Healthy Pregnancy
Monica Riccomini, RN, MSNLisa Lottritz RN, BSN
Outline of Today’s Topics
Preconception HealthPrenatal HealthFetal Infant Mortality ReviewCase StudyDiscussionClosing
Components of a Healthy Pregnancy
Preconception Health
Prenatal Health
Interconception Health
National Objective
Healthy People 2000 set a goal of 60% of primary care physicians will provide age-appropriate preconception careEstimated 1 in 4 providers currently provide preconception care
Preconception
Preconception HealthDefined as a women’s health status prior to becoming pregnant
Preconception CareInterventions that aim to identify and modify risks to a women’s health or pregnancy outcome through prevention and management
Preconception Risk Factors
Chronic Health ConditionsObesitySubstance UseSmokingSexual Transmitted InfectionsTeratogenic DrugsVaccinationsFolic Acid
Preconception Interventions
Smoking Cessation Folic Acid SupplementationMedication AdjustmentsPre-pregnancy Check UpObesity Control
Prenatal Health
Prenatal Care
Healthy Behaviors
Community Resources
National Objectives
Healthy People 2010 ObjectiveIncrease the proportion of pregnant women who receive early and adequate prenatal care to 90% of live births
Nevada Data, 2004
Early and Adequate Prenatal Care, 2004
67.4 66.1 67.158.6 56.8
90.073.3
70.253.8
0.0
20.0
40.0
60.0
80.0
100.0
HP 2010 NV Washoe Clark Rural
Geographic Area
% o
f W
om
en
Re
ce
ivin
g
Pre
na
tal C
are
1st Trimester
Adequate PNC
Pregnancy Weight Gain
..\Healthy Pregnancy\INSTITUTE OF MEDICINEappendix.doc
Evaluating Interventions
Data
Pregnancy Risk Assessment Monitoring System (PRAMS)
Perinatal Periods of Risk (PPOR)
Fetal Infant Mortality Review (FIMR)
National Objectives
Healthy People 2010 ObjectiveLess than 5 percent of the babies born will be low birth weight and less than 0.9 percent of the babies born will be VLBW
Nevada Data, 2004
% LBW and VLBW in Nevada, 2004
8.0 7.68.2
1.4
5.0
6.6
0.9 1.3 1.1 0.9
0.0
2.0
4.0
6.0
8.0
10.0
HP 2010 NV Washoe Clark Rural
Geographic Area
% L
BW
an
d V
LB
W
LBW
VLBW
National Objective
Healthy People 2010 ObjectiveReduce fetal deaths to 4.1 per 1,000 live births plus fetal deathsReduce all infant deaths to 4.5 per 1,000 live births
Nevada Data, 2004
4.1 4.5
7.036.2
7.94
3.8
6.92 6.96.48
5.1
012345678
Per 1,000 Live Births
HP 2010 Nevada Washoe Clark Rural
Geographic Area
Fetal and Infant Mortality, 2004
Fetal Deaths (Live Births Plus FetalDeaths)
Infant Deaths
Fetal Infant Mortality Review
FIMR is a process that looks at community level factors related to individual cases of fetal and infant deathsThe objective of FIMR is to improve community resources and health delivery systems for women, infants, and families
Case Review Team• Medical Records• Death Certificate• Home Interview
Community Action Team
FIMR
Case Study
19 year old African American femaleFetal demise at 27 weeks gestationSecond pregnancy, living child is 9 months oldPre-pregnancy weight is 192#, height is 5 foot 4 inchesQuit smoking when she found out she was pregnant
Case Study
Started prenatal care at 17 weeksHas been taking multi-vitamin daily since she was 6 weeks pregnantShe had gestational diabetes with both pregnancies She had 3 prenatal appointments
Case Review
Additional information neededPreconception risksPrenatal risksRecommendations
Nevada Data, 2004
Fetal Death Rate, 2004
7.56
0.00
14.71
20.55
13.02
6.78
0.00
5.00
10.00
15.00
20.00
25.00
Caucasian AfricanAmerican
NativeAmerican
Asian Hispanic Unknown
Race and Ethnicity
De
ath
Ra
te, P
er
1,0
00
Liv
e
Bir
ths
Source: State of Nevada Vital Statistics
Community Action Team
Interventions/Actions
Health Care Costs
The IOM report estimates preterm birth cost the US more than $26.2 billion in 2005The average hospital charge for the most severe (premature) babies was $77,000 per stay, compared to $1,700 for an uncomplicated newborn stay
Conclusion
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