NV Washoe Clark Rural

Geographic Area

% o

f W

om

en

Re

ce

ivin

g

Pre

na

tal C

are

1st Trimester

Adequate PNC

Pregnancy Weight Gain

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Evaluating Interventions

Data

Pregnancy Risk Assessment Monitoring System (PRAMS)

Perinatal Periods of Risk (PPOR)

Fetal Infant Mortality Review (FIMR)

National Objectives

Healthy People 2010 ObjectiveLess 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

Nevada Data, 2004

% LBW and VLBW in Nevada, 2004

8.0 7.68.2

1.4

5.0

6.6

0.9 1.3 1.1 0.9

0.0

2.0

4.0

6.0

8.0

10.0

HP 2010 NV Washoe Clark Rural

Geographic Area

% L

BW

an

d V

LB

W

LBW

VLBW

National Objective

Healthy People 2010 ObjectiveReduce fetal deaths to 4.1 per 1,000 live births plus fetal deathsReduce all infant deaths to 4.5 per 1,000 live births

Nevada Data, 2004

4.1 4.5

7.036.2

7.94

3.8

6.92 6.96.48

5.1

012345678

Per 1,000 Live Births

HP 2010 Nevada Washoe Clark Rural

Geographic Area

Fetal and Infant Mortality, 2004

Fetal Deaths (Live Births Plus FetalDeaths)

Infant Deaths

Fetal Infant Mortality Review

FIMR is a process that looks at community level factors related to individual cases of fetal and infant deathsThe objective of FIMR is to improve community resources and health delivery systems for women, infants, and families

Case Review Team• Medical Records• Death Certificate• Home Interview

Community Action Team

FIMR

Case Study

19 year old African American femaleFetal demise at 27 weeks gestationSecond pregnancy, living child is 9 months oldPre-pregnancy weight is 192#, height is 5 foot 4 inchesQuit smoking when she found out she was pregnant

Case Study

Started prenatal care at 17 weeksHas been taking multi-vitamin daily since she was 6 weeks pregnantShe had gestational diabetes with both pregnancies She had 3 prenatal appointments

Case Review

Additional information neededPreconception risksPrenatal risksRecommendations

Nevada Data, 2004

Fetal Death Rate, 2004

7.56

0.00

14.71

20.55

13.02

6.78

0.00

5.00

10.00

15.00

20.00

25.00

Caucasian AfricanAmerican

NativeAmerican

Asian Hispanic Unknown

Race and Ethnicity

De

ath

Ra

te, P

er

1,0

00

Liv

e

Bir

ths

Source: State of Nevada Vital Statistics

Community Action Team

Interventions/Actions

Health Care Costs

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

Conclusion