A Healthier Future for West Virginia - Healthy People 2010

16 - Maternal, Infant, and Child Health

Objectives | References

Background

The health of a population is reflected in the health of its most vulnerable members. A major focus of many public health efforts, therefore, is improving the health of pregnant women and their infants, including reductions in rates of birth defects, risk factors for infant death, and deaths of infants and their mothers.

The health of mothers, infants, and children is a priority for the state of West Virginia as it is both a reflection of present health status and a predictor of future health status. The focus areas address indicators among pregnant and postpartum women as well as those affecting infants' health and survival.

Infant death is an important measure of a nation's health and a worldwide indicator of health status and social well-being. Between 1997 and 1998, West Virginia's infant mortality rate decreased noticeably, from 9.5 deaths per 1,000 live births to 8.1. During the past decade, critical measures of increased risk of infant mortality, such as incidence of low birthweight (LBW) and very low birthweight (VLBW), have actually increased across the United States.

Four causes account for more than half of all infant deaths: birth defects, disorders relating to short gestation and unspecified LBW, sudden infant death syndrome (SIDS), and respiratory distress syndrome. The leading causes of neonatal death nationally in 1997 were birth defects, disorders related to short gestation and LBW, respiratory distress syndrome, and maternal complications of pregnancy. After the first month of life, SIDS is the leading cause of infant death, accounting for about one-third of all deaths during this period. Maternal age is a recognized risk factor for infant death. In the United States mortality rates are highest among infants born to young teenagers (16 years and under) and to mothers aged 44 years and older.

Fetal death is another important indicator of perinatal health. Nationally in 1997 6.8 fetal deaths were reported for every 1,000 live births and fetal deaths combined, representing a slight decline from the fetal mortality rate of 7.6 per 1,000 in 1987. In 1998 the fetal death ratio in West Virginia was 6.0 per 1,000 live births, a decrease from the 1997 ratio of 6.7 deaths per 1,000 live births. Fetal death is sometimes associated with amniotic fluid levels and maternal blood disorders. In West Virginia in 1998 the majority (91.2%) of fetal deaths were due to conditions originating in the perinatal period, including complications of placenta, cord and membrane (30.4%), maternal conditions (7.2%), maternal complications (9.6%), short gestation and low birthweight (6.4%), and other ill-defined perinatal conditions (28.8%). Congenital anomalies accounted for 8.0% of all fetal deaths. Early, comprehensive, and risk-appropriate care to manage such conditions has contributed to reductions in fetal mortality rates.

Short gestation and LBW are among the leading causes of neonatal deaths, accounting for 20% of neonatal deaths nationally. In 1998, a total of 11.6% of births were preterm, and 7.6% were LBW. Included in these statistics were infants born at VLBW, or less than 1,500 grams (3.3 pounds). The national rate of VLBW births in 1998 was 1.4%. In West Virginia in 1998 the VLBW rate was 1.5%.

LBW is associated with long-term disabilities such as cerebral palsy, autism, mental retardation, and vision and hearing impairments. Despite the low proportion of pregnancies resulting in LBW babies, expenditures for the care of LBW infants total more than half of the costs incurred for all newborns nationally. In 1998, the cost for a normal, healthy delivery averaged $1,900, whereas hospital costs for LBW infants averaged $6,200.

The general category of LBW infants includes both those born too early (preterm infants) and those who are born at full term but who are too small, a condition known as intrauterine growth retardation (IUGR). Maternal characteristics that are risk factors associated with IUGR include maternal LBW, prior LBW birth history, low pre-pregnancy weight, cigarette smoking, multiple births, and low pregnancy weight gain. Cigarette smoking is the greatest known risk factor.

VLBW usually is associated with preterm birth. Relatively little is known about the range of risk factors for preterm birth, but the primary risk factors are prior preterm birth and spontaneous abortion, low pre-pregnancy weight, and cigarette smoking. These risk factors, however, account for only one-third of all preterm births nationally. Maternal use of illicit drugs also may increase the risk of VLBW.

Many of the risk factors can be mitigated or prevented with good prenatal counseling and early prenatal education and care. Prenatal visits offer an opportunity to provide information about the adverse effects of substance use, including alcohol and tobacco, during pregnancy and provide a vehicle for referrals to treatment services. The use of timely, high-quality prenatal care can help to prevent poor birth outcomes and improve maternal health by identifying women who are particularly high-risk and taking steps to mitigate risks, such as risk of high blood pressure or other maternal complications. Interventions targeted at prevention and cessation of substance use during pregnancy may be helpful in further reducing the rate of VLBW infants. Further promotion of folic acid intake can help to reduce the rate of neural tube defects.

The Objectives

OBJECTIVE 16.1. Reduce the prevalence of cigarette smoking among pregnant women to 12% or lower. (Baseline: 25.4% in 1998)

Data Sources: West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion (OEHP), Health Statistics Center (HSC); Office of Maternal, Child & Family Health (OMCFH), Pregnancy Risk Assessment Monitoring System (PRAMS), Right From The Start Program (RFTS)

OBJECTIVE 16.2. Reduce low birthweight to a incidence of no more than 5% of live births and very low birthweight to no more than 1% of live births. (Baselines: 8.1% for low birthweight; 1.5% for very low birthweight in 1998)

Data Source: WVBPH, OEHP, HSC

FLAGSHIP OBJECTIVE
OBJECTIVE 16.3. Increase to at least 90% the proportion of all pregnant women who receive 1st trimester prenatal care. (Baseline: 80.1% in 1998)

Data Source: WVBPH, OEHP, HSC

OBJECTIVE 16.4. Reduce the infant mortality rate to less than 7 deaths per 1,000 live births. (Baseline: 8.1 deaths per 1,000 live births in 1998)

Data Source: WVBPH, OEHP, HSC

OBJECTIVE 16.5. Reduce the rate of child mortality to 30 per 100,000 children aged 1-4 and 17 per 100,000 children aged 5-14. (Baselines: 31.1 deaths per 100,000 children aged 1-4 in 1998; 18.9 deaths per 100,000 children aged 5-14 in 1998).

Data Source: WVBPH, OEHP, HSC

OBJECTIVE 16.6. Reduce the incidence of pre-term birth (< 39 weeks of gestation) to 7.6% of live births. (Baseline: 12.3% in 1998)

Data Source: WVBPH, OEHP, HSC

OBJECTIVE 16.7. Reduce the sudden infant death syndrome (SIDS) mortality rate to 0.3 per 1,000 live births. (Baseline: 1.7 deaths per 1,000 live births in 1998)

Data Source: WVBPH, OEHP, HSC

OBJECTIVE 16.8. (Developmental) Promote education to providers on counseling for postpartum depression at 4-6 week postpartum visit. (Baseline data to be established in 2000)

Data Source: WVBPH ,OMCFH, PRAMS

OBJECTIVE 16.9. Reduce the incidence of spina bifida and other neural tube defects to 3 per 10,000 live births. (Baseline: 4.3 per 10,000 live births in 1998)

Data Source: WVBPH, OEHP, HSC, Birth Defects Registry

OBJECTIVE 16.10. Ensure that all newborns are screened by state-sponsored programs to detect phenylketonuria (PKU), congenital hypothyroidism, galactosemia, and hemoglobinopathies. (Baseline: 99.76% in 1998)

Data Source: Title V Performance Measures, Health Resources Services Administration (HRSA), Materal Child Health Bureau

OBJECTIVE 16.11. Reduce the perinatal mortality rate per 1,000 live births (deaths of infants from 20 weeks gestation to 28 days) by 30%. (Baseline: 10.6 deaths per 1,000 live births in 1998)

Data Source: WVBPH, OEHP, HSC

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

The following list includes some of the organizations that will be leading the initiatives to reach the 2010 objectives:

Office of Maternal, Child & Family Health
Division of Women's and Perinatal Services
Right From The Start Project
Family Planning Project Division of Research, Evaluation, and Planning
SIDS Program
PRAMS
Newborn Screening Program
Adolescent Pregnancy Prevention Initiative
Adolescent Health Specialists
Office of Epidemiology and Health Promotion, Tobacco Prevention Program
The March of Dimes
Healthy Mothers Healthy Babies Coalition
WV Perinatal Task Force 2000
Women, Infants, and Children Nutrition Program (WIC)

Work Group Members

Judy McGill, MSN, MS, Work Group Leader, Director, Division of Perinatal and Women's Health, OMCFH
Diane Kopcial, MSN, Former Work Group Leader, Former Director of Women's Services, OMCFH
Lynn Hartman, WV Freedom for Reproductive Equality and Education (Free), Charleston
Charlotte Flannigan, Director of Program Services, March of Dimes
Felice Joseph, Pharmacist, PEIA
Karen Merriman, Assistant Vice President for Academic Life, University of Charleston
Brenda Isaacs, RN, Kanawha County Schools
Susan Thompson, Executive Director, Girl Scout Black Diamond Council
Lynn Hartsog, Director, Big Brothers/Big Sisters
Shirley Finn, United Methodist Center
Gary Gunnoe, DARE (Drug Abuse Resistance Education) Unit, Charleston
Elizabeth Carr, RN, Braxton County Health Department
Brenda Donithan, Mercer County Health Department
Cindy Day, CFNP, Youth Health Huntington Valley Health Systems (VHS)
Cathy Davis, NP, Youth Health Huntington
(VHS)
Catherine Colburn, RN, Obstetrics Coordinator, School of Medicine, WVU
Sharon Lewis, LSW, Executive Director, Women's Health Center of WV, Inc.
Trina Bartlett, MSW, Adolescent Health Coordinator, Community Council of Kanawha Valley, Inc.
Martha Cook Carter, RN, CNW, WomenCare
Ann Dacey, RNC-NP, Department of OB/GYN, WVU
Susan Watkins, RN, Women's Comprehensive Care
Paula Woodrum, NP, Charleston Psychiatric Group
Savolia Spottswood, Director of Minority Health Program, Racial/Ethnic Populations, Rural Healthy Policy, Office of Community and Rural Health Services
Patty Pearson, Crittenon Teen Pregnancy Prevention Media Task Force, Family Planning Program, OMCFH
Dawn Bell, PharmD, Department of Clinical Pharmacy, WVU
Robin Seabury, MS, Women's Services, BCCSP, OMCFH
Dee Ann Price, RN, Women's Services, BCCSP, OMCFH
Ken Selbe, Director, Women's Services, Perinatal Programs-Maternity Services, ART (Access to Rural Transportation, Perinatal Outreach Project), OMCFH
Kelly Blake, RHEP Site Coordinator, Mountain Health Partners Consortium, St. Joseph's Hospital

References/Resources

Camas OR et al. "The role of lifestyle in preventing low birth weight." Future Child 5, no.1 (1995): 121-138.

Lewit EM et al. "The direct cost of low birth weight." Future Child 5, no.1 (1995): 35-56.

U.S. Department of Health and Human Services. Healthy People 2010 (Conference Edition, in Two Volumes). Washington, DC: January 2000.

U.S. Department of Health and Human Services. Vital and Health Statistics. Medical and Life-style Risk Factors Affecting Fetal Mortality, 1989-90. Hyattsville, Maryland: August 1996.

Ventura SJ et al. "Births and deaths: preliminary data for 1997." National Vital Statistics Reports 47, no. 4 (1998).

Ventura SJ et al. "Births: final data for 1997." National Vital Statistics Reports 45, no.18 (1999).

For More Information

Office of Maternal, Child, & Family Health
Room 427
350 Capitol Street
Charleston, WV 25301-3715
Phone: (304) 558-5388; Fax: (304) 558-2183

This page was last updated June 22, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov