Category Archives: Low-birthweight infants
Ruth Ann Shepherd, MD, division director for maternal and child health in the Kentucky Department for Public Health, was an early pioneer in recognizing the critical public health problem of preterm births in Kentucky, and that the troubling trend was common to most states in the country. Dr. Shepherd’s research revealed that babies born at 37 or 38 weeks had far worse health outcomes than babies born at 39 or 40 weeks. With support from the leadership at the Kentucky Department of Health, and many other organizations who have since taken up the cause of helping to create conditions for healthier babies, many states are beginning to make strides in preventing early births. Last week, Dr. David Lakey acknowledged her leadership in preventing preterm birth and infant mortality by awarding her the Association of State and Territorial Health Officials (ASTHO) Presidential Meritorious Service Award.
Charles Kendell, MPA, chief of staff at the Kentucky Health Department, accepted the award on behalf of Dr. Shepherd, who was unable to attend the ASTHO meeting. NewPublicHealth caught up with Kendall to get his take on Kentucky’s role in catalyzing a national movement around healthier babies.
NewPublicHealth: Tell us about the award Dr. Shepherd received and what it was for.
Kendell: The award today was given by David Lakey as President of ASTHO for the last year. The Presidential Meritorious Service Award is given at the ASTHO president’s discretion for those he feels have contributed the most to the President’s Challenge that he or she has championed for the year. This year, he awarded it Dr. Ruth Shepherd, who was one of the early advocates for doing something about the prematurity birth rates in the country.
Dr. Shepherd has long championed that concern, and it was through her efforts that much of the initial data and advocacy and publicity about the issue became apparent to a lot of people. Through the connection of Dr. Shepherd to David Lakey, he was able to put a voice and a voice to the issue through his presidency. It’s really taken off from there, and connected with an awful lot of people.
NPH: What did the data Dr. Shepherd uncovered show?
David L. Lakey, MD, Commissioner of the Texas Department of State Health Services, ends his term as president of the Association of State and Territorial Health Officers, (ASTHO)at the group’s annual meeting in Austin this week. NewPublicHealth spoke with Dr. Lakey about his tenure and about his Presidential Challenge to reduce the number of preterm births.
NewPublicHealth: Did anything surprise you during your tenure as ASTHO president?
Dr. Lakey: I don’t think there was a specific surprise. It’s been a very busy year. Perhaps the one surprise might be that four years ago ASTHO started the Presidential Challenge under Judy Monroe, MD (then state health commissioner of Indiana, and now the head of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention) started this thing called the Presidential Challenge. Dr. Monroe started it as a charge to the state health officers to kind of walk the talk related to physical activity. And now, four years later, the Presidential Challenge really had its own legs and with a lot of support. This year’s challenge—reducing preterm births–became a pretty big initiative. We now have 49 states that have signed on to that initiative.
NPH: What specific actions do you think have helped the decline of preterm births?
Preterm babies are born at a higher rate in the US than in 130 other countries, including many poorer nations, according to a report released today, Born Too Soon: The Global Action Report on Preterm Birth, published by the March of Dimes and almost fifty other groups, including the World Health Organization.
Preterm birth (birth before 37 weeks completed gestation) is the leading cause of newborn death in the US—nearly half a million US babies are born too early each year. Babies who survive an early birth often have breathing problems, cerebral palsy, intellectual disabilities, and other lifelong problems. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants, and the costs exceed $26 billion each year. “While our country excels in helping preemies survive, we have failed to do enough to prevent preterm births and help more mothers carry their babies full-term," says Jennifer L. Howse, president of the March of Dimes.
The report also highlights health disparities for newborns in the US. The rate of preterm births for African American mothers is 18 percent; the rate for white mothers is 11 percent.
Worldwide, the new report finds that 15 million babies are born preterm each year, and more than one million die due to preterm complications. Of these babies, the report notes, three-quarters could be saved if current cost-effective interventions were made more widely available. Those interventions, according to Dr. Howse, include:
- Giving all women of childbearing age in the U.S. access to health care, including adolescents, and including care before, between, and during pregnancy
- Behavioral changes to reduce the risk of an early birth, such as not smoking during pregnancy
- Progesterone treatments for women who have had a previous preterm birth
- Better management of fertility treatments that result in multiple births
- Hospital quality improvement initiatives to reduce early inductions and Cesarean deliveries before a full 39 weeks of pregnancy unless medically necessary
“This report underscores the need for action to reduce premature birth in the U.S., and state and territorial health officials have a critical role in championing and implementing proven solutions,” says David L. Lakey, M.D., president of the Association of State and Territorial Health Officials and Commissioner of the Texas Department of State Health Services. “Interventions that promote full term, 39-week pregnancies and improve the health of babies can significantly reduce health care costs.” Reducing preterm births is Dr. Lakey’s Presidential Challenge during his term as ASTHO president.
In February, the Department of Health and Human Services announced “Strong Start," an initiative that includes funding for enhanced prenatal care and hospital quality improvement programs. And the March of Dimes has launched its “Healthy Babies Are Worth the Wait” campaign to let women know that if their pregnancy is healthy, it’s best to wait for labor to begin on its own rather than scheduling a delivery. Elizabeth Mason, MD, director of the Department of Maternal, Newborn, Child and Adolescent Health for the WHO says model practices in other countries that have reduced preterm births include creating medical homes for expectant mothers, reducing hospital infection rates and both prenatal care and care throughout a pregnancy to monitor for concerns.
Christopher Howson, PHD, Vice President for Global Programs at the March of Dimes Birth Defects Foundation, says the current worldwide rate of preterm births could be halved by 2025 if the recommended interventions are carried out. “That is eminently, eminently feasible,” says Howson.
Bonus Reading: For a state-by-state breakdown of preterm birth rates within the U.S., see the March of Dimes 2011 Premature Birth Report Card online at marchofdimes.com/prematurity.
Healthy Babies is the focus of the annual President’s Challenge of the Association of State and Territorial Health Officials, and this week the U.S. Department of Health and Human Services (HHS) put funding behind the issue as well, announcing the Start Strong initiative. The first activity of the initiative will be to give out more than $40 million in grants, through the Center for Medicare and Medicaid Innovation, to test ways to reduce the current high rate of premature births.
According to HHS, more than half a million infants are born prematurely in America each year, a rate that has grown by 36 percent over the last 20 years. Children born preterm are at risk for death and also often require significant medical attention, early intervention services and special education, and have conditions that may affect their productivity as adults.
The Center will award grants to health care providers and coalitions to improve prenatal care to women covered by Medicaid. The grants will support the testing of enhanced prenatal care through several approaches under evaluation, including:
- group visits with other pregnant women,
- birth centers providing case management, and
- maternity care homes where pregnant women have expanded access to better coordinated, enhanced prenatal care.
One million babies worldwide died this year because they were born too soon, according to the March of Dimes. The Empire State Building towers were lit in purple last night in honor of the first-ever World Prematurity Day. This day is a call to raise awareness efforts to reduce death and disability caused by premature birth.
An estimated 13 million babies are born early every year around the globe, including more than half a million in the United States, according to March of Dimes.
Learn more on the World Prematurity Day Facebook page, run a global alliance of partners including March of Dimes, the European Foundation for the Care of Newborn Infants, Australia's National Premmie Foundation and Africa's Little Big Souls.
>>Read more on maternal and infant health.
The annual Association of State and Territorial Health Officers (ASTHO) President’s Challenge will focus on infant mortality and healthy babies this year. ASTHO’s Healthy Babies Project will support state health officials and their staff in improving infant health outcomes.
ASTHO is collaborating with several organizations and government agencies, including the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA). The latest HRSA data shows that 29,138 infants died before their first birthday—an infant mortality rate of 6.8 deaths per 1,000 births in 2007, which is unchanged from the previous year. And one in eight babies is born too soon, according to the March of Dimes, posing health and development risks for the baby and stress issues for the family. NewPublicHealth spoke with HRSA Administrator Mary Wakefield, PhD, RN, about the partnership.
NewPublicHealth: This collaboration is not your first with ASTHO?
Dr. Wakefield: We’ve actually had a longstanding relationship with ASTHO and we’ve worked with their leadership and their board and members on different issues over the years. This year their new president David Lakey, from Texas, has a particular focus on improving birth outcomes, and this is one of those areas we focus on at HRSA, particularly through our Maternal Child Health Bureau. We very much share the same concerns and I think complement each other’s efforts. We’re working in partnership with ASTHO on this and also working with other stakeholders too, including state divisions of Maternal and Child Health, the American Academy of Pediatrics and the March of Dimes.
NPH: What are some programs at HRSA that address healthy babies?