Building Partnerships Across the State to
Improve Birth Outcomes and Create Healthy
Communities
January 13, 2014
Goal
Improve birth outcomes of all mothers
and infants in NJ
NJ Department
of Senior
Health Services
Department
of Health and
Objectives of Meeting
•
•
•
Learn about current NJ activities to improve birth outcomes
Generate a list of recommendations & prioritize how to move forward
Gain commitment for continued support
NJ Department
of Senior
Health Services
Department
of Health and
Opportunities for Intervention
NJ Department
of Senior
Health Services
Department
of Health and
Indicators:
• Preterm Birth
• Ensuring Health of Women
Before & During Pregnancy
• Smoking During Pregnancy
NJ Department
of Senior
Health Services
Department
of Health and
Preterm Birth
NJ Department
of Senior
Health Services
Department
of Health and
Preterm Birth:
Prematurity Report Card
•
March of Dimes Prematurity
Report Card
NJ Department
of Senior
Health Services
Department
of Health and
Preterm Birth: Rates
NJ Department
of Senior
Health Services
Department
of Health and
Preterm Birth: Impact
•
Neurologic/Developmental Outcomes
•
Medical conditions
•
Quality of Life for affected individual and family
•
Economic
− Intellectual disabilities, cerebral palsy, vision/hearing loss
− Reactive airway disease/asthma, apnea
− Emotional toll, multiple medical appointments
− Medical care, loss of work, services (e.g., Early Intervention, Educational,
SSI)
NJ Department
of Senior
Health Services
Department
of Health and
Preterm Birth: Economic Impact
•
Cost associated with preterm birth in US was $26.2 billion
(2005 data)
•
•
•
•
•
•
$16.9 billion in medical and health care costs for the baby
$1.9 billion in labor and delivery costs for mom
$611 million for early intervention services
$1.1 billion for special education services
$5.7 billion in lost work and pay for people born prematurely
Estimated savings in NJ:
•
•
•
Approximately 13,000 preterm births in 2009 (12% ).
8% reduction= 1,040 less preterm births
1,040 x $51,600/preterm infant =$53.7
million cost savings
Institute of Medicine. Preterm Birth: Causes, Consequences, and Prevention. 2006.
Source of Data: National Center for Health Statistics and NJSHAD
NJ Department
of Senior
Health Services
Department
of Health and
Infant Mortality
INFANT MORTALITY RATES
TOTAL
WHITE, NH
BLACK, NH
HISPANIC, AR
ASIAN, NH
US**
20.0
18.0
DEATHS/1000 LIVE BIRTHS
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Source: NJDOH Linked Birth Certificate Infant Death Certificate Files, as of 12/30/2013, New Jersey Residents.
NJ Department
of Senior
Health Services
Department
of Health and
2007
2008
2009*
Ensuring Health of Women
Before & During Pregnancy
NJ Department
of Senior
Health Services
Department
of Health and
Ensuring Health of Women:
Women’s Health Status
Data for Women of Childbearing Age (18-44 Years)
25.0%
% of Women of Childbearing Age
20.0%
15.0%
10.0%
5.0%
0.0%
Percentages
Consume >1
Alcoholic
Drink*
Binge Drank
in Past
Month**
Obese
Current
Smoker
Hypertension
Asthma
Arthritis
Diabetes
Cancer***
19.1%
6.6%
18.8%
15.7%
11.5%
11.4%
7.7%
2.3%
1.9%
NJ Department
of Senior
Health Services
Department
of Health and
Ensuring Health of Women:
Preconception Care/Counseling
•
Ensuring access to health care before a woman
becomes pregnant is essential
•
Preconception care offers opportunity to:
•
In NJ, only 34% of mothers report they received
preconception counseling (2010)
− address nutritional status
− medical conditions that impact pregnancy
− discuss importance of starting folic acid
− stopping smoking prior to pregnancy
− receiving prenatal care once pregnant
Data Source: New Jersey PRAMS
NJ Department
of Senior
Health Services
Department
of Health and
Ensuring Health of Women:
Early Prenatal Care
FIRST TRIMESTER PRENATAL CARE INITIATION*
TOTAL
WHITE, NH
NJ BLACK, NH
HISPANIC, AR
ASIAN, NH
US
100%
PERCENT OF BIRTHS
90%
80%
**
70%
60%
50%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010* 2011*
*Source: Preliminary NJDOH Birth Certificate Files, as of 12/30/2013
**From 2007, US data for 1st trimester prenatal care is reported based on those who used the 2003 birth certificate standard
verses those who do not. Therefore, US rates beyond that time period are not comparable.
NJ Department
of Senior
Health Services
Department
of Health and
Ensuring Health of Women:
Pregnancy Intention & Prenatal Care
Mothers Receiving Early Access to Prenatal
Care
Mothers Receiving No Prenatal Care
Intended
Intended
25%
69%
Unintended
Unintended
31%
0%
20%
40%
60%
80%
75%
0%
20%
Data Source: 2010 New Jersey PRAMS
NJ Department
of Senior
Health Services
Department
of Health and
40%
60%
80%
Smoking During Pregnancy
NJ Department
of Senior
Health Services
Department
of Health and
Smoking During Pregnancy:
Maternal Smoking
Maternal Smoking During the 3 Months before Getting Pregnant
Age 18 - 24
Age 25 - 29
Age 30 - 44
Age 45+
All Ages
35
% Mother Smoked
30
25
20
15
10
5
0
2002
2003
2004
2005
2006
2007
Source: NJ PRAMS data accessed 12/31/13 from http://apps.nccd.cdc.gov/cPONDER/
* Yes response to: mother smoked during the three months before getting pregnant?
NJ Department
of Senior
Health Services
Department
of Health and
2008
2009
2010
Smoking Cessation and Relapse
•
Among mothers who smoked during pregnancy
•
•
•
61% reported quitting during pregnancy
80% recall being counseled about effects of smoking on the baby
22% recall encouragement/help to quit
•
Approximately 50% of NJ mothers who quit smoking
during pregnancy relapsed after delivery
•
Relapse has significant effects on health of mother and
family
•
•
Woman more likely to smoke at beginning of subsequent pregnancies
Exposes newborn and other children to second hand smoke
• SIDS/SUID, asthma etc…
•
Longterm health effects for mother
Data Source: New Jersey PRAMS
NJ Department
of Senior
Health Services
Department
of Health and
Interventions & Programs
NJ Department
of Senior
Health Services
Department
of Health and
Improving Birth Outcomes
Possible Points for Intervention
Maternal
Health
Improving Pregnancy Outcomes
Healthy Start, Perinatal Addiction
Prevention Project
Reducing Maternal Smoking
Maternal
Care
Perinatal Risk Assessment
Central Intake
NJHA Perinatal Collaborative
MIEC Home Visiting
Newborn
Care
Healthy Babies are Worth the Wait
NJHA Perinatal Collaborative
Breastfeeding Promotion
Infant
Health
Healthy Babies are Worth the Wait
SUID/SIDS Review
MIEC Home Visiting
Early Intervention
NJ Department
of Senior
Health Services
Department
of Health and
Healthy NJ: Improving Maternal
& Child Health
•
•
•
Infant death rate (per 1,000 births)
•
•
No alcohol use during pregnancy (% of births)
5.1 (2007)
4.8 (2020)
75.6% (2008)
79.4% (2020)
8.1% (2008)
1.5% (2008)
7.7% (2020)
1.4% (2020)
94.2% (2008)
99.5% (2020)
88.9% (2008)
94.8% (2020)
Prenatal care in 1st trimester (% of births)
Low birth weight/Very low birth weight (% of births)
No cigarette smoking during pregnancy (% of births)
NJ Department
of Senior
Health Services
Department
of Health and
Improving Birth Outcomes
DOH Leadership
ASTHO Pledge
NGA Learning Network
Public Health/Social Services
DOH/DCF Home Visiting
Healthy Babies are Worth the Wait
Maternal Smoking Cessation
Perinatal Addiction Prevention
Health Care System
NJHA Perinatal Collaborative
NJ Baby Friendly Initiative
Payers
DHS/DOH Partnership
performance-based contracting
with Medicaid
NJ Department
of Senior
Health Services
Department
of Health and
Today
Source: UnitedFrontMN.org
NJ Department
of Senior
Health Services
Department
of Health and