Reducing Preterm Births in Ohio

Celeste Smith MA, PC

Toledo Lucas County Health Department

Local Office on Minority Health

Lauren Henderson MPH

March of Dimes

Maternal and Child Health Director Northeast Ohio

• March of Dimes mission and

purpose

• Priority Areas for Ohio

• Strategies and impact on

preterm birth

• Health equity

Today’s

Presentation

March of Dimes Mission

The mission of the March of Dimes is to improve the

health of babies by preventing premature birth, birth

defects, and infant mortality.

A FIGHTING CHANCE FOR EVERY BABY

Why Prematurity?

• 1 in 10 babies

• Leading cause of newborn death

• Significant health problems

• Premature birth costs a lot of money

Preterm Birth and Infant Mortality

Leading cause of Infant Mortality (2015)

Based on in-depth Child Fatality Reviews (CFRs) from 2012-2015

Retrieved from: https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/OEI/2015-

Ohio-Infant-Mortality-Report-FINAL.pdf?la=en

2016 PREMATURE BIRTH REPORT CARD

marchofdimes.org/reportcard

Gestational age is based on obstetric estimate. Source: National Center for Health Statistics, 2015 natality data..

PRETERM BIRTH RATES AND GRADES BY STATE

Preterm Birth Rates

*2015 data are preliminary. LMP=gestational age based on date of mother’s last menstrual periodOE=gestational age based on obstetric estimate.2020 and 2030 goals based on OE gestational age.Preterm is less than 37 weeks gestation. Source: National Center for Health Statistics, 1990-2014 final and 2015 preliminary natality data.Prepared by March of Dimes Perinatal Data Center, June 2016.

United States, 1990, 1995, 2000, 2005-2015*

*2015 data are preliminary.

Gestational age based on obstetric estimate.

Preterm is less than 37 weeks gestation.

Source: National Center for Health Statistics, 2014 final and 2015 preliminary natality data.

Prepared by March of Dimes Perinatal Data Center, June 2016.

9.57

9.62

9.00

9.25

9.50

9.75

2014 2015*

Perc

en

tag

e o

f li

ve b

irth

s

For the first time in 8

years, the US preterm

birth rate increased

slightly between 2014

and 2015.

Preterm Birth RatesUnited States, 2014 & 2015*

*2015 data are preliminary.

Gestational age based on obstetric estimate.

Preterm is less than 37 weeks gestation.

Costs per infant include all employer payments for newborn medical care during the first year of life.

Source: National Center for Health Statistics, 2014 final and 2015 preliminary natality data. Institute of Medicine, CostS of

Preterm Birth.

Prepared by March of Dimes Perinatal Data Center, June 2016.

If the US preterm birth rate had not

increased from 2014 to 2015…

Approximately 2,000 fewer babies would have been born preterm.

More than $100 million in medical and societal costs could have been avoided.

*2015 data are preliminary. Gestational age based on obstetric estimate. Preterm is less than 37 weeks gestation. Data shown only for select race/ethnicity categories. Race categories exclude Hispanics.Source: National Center for Health Statistics, 2014 final and 2015 preliminary natality data.Prepared by March of Dimes Perinatal Data Center, June 2016.

0.0%

+1.1%

+1.5%

-2.0%

-1.5%

-1.0%

-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

White Hispanic Black

Note: 2016 Report Card disparities data will use 2012-2014 average rates. This chart shows the change from 2014 to 2015

Percent change in preterm birth rates by maternal

race/ethnicity

United States, 2014 and 2015*

2016 PREMATURE BIRTH REPORT CARD

marchofdimes.org/reportcard

Rate and Grade

are unchanged

from 2015

Report CardThe preterm birth

rate among Black

women is 45%

higher than the

rate among all

other women.

2016 PREMATURE BIRTH REPORT CARD

COUNTIES IN OHIO

marchofdimes.org/reportcard

Counties with the greatest number of births are graded based on their 2014 preterm birth rates.

Counties Preterm birth rate Grade

Cuyahoga 11.8% F

Franklin 10.4% D

Hamilton 10.8% D

Lucas 11.6% F

Montgomery 11.0% D

Summit 10.4% D

Gestational age is based on obstetric estimate. Source: National Center for Health Statistics, 2014 natality data.

Prematurity in Ohio Cities

Goal of 8.1%

• Cleveland 98th

• Cincinnati 87th

• Columbus 86th

• Toledo 67th

The March of Dimes carries out this mission through

community services, advocacy, research, education and

support.

What are Preterm Birth Contributors

• Previous preterm birth

• Late/no prenatal care

• Smoking

• Drug use

• Poor nutrition

• Chronic health problems

• Stress

• Short pregnancy spacing

• Short cervix

Other Considerations:

• Biological

• Genetics

• Environment

• Geographies

Social determinants of

health including:

• Poverty

• Racism

• Crime

• Access to care

• Living conditions

Strategies that May Impact

Alignment

Collaboration

New Partners

Investment

Prevention

Place based strategies

Focus on the social determinants

Determinants of Health

Long before we need medical care, our foundation

for health begins in our homes, schools and

neighborhoods. Robert Wood Johnson Foundation

Graphic retrieved from the Institute of Public Health: http://www.publichealth.ie/healthinequalities/healthinequalities

Determinants of Health

March of Dimes Prematurity

Campaign

8.1% 2020 preterm birth rate goal for the U.S.

5.5% 2030 preterm birth rate goal for the US

New focus on high volume and high burden areas

and populations in Report Cards

Prematurity Campaign Roadmap

Roadmap Interventions

Birth spacing and interconception care

Elimination of non-medically indicated early elective

deliveries

Smoking Cessation

Group Prenatal Care

Access to progesterone shots for women with a previous

preterm birth

Low dose aspirin to prevent preeclampsia

Vaginal progesterone and cerclage for short cervix

Reduce multiple births conceived through Assisted

Reproductive TechnologyTarget geographies and/or racial and ethnic groups with high rates

and/or high birth volume.

Roadmap: Targeting 16 States /

Territories Accelerate change in 16 high burden and high birth volume

states/territories.

Consistent with fundamental public health principles and

strategies – services based on burden and volume.

Continue activities in all states/territories.

Target 16 States/Territories

•Phase I: 6 states/territories in 2017Alabama, Louisiana, Mississippi, Puerto Rico -

Highest rates.

Florida, Texas - Most populous high rate

states.

•Phase II: 10 additional states with births

>100,000 California, Georgia, Illinois, Michigan, New

Jersey, New York, North Carolina, Ohio,

Pennsylvania, Virginia.

Prematurity Campaign Roadmap

The Prematurity Campaign

Roadmap sets out our plan for

achieving the new 2020 and 2030

goals. To achieve them, we

must:

Optimize existing

interventions

Engage stakeholders.

Identify new treatments

based on translation of

discovery research.

March of Dimes investment in

the Prematurity Research

Centers is essential to

achieving 5.5% by 2030

5.5% by 2030

Ohio Strategies

1. Reduce the rate of women in the six targeted areas

or focus populations who have inter-pregnancy

intervals less than 18 months.

2. Provide progesterone therapy to women with a

previous preterm birth in the six targeted areas

3. Expand group prenatal care in targeted counties

and focused Ohio populations

4. Maintain an early elective delivery rate without

medical indication at or below 5% for Ohio

hospitals

Expand group prenatal care in targeted counties and

focused Ohio populations

Centering Pregnancy® and March of Dimes

Nationally

• MOD has strongly supported the spread of CP beginning in 2005

• 2012-2014 – In partnership with Anthem, MOD expanded CP to 13

states – 8,000 women participated, PTB rate was 7.4% (12% US)

• In 2014, 1,800 providers and 24,000 women benefited

Ohio

• $878,400 invested since 2007 (32 awards)

• 2013 - $102,400 – 8 grants – 750 – 1000 women

• 2014 - $83,121 – 3 grants – 500 – 750 women

• 2015 - $95,000 – 3 grants – 750 – 800 women

• 2016 - $150,000 – 7 grants – 1000 women

Centering Pregnancy® and

March of Dimes 2014-2016

Ohio Data Trends 2014-2016 2014 Percentage 2015 Percentage 2016 YTD Percentage

Total women participating 228 100 421 100 299 100

Women attending 8 or more

sessions29 23.6 109 32.3 58 31.4

Women attending CP <17 weeks 48 41.7 71 46.1 113 39.8

Women under 20 years of age 30 25.2 83 29.1 51 33.1

Black participation 64 55.7 278 90.8 144 91.7

Preterm births <37 weeks 6 5.8 22 8.2 7 4.9

Centering Pregnancy® and

March of Dimes 2017

• Program expansion

• Target Black participation

• Increase sessions attended

Reduce the rate of women in the six targeted areas

or focus populations who have inter-pregnancy

intervals less than 18 months.

• Focus inter-pregnancy intervals

• Developing baseline data for Ohio and targeted

counties

• Increase awareness

• Partnership building

• LARC

Maintain an early elective delivery rate without

medical indication at or below 5%

Healthy Babies are Worth the Wait

Provide progesterone therapy to women

with a previous preterm birth

• Increase consumer awareness

• Increase provider utilization

Prematurity Campaign Results

Since 2007 the prematurity rate has decreased

to 9.6%

• Fewer babies are now counted as preterm due to a

change in measurement by the National Center for

Health Statistics (NCHS).

• Progress has been made in reducing preterm birth

rates.

Progress is not victory

• Despite progress, the U.S. preterm birth rate ranks

poorly among Very High Human Development Index

(VHHDI) countries.

Preterm Birth Rates for Very High Human

Development Index Countries*

*Preterm birth rates per 100 live births in 2010 (baseline) for 39 countries with VHHDI.

Chang, H., Larson, J., Biencowe, H., et al. (2013). Preventing preterm births: Analysis of trends and potential reductions with interventions in 39 countries with very high human development

index. The Lancet, 381(9862), 223-234.

Results

With Roadmap activities:

1.3 million fewer babies will be born preterm

between 2014 and 2030 when we meet the 5.5%

2030 goal.

• 210,000 fewer babies will be born preterm from

2014-2020, when we meet the 8.1% 2020 goal.

• 1.1 million fewer babies will be born preterm from

2021-2030, when we meet the 5.5% 2030 goal.

March of Dimes Perinatal Data Center. Projected estimates each year based on 2014 live births and incremental declines between

9.6% in 2014 and 5.5% in 2030.

Gestational age determined using obstetric estimate of gestation.

Thank you