Healthy Babies are Worth the Wait

The March of Dimes has initiated a new project called Healthy Babies are Worth the Wait (HBWW). This public health campaign strives to prevent factors related to preterm birth, including social, medical and biological influences. Children born prematurely are more likely to have vision and hearing problems, lasting physical and mental disabilities, and learning delays later in life. [i] Aiming for pregnancies that are at least 39 weeks in length decreases the likelihood of children developing health problems There has been a rise of in the number of U.S. births before week 39 over the past two decades, with 12.8% of live births in 2006 classified as a preterm birth. [ii]

The Kentucky Department for Public Health in collaboration with the March of Dimes and Johnson & Johnson Pediatric Institute helped create HBWW: a community-based, preterm birth prevention initiative. An innovative key to the campaign is engaging the community among local- and state-level clinical and public health partners. It includes targeted resources for both the public (info sheet: http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html) and professionals (toolkit: http://www.marchofdimes.com/professionals/medicalresources_39weeks.html).

How can we use these strategies in our work throughout MCH? This collaborative theory and process influences much of our work, but more can be done across sectors, fields and levels of work. Check out a webinar March 29, 2012 11:00pm CST sponsored by Healthy People 2020 Leading Health Indicators: http://goo.gl/iFJbQ. Participants will learn about how collaboration and partnerships, provider initiatives, patient support, public engagement, and progress measures helped inform HBWW’s conceptualization.

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[i] March of Dimes. (2010, April). Your premature baby. Retrieved from March of Dimes: http://www.marchofdimes.com/baby/premature_indepth.html

[ii] March of Dimes (2011). Medical Resources. Retrieved from March of Dimes: http://www.marchofdimes.com/professionals/medicalresources_hbww.html.

Healthy Homes: Lead Poisoning

Keeping the home healthy: an environmental health issue. But should it also be a concern for MCH? Where children spend time eating, drinking, playing, doing homework and sleeping, should the MCH field focus on how living spaces may influence health? Many of the hazards that affect a child’s life course may originate in the home setting. However, should the government regulate private residencies; are they overstepping their boundaries into this sphere, or is this a case to protect a special vulnerable population?

Despite these concerns, public health officials are working to ensure children live fulfilling lives. A MCH campaign in St. Louis is working to prevent lead exposure in children. Researchers there began the Heavy Metal Project, offering low-income pregnant women free home inspections and screening. Moreover, if researchers found lead, they cleaned and covered old paint and replaced windows. Here, the project aimed to prevent newborns from being exposed to lead in the first place.

Was the program effective?

Compared to babies whose homes were not cleaned, babies who lived in homes researchers intervened in had lower blood lead levels. Visit the study’s methodologies and results at: http://www.ajog.org/article/S0002-9378%2812%2900002-6/fulltext.

Why is this significant?

Lead exposure has been shown to be related to brain damage, leading to lower IQ, behavioral problems and learning disabilities, as well as cardiovascular and immune system troubles later in life. Despite the fact that campaigns have been working for decades to remove lead pain from housing, about 250,000 children each year are diagnosed with lead levels higher than the recommended 10 micrograms. According to the Centers for Disease Control and Prevention (CDC), 24 million homes in the U.S. are still thought to have paint with lead.

In January 2012, the Advisory Committee on Childhood Lead Poisoning Prevention released recommendations to decrease the limit of how much lead exposure is considered dangerous. This was cut in half for children ages 5 and younger, from 10 micrograms to 5, doubling the number of children considered in danger of high levels.

Despite this, Congress has slashed funding for the CDC’s lead prevention grant program from $30 million to $2 million (that’s 94 %!). More and more children are now screened after age 5 for lead positioning; this is in contrast to families receiving home inspections before exposure occurs.

What factors influence this environmental MCH problem?

• Social determinants related to substandard housing
  • Socioeconomic status
  • Education
  • Race/ethnicity

• Children can also be exposed to lead via:
  • Tap water
  • Older toys
  • Jewelry
  • Soil around houses

For more information

Visit the CDC’s Healthy Homes and lead information website at http://www.cdc.gov/HealthyHomes/index.html and http://www.cdc.gov/nceh/lead/ respectively.

Our prenatal prospects: some thoughts

The “new” science of fetal orgins, as a  New York Times column by Nicholas Kristof describes, draws substantial correlations between many diseases (autism, schizophrenia, even obesity) and an infant’s uterine environment. Although research remains mixed, much of it indicates that life before birth has a substantial impact on later life course.

(FYI: Barker and colleagues were the first to describe this idea as the “fetal origins hypothesis“, back in 1995).

The uterine environment appears to affect how our genes express themselves (otherwise known as “epigenetic modification”). For example, stress experienced during pregnancy may actually predispose individuals to poor health outcomes. Consider a young woman, pregnant for the first time and living on Chicago’s south side. Her 9-to-5 may expose her to dangerous chemicals. A 90-minute commute may exacerbate this stress. She may find it difficult to quit smoking, eat healthily, or remember to take her prenatal vitamins as a result — compounding latent health risks for both herself and her unborn infant.

Here’s the deal. When we talk about the life course, we move beyond individual health to acknowledge the important impact of our environments — historical, economic, and social — on our health. Proponents of life course theory attempt to acknowledge all facets of health (physical, mental, spiritual) and work to explore the interactions between our biology and the world that surrounds us.

This past November, the Maternal and Child Health Bureau commissioned a concept paper on the lifecourse framework. It’s an important document that outlines LCT’s major concepts and ties them to MCH goals. You can read the full text here, in pdf form: http://mchb.hrsa.gov/training/documents/LifeCourseResourceSheet9-2010.pdf

For more on fetal origins and life course theory, check these links out:

http://www.time.com/time/health/article/0,8599,2020815,00.html

http://www.psychologytoday.com/blog/more-genes/200910/more-genes-i-so-what-is-fetal-programming

Women’s Health in Nepal

Women’s health issues are difficult to address in Nepal, a country known for its gender discrimination, low literacy rate in women, and high maternal mortality. Public Radio International interviewed Dr. Sangeeta Mishra about her struggle against these conditions as a gynecologist in Nepal on a Fulbright Scholarship at Johns Hopkins University.

According to Dr. Mishra, delivering babies at home is part of Nepalese culture: only 16 percent of women deliver in hospitals. She explains in the PRI interview:

“First thing which I realized was a major problem in Nepal was high rate of maternal mortality, and women were dying due to pregnancy-related complications. Women … are not aware of pregnancy [complications] … it’s just a normal thing and that they can deliver at home and they are not aware of the consequences that pregnancy can bring. So I plan to develop a major educational and awareness generation program for these women, where most of the deaths occur … to [inform] them of the importance of delivering at the hospital, or having a skilled helper at home.”

The full audio program is available through Public Radio International at http://www.pri.org/health/global-health/womens-health-nepal1422.html.

New Slideset Available on PeriStats

Mental Health Needs of Low-Income Children With Special Health Care Needs

The following information has been provided by the March of Dimes:

PeriStats is an online source for perinatal statistics developed by the March of Dimes Perinatal Data Center. PeriStats provides free access to maternal and infant health-related data at the US, state, county, and city level, and was developed to ensure that health professionals, researchers, medical librarians, policy-makers, students, and the media have easy access to this information. Data are updated throughout the year, and useful for multiple tasks, including fact-finding, health assessments, grant writing, policy development, lectures and presentations.

A US overview slideset is available in PeriStats: http://www.marchofdimes.com/peristats. The slideset offers more detail on perinatal health topics, such as late preterm birth, low
birthweight, and infant mortality. There are more than 40 slides to choose from for your presentations. Please contact us if you have any questions or suggestions at
http://www.marchofdimes.com/peristats/contactus.aspx.

Late preterm birth:
http://www.marchofdimes.com/peristats/slidesets/slideset_6_99.ppt#2…

Low birthweight:
http://www.marchofdimes.com/peristats/slidesets/slideset_6_99.ppt#2…

Infact mortality:
http://www.marchofdimes.com/peristats/slidesets/slideset_6_99.ppt#2…

PeriStats Features-

Export a chart in PeriStats to PowerPoint
Thereis an easy way to export charts in PeriStats to PowerPoint slides. The
image below shows where you can find the download slide button in
PeriStats. Slides are just a click away:
http://www.marchofdimes.com/Peristats/presentations/ptb_US_1996_200…

Export a table in PeriStats to Excel
Tables in PeriStats provide rates as well as counts where available.
PeriStats allows you to export tables to Excel at
http://www.marchofdimes.com/Peristats/CSVs/ptb_US_1996_2006_map_60_…

What is the Perinatal Data Center?
The March of Dimes Perinatal Data Center analyzes maternal and infant health data, and interprets this information for use by the March of Dimes, health professionals, research groups, and the media. The Center staff collaborate and provide guidance on epidemiological and statistical analyses and grants and present analytical findings at
national conferences and in peer-reviewed journals.