1. Flojaune Griffin, PhD, MPH Preconception Health Coordinator
Using Preconception Health Indicators to Shape Programs and Policy in California
3rd National Summit on Preconception Health and Health Care
Improving Preconception Health in a New Era of Health Care
Tampa/St. Petersburg, FL
June 13, 2011
Flojaune Griffin, PhD, MPH
Preconception Health Coordinator

2. Acknowledgements
Preconception Health at the California Department of Public Health, Maternal, Child and Adolescent Health Division is funded by Title V federal block grant
Centers for Disease Control and Prevention for providing travel funding
CDPH Preconception Health Team
Connie Mitchell, MD, MPH
Sangi Rajbhandari, MPH
Moreen Libet, PhD
Michael Curtis, PhD
Jennifer Troyan, MPH
Shabbir Ahmad, DVM, MS, PhD
Preconception Health Council of California and the March of Dimes

3. Presentation Objectives
The participant will be able to:
Explain how California has used select California MIHA preconception health indicators (now included in Healthy People 2020) to identify statewide needs
Describe the value of the state-wide Preconception Health Council of California
Describe California Department of Public Health initiatives that were developed from the indicator surveillance
By identifying populations in greatest need and targeting programming efforts in preconception and interconception health

4. Maternal & Infant Health Assessment (MIHA)
Annual population-based survey of California women with a recent live birth, since 1999
~ 7000 women since 2010 with WIC funding; before ~
Mailed survey with telephone follow-up to non-respondents
Available in English and Spanish
Ages 15 and older
Random stratified sample
Regions include top 20 birthing counties
Response rates ~70%
Based at MCAH
Similar to CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS)

5. Selected MIHA Preconception Health Indicators
Folic Acid
During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?

6. Daily folic acid use during the month before pregnancy California Maternal and Infant Health Assessment 2009
Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment
Data are weighted to reflect the population of women delivering a live birth in the survey year.

7. Selected MIHA Preconception Health Indicators
Folic Acid
During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?
Smoking
Have you smoked any cigarettes in the past 2 years?
During the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day?

8. Did not smoke during the three months before pregnancy California Maternal and Infant Health Assessment 2009
Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment
Data are weighted to reflect the population of women delivering a live birth in the survey year.

9. Selected MIHA Preconception Health Indicators
Folic Acid
During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?
Smoking
Have you smoked any cigarettes in the past 2 years?
During the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day?
Healthy Weight (Calculated BMI)
Just before you got pregnant, how much did you weigh?
How tall are you without shoes?

10. Healthy Weight just before pregnancy (BMI 18. 5-24
Healthy Weight just before pregnancy (BMI kg/m2) California Maternal and Infant Health Assessment 2009
Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment
Data are weighted to reflect the population of women delivering a live birth in the survey year.

11. Selected MIHA Preconception Health Indicators
Folic Acid
During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?
Smoking
Have you smoked any cigarettes in the past 2 years?
During the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day?
Healthy Weight (Calculated BMI)
Just before you got pregnant, how much did you weigh?
How tall are you without shoes?
Postpartum Visit
Since your most recent birth, have you had a postpartum checkup (the medical checkup that is done about 6 weeks after a woman gives birth)?

12. Six Week Postpartum Medical Checkup California Maternal and Infant Health Assessment 2009
Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment
Data are weighted to reflect the population of women delivering a live birth in the survey year.

13. Preconception Health Council of California Activities
EveryWomanCalifornia Website
Public and Health Professionals
California Adoption of Colorado Guidelines for Clinical Care
Standardize the content of well women visits
Health Assessment
Management of Chronic Conditions
Appropriate contraception
Interconception Care Project of California
Standardize the content of postpartum visits
Central clearinghouse for CA preconception health information
Addressing high risk factors in clinical care during the preconception and interconception time period
High prevalence of reported PP visit, retooled goal of increasing adhere

14. California Department of Public Health Activities
Social Marketing Campaigns
HRSA First Time Motherhood Grant
Latina Folic Acid
African American
Youth (ages 15-24)
Black Infant Health Program Curriculum
Group life course intervention
10 prenatal and 10 postpartum visits
Diabetes and Pregnancy Program
Provider training for pregnancy readiness
Institute of Medicine Recommendations
Gap in USPSTF Recommendations
Essential Health Care Benefit
Family Planning, Preconception and Interconception health services
Indicators used to target campaigns
Because of the low prevalence of preventive factors and high prevalence of risk factors, BIH moved from an individual to a group intervention model, focusing on lifecourse and addressing the importance of risk factors with high prevalence among AA in CA
Additional risk of maternal complications for women with comorbidities (smoking, obesity)
Greater need for postpartum follow up for glycemic control and preconception counseling about pregnancy readiness and improvement of health status – addressing reproductive planning in program content
Given the needs expressed in MIHA and other state data (BSMF, CWHS, PAMR) IOM recommendations

15. Conclusions
MIHA is useful in identifying areas of need and guiding program development
Strengths
MIHA response rate is 70%
Reflective of the annual population giving birth in California
Limitations
Preconception period is long and variable
Difficult to measure impact of targeted campaigns
MIHA only assesses live births
MIHA is useful, but not sufficient in measuring preconception health
Need more indicators of preconception health (morbidity and wellness)
Need data measuring health status and behaviors of
All women of reproductive age
Pregnant women with embryo or fetal deaths

16. For Additional Information or Questions Contact:
Flojaune Griffin, PhD, MPH
Preconception Health Coordinator
Maternal, Child and Adolescent Health Division
Program Development Branch
(916)