1. Preconception Health in NC Think Tank Meeting #3 August 16, 2007

2. What’s UP?  NC Women’s Health Report Card Released  National Preconception Clinical Curriculum to be housed on mombaby.org  NC Featured on National Webcast – National Association of City and County Health Officials  National Summit on Preconception Health  October 29-31 in Oakland, CA  5 presentations/posters from NC

3. Planning Steps March 2007 Think Tank Meeting #1 To initiate a focused, collaborative, comprehensive process to create a state Preconception Action Plan May 2007 Think Tank Meeting #2 To collect diverse ideas and understand how preconception fits into existing work August 2007 Think Tank Meeting #3 To develop the components of the plan

4. Guiding Principles Focus on the whole woman – not only her reproductive capacity. Consider the woman’s health needs and related wellness recommendations within the context of her family and community. Be careful that messages don’t imply that certain groups of women should not become mothers. Be cognizant of health disparities and prioritize programs with potential to close the gaps.

5. Work should address… Clinical practice – continuity of care Evaluation & research Integrating new messages into current campaigns Policy & advocacy Holistic view of health Social marketing Interconception health

6. Themes Include men & families Start early / young Use existing programs to carry messages Build on public health outreach into worksites, private practice, and communities Master tool kit – clear and consistent messages

7. Potential Target Audiences Age (teens, 20s, 30s, 40s) Contemplators / Non- Contemplators Race/Ethnicity Gender Income Education Mothers Geography (13 counties have most of the excess infant death) Families / Couples Women w/health conditions Communities Health care providers (OBs, Pediatrics, Family Medicine, Internal Medicine, etc) Public health leaders State opinion leaders Media Insurers / Funders Researchers

8. The chasm  There is a gap between knowing and doing.  We need to use education and resources – knowledge and mechanisms to narrow that gap and enable women to make positive changes.

9. Qualitative Data

10. Data Sources What New Mothers Say: Personal Comments from the North Carolina PRAMS Survey, NC DHHS SCHS, May 2007 Latina Infant Mortality Awareness Project, NC Healthy Start Foundation, April 2007 Women’s Health: Attitudes and Practices in North Carolina – Focus Group Research, NC SIM Collaborative/NC Healthy Start Foundation, June 2005 Uncovering Community Voices: A Catalog of Qualitative Data Regarding Women’s Health in North Carolina 1995 – 2005, UNC MCH 315 Spring 2005 Class with Supervision from UNC Sheps Center and UNC Center for Maternal and Infant Health

11. What women say… Behavior Change: Awareness not enough to change behaviors. Knowledge of family history, family support and healthcare options can lead to change. Stress: Emotional, physical and financial stress negatively influence health. Need more social support and networking.

12. What women say… Mental health issues, especially depression, are significant. Lack of resources in communities. Barriers to Health Care: Cost. Racism. Lack of – insurance, access, trust/respect, childcare, and transportation.

13. What women say… Approach to Healthcare: Prefer holistic approach. Substance Use: Many women reported they knew someone struggling with drug addiction. Reported as coping mechanism for extreme stress. Most pregnancies are unplanned. Women are concerned about becoming pregnant but don’t use contraception. Inconvenient clinic hours and quality of care problems with family planning services.

14. Quantitative Data

15. Obesity and Related Conditions 25% of NC Women aged 18 – 44 y.o. are obese BRFSS 2005 Obesity increases risk for hypertension (13%) and diabetes (2%) BRFSS 2005 62% of NC women do not meet minimum recommendations for physical activity NC Women’s Health Report Card, 2007

16. DIABETES PREVALANCE NC 2000 - 2006 YEARESTIMATED POPULATION PERCENT 2000379,0006.4% 2001418,0006.7% 2002449,0007.2% 2003518,0008.1% 2004609,0009.6% 2005547,0008.5% 2006600,0009.1% Source: State Center for Health Statistics, North Carolina

17. Gestational Diabetes  Occurs only during pregnancy and affects 2- 4% of all pregnant women.  Obesity is a risk factor for the development of gestational diabetes.  Women who develop gestational diabetes are at higher risk of developing type 2 diabetes. Source: ADA. Clinical Practice Recommendations 2005. Diabetes Care 28 (Sup 1): S38. (17)

18. Complications Associated with Obesity  Obesity is a risk factor in the higher perinatal mortality and morbidity rate found in type 2 diabetes, including congenital malformation and macrosomia. Complications include:  Hypertension  Obstructive sleep apnea  Preeclampsia  Increased urinary tract infections  Higher rates of cesarean and difficult deliveries in the mother Source: Diabetes Care. 1992; 15:1640-57

19. Impact on Infants  Major congenital malformations remain the leading cause of mortality and serious morbidity in infants of mothers with type 1 and type 2 diabetes.  Observational studies indicate that the risk of malformations increases continuously with maternal glycemia during the first 6-8 weeks of gestation (1 st trimester). Source: ADA. Clinical Practice Recommendations 2005. Diabetes Care 28 (Sup 1): S38. (17)

20. Substance Use NC Women Aged 18 – 44 years old 24% Use Tobacco 8% Engage in Binge Drinking 7% Engage in Illicit Drug Use* NC BRFSS 2005 *NC Adults aged 12 and older, SAMHSA, National Survey on Drug Abuse and Health, 2005

21. Substance Use Lack of outpatient and inpatient services Need for provider training and screening tools Need for more NC-specific research

22. NC Women & Factors Affecting Pregnancy Outcomes 45% of pregnancies are unintended NC PRAMS 1997 - 2000 62% do not take folic acid daily NC BRFSS 2006 19% may not be rubella immune NC State Lab, prenatal clients, 2006

23. NC Women and Sickle Cell Nationally one in every 12 African Americans has sickle cell trait NIH NHLBI, 2007 3,908 newborns born in NC with sickle cell trait in 2006 NC State Lab

24. STIs/HIV Case Rate NC Women Aged 18 – 44 years old 1320.3/100,000 Chlamydia Case Rate 432.5/100,000 Gonorrhea Case Rate 312.4/100,000 living with HIV/AIDS 8.1/100,000 Syphilis Case Rate (PSEL) NC DPH, HIV/STD Prevention and Care Branch 2006

25. Mental Health NC Women Aged 18 – 44 years old 23% Report 1- 8 days of poor mental health during the past month NC BRFSS, 2005 20% Report being moderately or very depressed in the months after delivery NC PRAMS 2000, 2003

26. Barriers to Healthcare NC Women - Aged 18 – 44 years old 24% Uninsured 27% No dental visit in the past year NC BRFSS 2005

27. Criteria for Areas of Focus  Impact women’s and/or infant health  Consistent with CDC Recommendations  Based on best available scientific evidence, including NC data highlighting disparities and needs/gaps  Reflect issues that women have highlighted as important to them  Reflect priorities of participants in previous meetings  Offer concrete opportunities for action  BONUS: Impact chronic disease in the future

28. What Bubbles to the Top? 1) Pregnancy Intendedness 2) Substance Use 3) Obesity and Related Conditions 4) Mental Health 5) Barriers to Healthcare

29. Questions?

30. Structure Leadership Team Topic Area Groups (Workgroups) Collaborate around agreed-upon areas of focus Will have Chairperson and develop agenda Collaborate on existing programs, funding opportunities, develop new programs/advocacy plans, measurement of progress Use expertise of researchers and messaging experts as needed Preconception Collaborators (project-specific)

31. Leadership Structure Preconception Leadership Team Preconception Collaborators Pregnancy Intendedness Barriers to Healthcare Obesity / Related Issues Mental Health Substanc e Use Other?

32. The Website www.mombaby.org Resources National News Minutes Feedback

33. Please join us! Sign up for the Leadership Team, a workgroup(s), or to provide other support Workgroups will meet in Fall 2007 Progress reports from workgroups to be given at next large-group meeting on December 4 (save the date!) NC Preconception Conference: January 23, 2008 (Greenville)