Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
MELISSA BAKER: Good morning. This morning we’re going to look at some of the findings from the West Virginia PRAM’s Project, particularly those relating to the pre-term births during the years of 1996 through 2000. Healthy People 2010 Objective as well as the West Virginia Healthy People 2010 Objective targets the pre-term births and their reduction, particularly reducing the incidence of the pre-term births to no more than 7.6% of the total births. The variables that we used for this particular study were gestational age, and we used the less than 37 weeks and the greater than or equal to 37 weeks, birth weight and again, we used the 2,500 grams. Maternal age, we looked at less than 19 and greater than or equal to 19. Maternal smoking habits-- and we took this variable from the birth certificate.
Recording of an infant birth defect on the birth certificate, and we also looked at the stressors question from the PRAM’s survey, and that was if the mom indicated she experienced at least three or more stressors in the 12 months before her delivery, such as family illness, divorce, lost jobs, physical fights, someone with a drinking or drug problem, or someone close to you died. When we look at pre-term births as a total of all births in West Virginia, you see that we have not declined. It’s not anywhere near the Healthy People 2010 Objective of 7.6 we, kind of, actually look like we’re going in the wrong direction. The first variable when we looked at gestational age and low birth weight, we see that there’s a much larger percentage of pre-term births or low birth weight compared to the full term, and though there’s been a very slight decline, it’s not a significant decline.
Next we looked at the gestational age by maternal age, and I took out a couple of slides because we thought there were four presenters, so this is the only one I left in, but you’ll see that younger mom’s do have a slightly higher pre-term percentage as compared to their full term. And I’m sure if we were to put in a third category for the maternal ages, mothers greater than or equal to 35 years of age, we would see that it little more or mirrored the younger mothers. Next, the smoking maternal habits during pregnancy that we took from the birth certificate response. We know that smoking in West Virginia is extremely high before, during, and after delivery, and this is cause for several programs to be developed in the Maternal and Child Health Program, targeting these mothers to help try to decrease the bad smoking habits that we have in West Virginia. After delivery, we looked back at those pre-term births and see that those have a much higher percentage of birth defects on the pre-term births as compared to the full term births.
In 2002, our vital statistics office developed a trigger mechanism so that when a birth defect is marked on a birth certificate, the people then filling out the birth certificates are told to fill out a birth defects registry form. So, it’ll be interesting when we get our 2002 data to start looking to see if that trigger mechanism has had an impact on the number of birth defects that are recorded. Next, we looked at the stressors during the 12 months before delivery, and again, I say these are from the mom selected you asked that she had experienced three or more stressors, such as family illness, divorce, lost jobs, drinking or drug problems, or someone close to her died. And you’ll see that the stressors affect both pre-term and full term, but the pre-term is just slightly a bit higher for the mothers who have experienced at least three or more stressors during their 12 months before delivery.
In conclusion, the pre-term births in West Virginia, we found are most highly associated with low birth weight, the mothers being less than 19 years of age, and as I said, if we would have looked at the mothers that are older than 35, I think we would have seen a higher percentage of pre-term births there, too. Smoking during pregnancy, having a birth defect that was indicated later on the birth certificate, and the mother experiencing at least three or more stressors during her pregnancy. The public health implications are that we know that pre-term birth is among the leading causes of neonatal deaths, not linked with birth defects, and that the survival rates have been shown to increase as gestational age progresses. So, the reduction in pre-term deliveries are best hope for decrease and infant illness, disability, and death. Because the specific causes of pre-term delivery are unclear, we know that we need additional study before we can develop any more specific detailed interventions. And pre-term birth is associated with a number of modifiable risk factors, predominantly that one in West Virginia of smoking, but it also includes alcohol and other illegal drug use during pregnancy.
In West Virginia, we’re addressing these issues by trying to educate the public more about the implications of pre-term birth and possible prevention efforts that we are developing. We’re in partnership with the March of Dimes for the past few years in a couple of campaign efforts. We have nurse educators who go across the state to particular health fairs and other events and they distribute the literature and education material to the public, particularly those mothers of child bearing age in regards to pre-term births and its implications. We also have in our birth defects project, we have now gone from a passive to an active system, so we have nurse abstractors who go out to the birthing facilities and actually review these charts now. And one of the additional variables that they are looking for now is pre-term delivery, whether there’s a birth defect indicated on the chart or not.
And as these nurses go to the hospitals, they’re now leaving literature, too, to leave through the hospital either for the health care providers and for the public as they come in regarding pre-term birth and their implications. And lastly, earlier this year in West Virginia, we actually held a pre-term birth summit, and it was targeting the health care providers and what was their community involvement, and what we could do to address this pressing issue a little bit more in West Virginia to hopefully bring down our pre-term and get us a little bit closer to our 2010 objectives.