Health and Wellness in Charlottesville: At a Crossroads

1. Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes Lilian Peake, MD, MPH Charlottesville-Albemarle Health Department October 22, 2008

2. Infant MortalityAlbemarle, Charlottesville and Virginia1995-2006

3. Infant Mortality by RaceAlbemarle and Charlottesville1995-2005

4. Infant Mortality Among Black InfantsTJHD, Virginia, U.S.1998-2004

5. Top 5 Causes of Infant MortalityTJHD, 2002-2006 Source: Division of Women’s and Infant’s Health, Virginia Department of Health

6. Congenital Malformations (Birth Defects) Source: Division of Women’s and Infant’s Health, Virginia Department of Health

7. What are the most common birth defects? • Down Syndrome • Heart defects • Neural tube defects • Metabolic disorders - • e.g. Tay-Sachs disease • Musculoskeletal defects • Gastrointestinal defects

8. What causes birth defects? • Genetics • Alcohol • Certain drugs - e.g., Accutane, cocaine • Certain Infections - e.g., syphilis • Certain chemicals • Insufficient amounts of folate • Multifactorial • Causes of 70% are unknown

9. How can women reduce their risk of having a baby with a birth defect? • Have a preconception visit with healthcare provider • Health history/genetic counseling • Take folate vitamin (all women of child bearing age) • Avoid drinking alcohol, smoking and using drugs • Avoid medications without first checking with healthcare provider • Avoid changing cat’s litter box and eating raw and undercooked meats (infection with toxoplasmosis)

10. Low Birth Weight Source: Division of Women’s and Infant’s Health, Virginia Department of Health

11. Percent of Low Weight (<2500g) Births Albemarle, Charlottesville, Virginia 1997-2004

12. Percent of Low Weight Births for Black Infants Charlottesville-Albemarle, Virginia, U.S. 1997-2004

13. What causes low birth weight? • Birth defects • Mom has chronic health problems • e.g., high blood pressure, diabetes • Mom smokes while pregnant • Mom drinks alcohol or uses illicit drugs while pregnant • Infections in mom or fetus • Rubella, chickenpox, toxoplasmosis • Socioeconomic factors • Income, mom’s education

14. How can women reduce their risk of having a baby that has a low birth weight? • Have a preconception check-up • Folate; treat chronic medical conditions; health history • Receive early and regular prenatal care • Get help to stop smoking • Do not drink alcohol or use illegal drugs • Learn about signs and symptoms of preterm labor and call healthcare provider if develop them

15. % of Infant Deaths by Number of Prenatal VisitsTJHD, 2002-2006 Source: Division of Women’s and Infant’s Health, Virginia Department of Health

16. Percent of Births With >10 Prenatal Visits Albemarle and Charlottesville,1999-2004

17. Study of Medicaid-eligible moms who delivered at UVA between Dec. 2007 and Feb. 2008 Phone survey Only able to reach 32 of the 125 moms Mean age = 25 (18-38) 50% graduated from high school 78% had not planned pregnancy 97% received some prenatal care (4-20 visits) 78% not married Local Barriers to Prenatal Care

18. Local Barriers to Prenatal Care Difficulty making appointments Long lag time in getting first appointment Multiple steps Mailed appointment time (in English) rather than scheduling by phone Transportation problems Problems communicating with healthcare providers Feeling too sick to go to appointment

19. No 1st Trimester Prenatal Care and Low Birth Weight City of Charlottesville, 1990-2006 The Meadows Greenbrier Barracks Road Barracks Rugby Venable Locust Grove Lewis Mountain Rose Hill North Downtown 10th &Page Starr Hill Martha Jefferson Jefferson Park Ave. Fifeville Woolen Mills Ridge St. Johnson Village Belmont Fry’s Spring

20. Births To Mothers With Less Than 12th Grade Education, Albemarle, Charlottesville, and Virginia 2002-2005

21. Barracks/ Rugby Greenbrier Greenbrier Barracks/ Rugby Venable 10th & Page 10th & Page Locust Grove Belmont Belmont Ridge St. Ridge St. Fry’s Spring

22. Black Mothers’ Education Less than 12 Years • South Barracks/Rugby 54% (26) • Ridge St./North area 51% (399) • 10th and Page 44. 36% (266) • Central Fry’s Spring 44% (25) • Southwest Belmont 42% (19) • Ridge St./South 42% (236) • Southeast Venable 40% (75)

23. Teen Pregnancy RateAlbemarle, Charlottesville, and Virginia3-Year Rolling Averages, 1997-2005

24. SIDS Source: Division of Women’s and Infant’s Health, Virginia Department of Health

25. What is SIDS? • Sudden, unexplained infant deaths • Cause of death is unknown • Not due to a chronic disease or illness • After the cause of death has been determined, infant deaths that were initially classified as sudden, unexplained infant death can be referred to as sudden, unexpected infant deaths (SUID)

26. Causes of SUID • Accidental suffocation or strangulation • Accidental poisoning • Obstruction of respiratory tract • Accidental falls • Neglect, abandonment and other maltreatment syndromes • Assault and homicide • Other symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified - unknown cause, or unexplained heart or breathing failure

27. How can families reduce the risk of SIDS? • Put your baby on her back to sleep • Don’t put baby on soft sleep surfaces and avoid loose bedding • Waterbed, couch, sofa, or pillows, or sleeping with stuffed toys • Don’t let your baby become overheated while sleeping • Don’t smoke during pregnancy and don’t let anyone smoke around your baby • Don’t let the baby sleep in your bed

28. Questions?