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Healthy Pregnancy. Monica Riccomini, RN, MSN Lisa Lottritz RN, BSN. Outline of Todays Topics. Preconception Health Prenatal Health Fetal Infant Mortality Review Case Study Discussion Closing. Components of a Healthy Pregnancy. Preconception Health Prenatal Health - PowerPoint PPT Presentation

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  • Healthy PregnancyMonica Riccomini, RN, MSNLisa Lottritz RN, BSN

  • Outline of Todays TopicsPreconception HealthPrenatal HealthFetal Infant Mortality ReviewCase StudyDiscussionClosing

  • Components of a Healthy PregnancyPreconception Health

    Prenatal Health

    Interconception Health

  • National ObjectiveHealthy 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

  • PreconceptionPreconception HealthDefined as a womens health status prior to becoming pregnantPreconception CareInterventions that aim to identify and modify risks to a womens health or pregnancy outcome through prevention and management

  • Preconception Risk FactorsChronic Health ConditionsObesitySubstance UseSmokingSexual Transmitted InfectionsTeratogenic DrugsVaccinationsFolic Acid

  • Preconception InterventionsSmoking Cessation Folic Acid SupplementationMedication AdjustmentsPre-pregnancy Check UpObesity Control

  • Prenatal HealthPrenatal Care

    Healthy Behaviors

    Community Resources

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

  • Nevada Data, 2004

    Chart5

    9090

    67.3558.56

    73.2970.24

    66.1456.75

    67.0553.83

    1st Trimester

    Adequate PNC

    Geographic Area

    % of Women Receiving Prenatal Care

    Early and Adequate Prenatal Care, 2004

    Birth Weight

    Geographic Area% LBW% VLBW

    HP 20105.00.9

    NV8.01.3

    Washoe7.61.1

    Clark8.21.4

    Rural6.60.9

    Birth Weight

    LBW

    VLBW

    Geographic Area

    % LBW and VLBW

    % LBW and VLBW in Nevada, 2004

    Alcohol

    Geographic AreaAll LiveLBW

    HP 2010

    NV1.110.1

    Washoe1.66.2

    Clark1.112.1

    Rural1.03.0

    Alcohol

    1

    LBW

    VLBW

    Geographic Area

    % LBW

    % LBW in Nevada, 2004

    Prenatal Care

    HP 2010HP 2010

    1.110.08

    1.476.17

    1.0512.09

    0.943.03

    All Live

    LBW

    Geographic Area

    % Alcohol Use

    Maternal Alcohol Use Among Live Births and Low Birth Weight Infants, 2004

    Teen Births

    Geographic Area1st TrimesterAdequate PNC

    HP 201090.090.0

    NV67.458.6

    Washoe73.370.2

    Clark66.156.8

    Rural67.153.8

    Teen Births

    1st Trimester

    Adequate PNC

    Geographic Area

    % of Women Receiving Prenatal Care

    Early and Adequate Prenatal Care, 2004

    Infant Mortality

    Geographic AreaBirth Rate

    HP 2010

    NV47.6

    Washoe42.7

    Clark50.0

    Rural41.0

    Infant Mortality

    Teen Births

    VLBW

    Geographic Area

    Teen Birth Rate per 1,000 females (15-19)

    Teen Births (15-19), 2004

    Tobacco

    Geographic AreaRate/1000 Births

    HP 20104.5

    NV5.6

    Washoe5.7

    Clark5.9

    Rural3.2

    Tobacco

    LBW

    VLBW

    Geographic Area

    Infant Mortality Per 1,000 Live Births

    Infant Mortality, 2004

    LBW

    Geographic AreaAll LiveLBW

    HP 2010

    NV8.112.1

    Washoe9.412.5

    Clark6.812.3

    Rural16.111.0

    LBW

    All Live

    LBW

    Geographic Area

    % Tobacco Use

    Maternal Tobacco Use Among Live Births and Low Birth Weight Infants, 2004

    Indicator8

    Geographic Area% LBW% VLBW

    HP 20105.03.0

    National7.64.5

    NV8.15.1

    Washoe7.74.8

    Clark8.45.4

    Rural6.94.3

    Indicator8

    LBW

    VLBW

    Geographic Area

    % LBW

    % LBW in Nevada, 2004

    Sheet2

    Geographic Area% LBW% VLBW

    HP 20105.03.0

    National7.64.5

    NV8.15.1

    Washoe7.74.8

    Clark8.45.4

    Rural6.94.3

    Sheet2

    LBW

    VLBW

    Geographic Area

    % LBW

    % LBW in Nevada, 2004

    Sheet3

  • Pregnancy Weight Gain..\Healthy Pregnancy\INSTITUTE OF MEDICINEappendix.doc

  • Evaluating InterventionsData

    Pregnancy Risk Assessment Monitoring System (PRAMS)

    Perinatal Periods of Risk (PPOR)

    Fetal Infant Mortality Review (FIMR)

  • National ObjectivesHealthy 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

    Chart4

    50.9

    7.961.25

    7.551.05

    8.231.35

    6.640.85

    LBW

    VLBW

    Geographic Area

    % LBW and VLBW

    % LBW and VLBW in Nevada, 2004

    Birth Weight

    Geographic Area% LBW% VLBW

    HP 20105.00.9

    NV8.01.3

    Washoe7.61.1

    Clark8.21.4

    Rural6.60.9

    Birth Weight

    LBW

    VLBW

    Geographic Area

    % LBW and VLBW

    % LBW and VLBW in Nevada, 2004

    Alcohol

    Geographic AreaAll LiveLBW

    HP 2010

    NV1.110.1

    Washoe1.66.2

    Clark1.112.1

    Rural1.03.0

    Alcohol

    1

    LBW

    VLBW

    Geographic Area

    % LBW

    % LBW in Nevada, 2004

    Prenatal Care

    HP 2010HP 2010

    1.110.08

    1.476.17

    1.0512.09

    0.943.03

    All Live

    LBW

    Geographic Area

    % Alcohol Use

    Maternal Alcohol Use Among Live Births and Low Birth Weight Infants, 2004

    Teen Births

    Geographic Area1st TrimesterAdequate PNC

    HP 201090.090.0

    NV67.458.6

    Washoe73.370.2

    Clark66.156.8

    Rural67.153.8

    Teen Births

    1st Trimester

    Adequate PNC

    Geographic Area

    % of Women Receiving Prenatal Care

    Early and Adequate Prenatal Care, 2004

    Infant Mortality

    Geographic AreaBirth Rate

    HP 2010

    NV47.6

    Washoe42.7

    Clark50.0

    Rural41.0

    Infant Mortality

    Teen Births

    VLBW

    Geographic Area

    Teen Birth Rate per 1,000 females (15-19)

    Teen Births (15-19), 2004

    Tobacco

    Geographic AreaRate/1000 Births

    HP 20104.5

    NV5.6

    Washoe5.7

    Clark5.9

    Rural3.2

    Tobacco

    LBW

    VLBW

    Geographic Area

    Infant Mortality Per 1,000 Live Births

    Infant Mortality, 2004

    LBW

    Geographic AreaAll LiveLBW

    HP 2010

    NV8.112.1

    Washoe9.412.5

    Clark6.812.3

    Rural16.111.0

    LBW

    All Live

    LBW

    Geographic Area

    % Tobacco Use

    Maternal Tobacco Use Among Live Births and Low Birth Weight Infants, 2004

    Indicator8

    Geographic Area% LBW% VLBW

    HP 20105.03.0

    National7.64.5

    NV8.15.1

    Washoe7.74.8

    Clark8.45.4

    Rural6.94.3

    Indicator8

    LBW

    VLBW

    Geographic Area

    % LBW

    % LBW in Nevada, 2004

    Sheet2

    Geographic Area% LBW% VLBW

    HP 20105.03.0

    National7.64.5

    NV8.15.1

    Washoe7.74.8

    Clark8.45.4

    Rural6.94.3

    Sheet2

    LBW

    VLBW

    Geographic Area

    % LBW

    % LBW in Nevada, 2004

    Sheet3

  • National ObjectiveHealthy 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

    Chart1

    4.14.5

    7.036.2

    7.943.8

    6.926.9

    6.485.1

    Fetal Deaths (Live Births Plus Fetal Deaths)

    Infant Deaths

    Geographic Area

    Per 1,000 Live Births

    Fetal and Infant Mortality, 2004

    Fetal and Infant Mortality

    Geographic AreaFetal Deaths (Live Births Plus Fetal Deaths)Infant Deaths

    HP 20104.14.5

    Nevada7.036.2

    Washoe7.943.8

    Clark6.926.9

    Rural6.485.1

    Fetal and Infant Mortality

    Fetal Deaths (Live Births Plus Fetal Deaths)

    Infant Deaths

    Geographic Area

    Per 1,000 Live Births

    Fetal and Infant Mortality, 2004

    Sheet2

    Source: State of Nevada Vital Statistics

    Sheet3

  • Fetal Infant Mortality ReviewFIMR 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 Study19 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 StudyStarted 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 ReviewAdditional information neededPreconception risksPrenatal risksRecommendations

  • Nevada Data, 2004

    Chart1

    6.7819599864

    20.5479452055

    14.7058823529

    13.0208333333

    7.5634792004

    0

    Source: State of Nevada Vital Statistics

    Fetal Death Rate

    Race and Ethnicity

    Death Rate, Per 1,000 Live Births

    Fetal Death Rate, 2004

    Sheet1

    Deaths, Per 1,000 Live BirthsLive birthsFetal Death RateInfant Mortality Rate

    Caucasian2029296.783.22

    African American314320.5538.65

    Native American213414.71NA

    Asian537913.023.65

    Hispanic1418377.566.77

    Unknown0710.00

    Sheet1

    Source: State of Nevada Vital Statistics

    Fetal Death Rate

    Race and Ethnicity

    Death Rate, Per 1,000 Live Births

    Fetal Death Rate, 2004

    Sheet2

    Sheet3

  • Community Action TeamInterventions/Actions

  • Health Care CostsThe IOM report estimates preterm birth cost t