AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
STEVE ABELMAN: Good afternoon, everybody. I am Steve Abelman from the March of Dimes. And based on this morning's enthusiastic presentation, we've all decided to sort of change up our presentations a little bit, we are all going to do it in rap.
UNIDENTIFIED PERSON: I'm ready.
STEVE ABELMAN: They hadn't heard that one. No, but based on -- we are hopefully maintaining the momentums from this morning's enthusiastic presentation as well as Marion Wright Edelman's presentation and talk a little bit about why we are all here, high risk pregnancies. And we are going to assess and address the risk, and hopefully I'm going to do some of the assessments and our panelists, Dan Thompson, Janis Biermann and Pamela Xaverius, are going to address the risks, and I will introduce each of them prior to their presentation.
And a lot of what I'm going to go over, I'm going to do very quickly because it is just basically setting up everything for them, in addition to which you heard a lot of it this morning from Dr. Collins and probably other presentations that you saw before.
But briefly to refresh who we are and why we are so committed to this conference and the entire topic is that our mission is to improve the health of babies by preventing birth defects and infant mortality. And we advance this mission through programs of research, community service, education and advocacy, all of which we are intimately involved in here.
Again, you heard some of this morning, but over 77,000 babies are born every week. Almost 10,000 of them are born preterm. That's over 12 percent. One out of ever eight babies is born preterm in the US and the trend, as we all know, is rising.
6,000 of those babies are born low birth weight. Obviously, there's an overlap between prematurity and low birth weight, but not totally. So that is another risk that needs to be addressed.
And 538 babies are -- suffer infant mortality which obviously is a key statistic for AMCHP to concentrate on.
Every three and a half minutes, a baby is born with a birth defect. So in 2001, birth defects accounted for 20 percent of all infant deaths.
And one in 28 babies is born to a mother who started prenatal care late or did not get any prenatal care at all. Again, a lot of the information that we've heard before. But the risk factors are multifactorial. There isn't any single risk factor that leads to a high risk birth. There is obviously multiple factor, there is age, socioeconomic status, the physical factors, unintended pregnancies, maternal weight, all sorts of infection are risk factors, stress and the behavioral aspects.
And in this session we are really only going to address the multiple, age and substance abuse or tobacco use factors. But just be aware, as you all are, that the risk factors are multifactorial. There are overlaps among all of these. And that's part of the problem we need to address both from a research and an education perspective.
Just to concentrate specifically for a couple of minutes on preterm birth, as I said, 12 percent of all babies are born preterm. In the last decade, that rate has gone up by 13 percent, and as Dr. Collins said this morning, the disparity is very obvious with over one and a half times the rate of preterm birth among African Americans versus the general population at large.
Low birth weight, almost eight percent of all babies are low birth weight in the US. And again, the racial disparities leading to African American infants, two times as likely to be born at low birth weight than Hispanic infants.
And compared with singleton births, the multiple births in the US are nine times as likely to be low birth weight in 2002 and Dan Thompson is going to address some of that.
Infant mortality, again all these risk factors are leading to low birth rate, prematurity or infant mortality. Over 27,000 infants died before their first birthday. And that infant mortality rate again in the last decade has gone up by 23 percent. All these statistics are obviously going in the wrong direction.
And the leading causes of infant mortality are related to a lot of the risk factors or a lot of the risk factors lead to some of the indicators of infant mortality. Birth defects, prematurity and low birth weight, SIDS and other maternal and fetal implications.
Infant mortality was highest among women under 20 and over 40 years of age. So age is obviously a factor in infant mortality.
And the Singleton and multiple issue. Almost 97 percent of all live births were singletons with slightly more than three percent of multiple birth. But that multiple birth ratio has increased by 20 percent in the last six years. And compared with the Singleton births, multiple births were about six times as likely to be preterm in 2002.
And then the behavioral risks, and we all know about smoking, drug, alcohol use, they all lead to various consequences. Birth defects, developmental disabilities, low birth weight, infant mortality. Almost 21 percent of women in the US reported smoking.
I should mention that all of these statistics that I'm sharing with you now come of the peristats web site. The March of Dimes..com and if you go to professional and researchers, you'll find a tool bar for peristats. And all of our data is accumulated from a variety of federal, state and local sources, and we compile it into our peristats web site that deal with a lot of these issues on infant mortality, birth defects, low birth weight, prematurity, access to care, et cetera on a state and in many cases down to a county level. It's a great resource for all of you who are putting together risk assessments for your various projects. Excuse me, community assessments for your various projects, assessing the risk.
Smoking. We know the impact of smoking. 20 percent of all low birth weight can be related to smoking. Eight percent of preterm births. Five percent of perinatal debt. Smoking leads to increases of preterm birth, pre prom, small for gestational age infants, low birth weight infants, and we know it also increases the risk of still birth and increases the risk of SIDS leading to the increase of infant mortality.
And in the interest of time I'm going through this very quickly, you all have the handouts.
Access to prenatal care. Almost 84 percent of the live births were to women receiving early prenatal care. 13 percent didn't begin care until the second trimester, and almost four percent were women who had live births who received late or no prenatal care. That leads to the fact that 75 percent of the live births were to women receiving adequate or adequate plus prenatal care, but 11.3 percent were women receiving inadequate prenatal care. Just what Marion Wright Edelman was talking about at lunch time, the access to care.
Maternal age, Dan will address this specifically in Florida, but of all the live births in the US, 11.3 percent were to women under the age of 20. And 35 percent were to women between the ages of 30 and 39. And almost two and a half percent were to women over the age of 40.
And we know that babies delivered to the younger and the older cohorts are often at the increased risk of poor outcomes. So part of the risk that needs to be addressed.
In the United States, the multiple birth ratio was highest for women over 40. 60 percent of multiple births were from women over 40.
And unintended pregnancies. The U-shaped curve of unintended pregnancies is very consistent with maternal age. So, how do we address all that? Prenatal care early and often. Education, smoking, which is something we will address, and behavior modification which is also something that we will address.
So that just gives you a brief overview of all of the various ways that risk assessment needs to be looked at, but specifically concentrating on age and smoking, because those are the issues that our speakers are going to discuss.
And our first speaker is Dan Thompson who is an associate in research at Florida State University at the Florida Department of Health. He started his career in data analysis as a timber estimator in Georgia. You'll see how he transitioned from timber to maternal health. He's worked as a statistician, a programer, systems analyst, epidemiologist and is currently employed as an associate in research at Florida State University on contract to the Florida Department of Health. He has a Bachelor's degree in forestry from Virginia Tech and then was smart enough to make the transition to a Master's in public health from the University of South Florida, and he's currently enrolled in the Emery University, MCH epidemiology certification program. So not only is he continuing his advancement in education, but his son is now at FSU, so it's sort of a complicated circle where his money goes to FSU, his son goes to FSU, money goes back to Dan, his son goes to SFU.
So with that, I'll bring Dan Thompson up.