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Preconception Health in NC Think Tank Meeting #3 August 16, 2007. What’s UP?. NC Women’s Health Report Card Released National Preconception Clinical Curriculum to be housed on mombaby.org NC Featured on National Webcast – National Association of City and County Health Officials
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Preconception Health in NC Think Tank Meeting #3 August 16, 2007
What’s UP? • NC Women’s Health Report Card Released • National Preconception Clinical Curriculum to be housed on mombaby.org • NC Featured on National Webcast – National Association of City and County Health Officials • National Summit on Preconception Health • October 29-31 in Oakland, CA • 5 presentations/posters from NC
Planning Steps March 2007 Think Tank Meeting #1 • To initiate a focused, collaborative, comprehensive process to create a state Preconception Action Plan May 2007 Think Tank Meeting #2 • To collect diverse ideas and understand how preconception fits into existing work August 2007 Think Tank Meeting #3 • To develop the components of the plan
Guiding Principles • Focus on the whole woman – not only her reproductive capacity. • Consider the woman’s health needs and related wellness recommendations within the context of her family and community. • Be careful that messages don’t imply that certain groups of women should not become mothers. • Be cognizant of health disparities and prioritize programs with potential to close the gaps.
Work should address… • Clinical practice – continuity of care • Evaluation & research • Integrating new messages into current campaigns • Policy & advocacy • Holistic view of health • Social marketing • Interconception health
Themes • Include men & families • Start early / young • Use existing programs to carry messages • Build on public health outreach into worksites, private practice, and communities • Master tool kit – clear and consistent messages
Age (teens, 20s, 30s, 40s) Contemplators / Non- Contemplators Race/Ethnicity Gender Income Education Mothers Geography (13 counties have most of the excess infant death) Families / Couples Women w/health conditions Communities Health care providers (OBs, Pediatrics, Family Medicine, Internal Medicine, etc) Public health leaders State opinion leaders Media Insurers / Funders Researchers Potential Target Audiences
The chasm • There is a gap between knowing and doing. • We need to use education and resources – knowledge and mechanisms to narrow that gap and enable women to make positive changes.
Data Sources What New Mothers Say: Personal Comments from the North Carolina PRAMS Survey, NC DHHS SCHS, May 2007 Latina Infant Mortality Awareness Project, NC Healthy Start Foundation, April 2007 Women’s Health: Attitudes and Practices in North Carolina – Focus Group Research, NC SIM Collaborative/NC Healthy Start Foundation, June 2005 Uncovering Community Voices: A Catalog of Qualitative Data Regarding Women’s Health in North Carolina 1995 – 2005, UNC MCH 315 Spring 2005 Class with Supervision from UNC Sheps Center and UNC Center for Maternal and Infant Health
What women say… • Behavior Change: Awareness not enough to change behaviors. Knowledge of family history, family support and healthcare options can lead to change. • Stress: Emotional, physical and financial stress negatively influence health. Need more social support and networking.
What women say… • Mental health issues, especially depression, are significant. Lack of resources in communities. • Barriers to Health Care: Cost. Racism. Lack of – insurance, access, trust/respect, childcare, and transportation.
What women say… • Approach to Healthcare: Prefer holistic approach. • Substance Use: Many women reported they knew someone struggling with drug addiction. Reported as coping mechanism for extreme stress. • Most pregnancies are unplanned. Women are concerned about becoming pregnant but don’t use contraception. Inconvenient clinic hours and quality of care problems with family planning services.
Obesity and Related Conditions • 25% of NC Women aged 18 – 44 y.o. are obese BRFSS 2005 • Obesity increases risk for hypertension (13%) and diabetes (2%) BRFSS 2005 • 62% of NC women do not meet minimum recommendations for physical activity NC Women’s Health Report Card, 2007
DIABETES PREVALANCE NC 2000 - 2006 Source: State Center for Health Statistics, North Carolina
Gestational Diabetes • Occurs only during pregnancy and affects 2-4% of all pregnant women. • Obesity is a risk factor for the development of gestational diabetes. • Women who develop gestational diabetes are at higher risk of developing type 2 diabetes. Source: ADA. Clinical Practice Recommendations 2005. Diabetes Care 28 (Sup 1): S38. (17)
Complications Associated with Obesity • Obesity is a risk factor in the higher perinatal mortality and morbidity rate found in type 2 diabetes, including congenital malformation and macrosomia. Complications include: • Hypertension • Obstructive sleep apnea • Preeclampsia • Increased urinary tract infections • Higher rates of cesarean and difficult deliveries in the mother Source: Diabetes Care. 1992; 15:1640-57
Impact on Infants • Major congenital malformations remain the leading cause of mortality and serious morbidity in infants of mothers with type 1 and type 2 diabetes. • Observational studies indicate that the risk of malformations increases continuously with maternal glycemia during the first 6-8 weeks of gestation (1st trimester). Source: ADA. Clinical Practice Recommendations 2005. Diabetes Care 28 (Sup 1): S38. (17)
Substance UseNC Women Aged 18 – 44 years old 24%Use Tobacco 8%Engage in Binge Drinking 7%Engage in Illicit Drug Use* NC BRFSS 2005 *NC Adults aged 12 and older, SAMHSA, National Survey on Drug Abuse and Health, 2005
Substance Use • Lack of outpatient and inpatient services • Need for provider training and screening tools • Need for more NC-specific research
NC Women & Factors Affecting Pregnancy Outcomes 45% of pregnancies are unintended NC PRAMS 1997 - 2000 62%do not take folic acid daily NC BRFSS 2006 19%may not be rubella immune NC State Lab, prenatal clients, 2006
NC Women and Sickle Cell • Nationally one in every 12 African Americans has sickle cell trait NIH NHLBI, 2007 • 3,908 newborns born in NC with sickle cell trait in 2006 NC State Lab
STIs/HIV Case RateNC Women Aged 18 – 44 years old 1320.3/100,000Chlamydia Case Rate 432.5/100,000GonorrheaCase Rate 312.4/100,000 living with HIV/AIDS 8.1/100,000Syphilis Case Rate (PSEL) NC DPH, HIV/STD Prevention and Care Branch 2006
Mental HealthNC Women Aged 18 – 44 years old 23% Report 1- 8 days of poor mental health during the past monthNC BRFSS, 2005 20% Report being moderately or very depressed in the months after deliveryNC PRAMS 2000, 2003
Barriers to HealthcareNC Women - Aged 18 – 44 years old 24% Uninsured 27% No dental visit in the past year NC BRFSS 2005
Criteria for Areas of Focus • Impact women’s and/or infant health • Consistent with CDC Recommendations • Based on best available scientific evidence, including NC data highlighting disparities and needs/gaps • Reflect issues that women have highlighted as important to them • Reflect priorities of participants in previous meetings • Offer concrete opportunities for action • BONUS: Impact chronic disease in the future
What Bubbles to the Top? 1) Pregnancy Intendedness 2) Substance Use 3) Obesity and Related Conditions 4) Mental Health 5) Barriers to Healthcare
Structure • Leadership Team • Topic Area Groups (Workgroups) • Collaborate around agreed-upon areas of focus • Will have Chairperson and develop agenda • Collaborate on existing programs, funding opportunities, develop new programs/advocacy plans, measurement of progress • Use expertise of researchers and messaging experts as needed • Preconception Collaborators (project-specific)
Leadership Structure PreconceptionLeadership Team Barriers to Healthcare Mental Health Preconception Collaborators Substance Use Obesity / Related Issues Other? Pregnancy Intendedness
The Website www.mombaby.org • Resources • National News • Minutes • Feedback
Please join us! • Sign up for the Leadership Team, a workgroup(s), or to provide other support • Workgroups will meet in Fall 2007 • Progress reports from workgroups to be given at next large-group meeting on December 4 (save the date!) • NC Preconception Conference: January 23, 2008 (Greenville)