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Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
Trends In African American Birth Outcomes
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Trends In African American Birth Outcomes

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  • FIRST….Reiterate that this is ALL BIRTHS Total C-Section Rate – Blue line - per 100 births : The total cesarean section rate among all live births - decreased 8.0% between 1991 and 1995, - and then increased 10.6% between 1996 and 2000. Primary C-Section Rate – Orange line – per 100 births with no previous c-section: The primary cesarean section rate followed the same trend, with a 7.5% decrease and a 10.3% increase, respectively. VBAC Rate – Green line – per 100 births with a previous c-section The rate of VBACs among all live births - increased 32.9% between 1991 and 1996, - and then decreased 24.8% between 1997 and 2000.
  • Through a remarkable series of studies, Barker and his colleagues were able to show an association between low birth weight and coronary heart disease, …
  • … and diabetes later on in life. Now when we think of the risk factors for heart disease, we think of smoking and high blood pressure and cholesterol and obesity and so forth  but low birth weight? What does low birth weight have anything to do with heart disease forty to fifty years later in life? Barker and his colleagues hypothesized that there are these critical periods in development during which the functions of an organ or system are being programmed, and any disruption to development during these critical periods will impair the optimal functioning of these organs or systems for life. For example, undernutrition during fetal development may permanently alter the structure or function of the pancreas, which may not be able to handle blood sugar load as well later on in life, leading to increased susceptibility for the development of diabetes mellitus. Obviously it’s a lot more complicated than that, but I started thinking that if that’s true, could one’s reproductive potential be similarly programmed in utero so that one’s future birth outcomes are already determined during fetal development and early infancy? And I’m not just talking about having small uterus and ovaries, but virtually all the body’s organs and systems that are involved in maintaining a healthy pregnancy.
  • Some increasing factors contributing to the national increase for preterm birth are unlikely to decrease making it even more important for strategies to focus on preventing preventable causes of preterm birth. For example, the proportion of births to women of advanced maternal age is rising steadily and as a cohort they are more likely to have spontaneous and indicated preterm births. In addition the father is often of advanced paternal age and several studies now demonstrate an independent risk for aging fathers. The epidemic of inductions, epidurals, scheduled deliveries and procedures such as universal electronic fetal monitoring often lead to interventions that lead to preterm delivery. Providers must practice evidence based medicine when the data are available and follow clinical guidelines based on this evidence, including not to electively induce until 39 weeks of gestation and even then only with evidence of fetal lung maturity. Adherence to this and other ACOG clinical practice bulletins would help to decrease increasing rates of moderately preterm deliveries. The interplay among stress, substance abuse and infections (most of which are asymptomatic) are also increasing and can contribute to earlier deliveries in the absence of appropriate screening and treatment. However, much more research is need on the role of stress and what interventions should be promoted. Evidence points to chronic stress and especially stress early in pregnancy as a contributor and host response to infections/inflammation when chronically stressed is also under study.
  • To better understand what women surveyed knew about folic acid, a few more questions were asked. Women who said they had heard, read or seen something about folic acid were asked what they recalled about folic acid through an open-ended question, which asked: “What have you heard, read or seen about folic acid?” In 2005, 19 % of those surveyed mentioned that folic acid helps prevent birth defects. This figure has increased since 1995 when 4% of women mentioned that folic acid helps prevent birth defects, but has decreased since 2004. In the 2005 survey, only 7 % of women mentioned that folic acid should be taken before pregnancy. While this response has improved from 2% in 1995, the rate remains low. Although women’s awareness of folic acid has been improving since 1995, women’s specific knowledge about folic acid has declined since 2004. In 2005 the rate of women who mentioned that folic acid helps prevent birth defects has declined to the level of 2001. Further, more than 9 out of 10 women did not know that folic acid should be taken before pregnancy.
  • Transcript

    • 1. National and Regional Trends in African American Birth Outcomes Karla Damus, RN MSPH PhD Associate Professor Dept OB/GYN and Women’s Health Albert Einstein College of Medicine National March of Dimes
    • 2. Women by Race/Ethnicity United States, 2000 145.3 million female population Source: US Census Bureau, 2000 Summary File 1
    • 3. Maternal Mortality by Race United States, 1970 -2003 Maternal death per 100,000 live births Note: Rates for 1970-1988 are based on race of child. Rates for 1989-2003 are based on race of mother. Source: National Center for Health Statistics, final mortality data Prepared by March of Dimes Perinatal Data Center, 2006
    • 4. www.healthypeople.gov
    • 5. The Current Agenda <ul><li>Goal #1: Increase quality and healthy years of life </li></ul><ul><li>Goal #2: Eliminate health disparities </li></ul><ul><ul><li>gender </li></ul></ul><ul><ul><li>race/ethnicity </li></ul></ul><ul><ul><li>income and education </li></ul></ul><ul><ul><li>disability </li></ul></ul><ul><ul><li>geographic location </li></ul></ul><ul><ul><li>sexual orientation </li></ul></ul>
    • 6. Questions <ul><li>What data are needed to describe disparities in birth outcomes in communities? </li></ul><ul><li>What data need to be collected to help inform possible reasons for disparities in birth outcomes? </li></ul><ul><li>What strategies have been shown to reduce disparities? </li></ul><ul><li>What relationships/partnerships need to be in place to address disparities in communities? </li></ul><ul><li>What programs need to be developed to address disparities at the community and population level? </li></ul><ul><li>What activities has the community tried? What’s worked/ What hasn’t? Why? </li></ul><ul><li>What are realistic goals for our organization/ communities? What are we ready to work toward? Opportunities? Venues? Approaches? Other relevant organizations? </li></ul>
    • 7. Births by Race/Ethnicity US 2001-2003 average In 2004 there were 4,112,052 live births registered in the US
    • 8. Infant Mortality United States, 1915- 2002 Rate per 1,000 live births Source: National Center for Health Statistics, final mortality data Prepared by March of Dimes Perinatal Data Center, 2002
    • 9. www.cdc.gov/mmwr <ul><li>Unexpected findings- most of increase due to: </li></ul><ul><ul><li>non Hispanic white </li></ul></ul><ul><ul><li>&gt;30 years </li></ul></ul><ul><ul><li>married </li></ul></ul><ul><ul><li>&gt;high school </li></ul></ul><ul><ul><li>onset PNC first trimester </li></ul></ul><ul><ul><li>nonsmoker </li></ul></ul><ul><ul><li>private insurance </li></ul></ul>
    • 10. Infant Mortality by Maternal Race United States, 1990 -2004* Rate per 1,000 live births Source: National Center for Health Statistics, final mortality data *preliminary data Prepared by March of Dimes Perinatal Data Center, 2007 2010 0bj
    • 11. Black/White Infant Mortality Rate Ratio United States, 1980-2004* Source: NCHS, final mortality data *preliminary mortality data
    • 12. Racial and Ethnic Disparities Infant Mortality Rates, US 2001 Per 1,000 Live Births NCHS 2003 HP 2010 Objective 4.5
    • 13. Infant Mortality by Race/Ethnicity New York City, 1990-2001 Rate per 1,000 live births Office of Vital Statistics and Maternal, Infant &amp; Reproductive Health Program , NYCDOH Prepared by March of Dimes Perinatal Data Center, 20002
    • 14. Infant Mortality Rates by Race/Ethnicity US Region, 2000-2002 average Source: National Center for Health Statistics, final mortality data Prepared by March of Dimes Perinatal Data Center, 2007 7.7 6.2 5.4 5.7 6.9 Total 4.0 3.4 5.6 4.9 4.7 Asian 8.2 5.8 10.5 8.7 8.8 Native Am 13.6 12.4 15.5 11.6 13.6 Black 6.2 4.9 6.1 5.2 5.7 White 5.3 6.1 6.6 5.4 5.5 Hispanic South NE Midwest West US  
    • 15. Infant Mortality Rates by State, 2003 Source: National Center for Health Statistics, 2003 period linked birth/infant death data.
    • 16. Three Leading Causes of Infant Mortality United States, 1990 and 2004* Rate per 100,000 live births Source: National Center for Health Statistics *preliminary mortality data for 2004 Prepared by March of Dimes Perinatal Data Center, 2007
    • 17. Three Leading Causes of Infant Deaths by Race/Ethnicity, US , 2000 Per 1,000 Live Births NCHS 2001
    • 18. Preterm Birth Rates United States, 1983, 1993, 2003, 2005* Preterm is less than 37 completed weeks gestation. Source: National Center for Health Statistics, final natality data Prepared by March of Dimes Perinatal Data Center, 2005 *preliminary Percent HP 2010 Objective &gt;30% Increase Percent &gt; 1 out of 8 births or 508,000 babies born preterm in 2005
    • 19. Preterm (&lt;37 wks) Births by Maternal Race/Ethnicity, US, 1990-2004 Source: National Center for Health Statistics, final natality data. Note: All race categories exclude Hispanic births. Data from 1990 excludes NH and OK. Data from 1991 and 1992 excludes NH. The reporting of Hispanic ethnicity was not required in these states during these years.
    • 20. Preterm Birth Rates by Race/Ethnicity and US Region, 2001-2003 average Source: National Center for Health Statistics, final natality data Prepared by March of Dimes Perinatal Data Center, 2007 13.5 11.2 12.0 10.8 12.1 Total 11.0 9.5 10.4 10.5 10.4 Asian 13.1 11.9 13.0 13.5 13.2 Native Am 18.4 16.2 17.9 15.6 17.7 Black 12.0 10.0 11.0 10.1 11.0 White 12.4 12.0 11.4 11.0 11.6 Hispanic South NE Midwest West US  
    • 21. Preterm Birth Rates by Race/Ethnicity &amp; Education, IOM 2006 8.4 9.4 7.5 7.0 12.8 &gt; 16 9.3 9.9 9.1 8.3 14.5 13-15 10.4 11.8 10.5 9.9 16.8 8-12 10.7 14.8 11.5 11.0 19.6 &lt; 8 Hispanic Am Indian Asian Pacific Islander Non HispanicWhite Non Hispanic Black Years of Ed
    • 22. Singleton Preterm Births by Maternal Race/Ethnicity and Education, 2001-2002 http://diversitydata.sph.harvard.edu
    • 23. &nbsp;
    • 24. Definitions <ul><li>Preterm birth: </li></ul><ul><ul><li>&lt; 37 completed weeks gestation </li></ul></ul><ul><li>Late preterm (or Near-Term): </li></ul><ul><ul><li>34-36 completed weeks </li></ul></ul><ul><li>Very preterm: </li></ul><ul><ul><li>&lt;32 completed weeks </li></ul></ul>
    • 25. Total (&lt;37 weeks), Very (&lt;32 weeks) and Late Preterm Births (34-36 weeks) U.S., 1990- 2003 Percent Late Preterm
    • 26. VPTB (&lt;32 wks) by Race/Ethnicity US Region, 2001-2003 average Source: National Center for Health Statistics, final natality data Prepared by March of Dimes Perinatal Data Center, 2007 2.2 1.9 2.0 1.5 2.0 Total 1.4 1.3 1.5 1.4 1.4 Asian 2.2 2.0 2.0 2.1 2.1 Native Am 4.1 3.8 4.2 3.2 4.0 Black 1.7 1.5 1.6 1.2 1.6 White 1.8 2.1 1.8 1.5 1.7 Hispanic South NE Midwest West US  
    • 27. Distribution of Preterm Births by Gestational Age, US, 2002 Source: National Center for Health Statistics, 2002 natality file Prepared by the March of Dimes Perinatal Data Center, 2004 (34 Weeks) (33 Weeks) (32 Weeks) (&lt;32 Weeks) (35 Weeks) (36 Weeks) “ Near term infants had significantly more medical problems and increased hospital costs compared with contemporaneous full term infants Near term infants may represent an unrecognized at-risk neonatal population.” Wang, et al. Clinical Outcomes of Near-Term Infants, Pediatrics (114) 372-6, 2004 . ~71% of PTB 34 - 36 weeks late preterm
    • 28. (1) Per 100 births (2) Per 100 births to women with no previous cesarean (3) Per 100 births to women with a previous cesarean Source: NCHS, final natality data, 1993-2003 and 2004 preliminary data Prepared by March of Dimes Perinatal Data Center, 2005 Total and Primary Cesarean and VBAC United States, 1993 - 2005 Preliminary
    • 29. Human Brain Growth in Gestation Kinney, 2006
    • 30. PEDIATRICS Vol. 118 No. 3 Sept 2006, pp. 1207-1214
    • 31. Differences in Singleton Preterm Birth Rates by Race/Ethnicity, 1992 and 2002
    • 32. Cesarean Section and Labor Induction Rates among Singleton Live Births by Week of Gestation US, 1992 and 2002 Late Preterm
    • 33. Birth Weight and Coronary Heart Disease Barker Hypothesis Age Adjusted Relative Risk Rich-Edwards 1997 Birthweight (lbs)
    • 34. Birth Weight and Insulin Resistance Syndrome Barker Hypothesis Odds ratio adjusted for BMI Barker 1993 Birthweight (lbs)
    • 35. &nbsp;
    • 36. Factors that Contribute to Increasing Rates of Preterm Birth <ul><li>Increasing rates of births to women 35+ years of age </li></ul><ul><ul><li>Independent risk of advanced PATERNAL age </li></ul></ul><ul><li>Increasing rates of multiple births </li></ul><ul><li>Indicated deliveries </li></ul><ul><ul><li>Induction </li></ul></ul><ul><ul><li>Enhanced management of maternal and fetal conditions </li></ul></ul><ul><ul><li>Patient preference/consumerism (CDMR) </li></ul></ul><ul><li>Substance abuse </li></ul><ul><ul><li>Tobacco </li></ul></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Illicit drugs </li></ul></ul><ul><li>Bacterial and viral infections </li></ul><ul><li>Increased stress (catastrophic events, DV, racism) </li></ul>
    • 37. Risk Factors for Preterm Labor/Delivery <ul><li>The best predictors of having a preterm birth are: </li></ul><ul><ul><ul><li>current multifetal pregnancy </li></ul></ul></ul><ul><ul><ul><li>a history of preterm labor/delivery or prior low birthweight </li></ul></ul></ul><ul><ul><ul><li>mid trimester bleeding (repeat) </li></ul></ul></ul><ul><ul><ul><li>some uterine, cervical and placental abnormalities </li></ul></ul></ul><ul><li>Other risk factors: </li></ul><ul><ul><li>unintended pregnancy </li></ul></ul><ul><ul><li>maternal age (&lt;17 and &gt;35 yrs) </li></ul></ul><ul><ul><li>black race </li></ul></ul><ul><ul><li>low SES </li></ul></ul><ul><ul><li>unmarried </li></ul></ul><ul><ul><li>previous fetal or neonatal death </li></ul></ul><ul><ul><li>3+ spontaneous terminations </li></ul></ul><ul><ul><li>uterine abnormalities </li></ul></ul><ul><ul><li>incompetent cervix </li></ul></ul><ul><ul><li>cervical procedures </li></ul></ul><ul><ul><li>genetic predisposition </li></ul></ul><ul><ul><li>low pre-pregnant weight </li></ul></ul><ul><ul><li>obesity </li></ul></ul><ul><ul><li>infections </li></ul></ul><ul><ul><li>anemia </li></ul></ul><ul><ul><li>major stress </li></ul></ul><ul><ul><li>lack of social supports </li></ul></ul><ul><ul><li>tobacco use </li></ul></ul><ul><ul><li>illicit drug use </li></ul></ul><ul><ul><li>alcohol abuse </li></ul></ul><ul><ul><li>folic acid deficiency </li></ul></ul>
    • 38. 1985
    • 39. &nbsp;
    • 40. Folic Acid-Specific Knowledge March of Dimes Folic Acid Survey Percentage of women ages 18-45
    • 41. Folate Levels Drop Significantly <ul><li>A CDC study released Thursday found an 8 to 16 % decline in folate levels based on results of the NHANES (interviews, PE, and blood tests of about 4,500 US women, ages 15 to 44, done between 1999 and 2004). </li></ul><ul><li>It was the first time such a decline has been seen since the start of government health campaigns urging women to make sure they get enough folic acid. </li></ul><ul><li>The decline was most pronounced in white women, although black women continue to be the racial group with the least folate in their blood. </li></ul>
    • 42. &nbsp;
    • 43. Smoking Among Women of Childbearing Age US, 2003 Smoking is defined as having ever smoked 100 cigarettes in a lifetime and currently smoking everyday or some days. Percent reported is among women ages 18-44. Source: Smoking: Behavioral Risk Factor Surveillance System. Behavioral Surveillance Branch, Centers for Disease Control and Prevention..
    • 44. Multiple Birth Ratios by Maternal Race/Ethnicity United States, 1992-2002 Source: National Center for Health Statistics, final natality data Prepared by March of Dimes Perinatal Data Center, 2005 Per 1,000 live births Percent Change ‘96-’02 = 21.5%
    • 45. Higher-Order Multiple Birth Ratios By Maternal Race, United States, 1980-2002 Ratio per 100,000 live births Source: NCHS, final natality data Prepared by March of Dimes Perinatal Data Center, 2004
    • 46. Institute of Medicine Report, July 2006 The IOM estimates the total national cost of premature births to be at a minimum $26.2 billion . This estimate includes many costs, such as in-patient hospital costs, lost wages and productivity and early intervention programs.
    • 47. Institute of Medicine Report on Preterm Birth, 2006 <ul><li>- One of the three major themes is disparities in PTB rates among different groups (racial, ethnic, or socioeconomic). </li></ul><ul><li>- Literature on causes of racial/ethnic disparities in PTB and effects of nativity need to be developed. </li></ul><ul><li>- Studies show that differences in PTB between African-American and white women remain after adjusting for socioeconomic differences. </li></ul><ul><li>- Literature on maternal behaviors such as smoking, drug use, and alcohol find that African-American women smoke less than white women during pregnancy and that the prevalence of drugs and alcohol use is no greater among pregnant African-American women compared to white women. </li></ul>
    • 48. Institute of Medicine Report on Preterm Birth, 2006 <ul><li>Infections may play a role in PTB, and studies have shown that African-American women are more likely than white women to experience infections such as bacterial vaginosis and sexually transmitted infections. The reasons for increased susceptibility to infection among pregnant African-American women are unknown. </li></ul><ul><li>Unknown how genes or interactions of genes and the environment contribute to racial/ethnic disparities in PTB or why foreign-born and US-born women of the same race have different PTB rates given a common genetic ancestry. </li></ul><ul><li>Concludes that racial-ethnic differences in socioeconomic condition, maternal behaviors, stress, infection, and genetics can not fully account for disparities. </li></ul>
    • 49. Research Agenda <ul><li>Research agenda Recommendation II-3: Expand research into the causes and methods for the prevention of the racial-ethnic and socioeconomic disparities in the rates of preterm birth. </li></ul><ul><li>This research agenda should continue to prioritize efforts to understand factors contributing to the high rates of preterm birth among African American infants and should also encourage investigation into the disparities among other racial-ethnic subgroups. </li></ul><ul><li>Proposes that research should be guided by an integrated approach that examines co-occurrence and interactions among multiple determinants of disparities in preterm birth, including racism, which operates at multiple levels and across a life course. </li></ul>
    • 50. proteases Uterine Contractions Cervical Change • Infection: - Chorion-Decidual - Systemic Decidual Hemorrhage Abruption CRH E1-E3 Prothrombin G20210A Factor V Leiden Proteins C, S, Z Type 1 Plasminogen MTHFR Pathological Uterine Distention • Multifetal Preg • Polyhydramnios • Uterine abnormalities Inflammation <ul><li>Maternal-Fetal Stress </li></ul><ul><li>Premature Onset of Physiologic Initiators </li></ul>Activation of Maternal/Fetal HPA Axis CRH + + Chorion Decidua uterotonins Mechanical stretch Gap jct IL-8 PGE2 Oxytocin recep pPROM Interleukins IL-1, IL-5, IL-8 TNF-  Fas L Adapted from: Lockwood CJ, Paediatr Perinat Epidemiol 2001;15:78 and Wang X, et al. Paediatr Perinat Epidemiol 2001; 15: 63 Susceptibility to Environmental toxins CYP1A1 GSTT1 MMPs PTB Allergic Pathway
    • 51. &nbsp;
    • 52. Green et al. AJOG 193:626-35, Sept 2005.
    • 53. The 2006 PRI Grantees <ul><li>A Comprehensive Study of Genetic Susceptibility to Preterm Delivery </li></ul><ul><li>Pharmacological Investigation of Novel Anti-inflammatory Therapeutic Strategies for the Treatment and Prevention of Preterm Birth using Human Ex-Vivo Models </li></ul><ul><li>Maternal and Infant Genetic Contributions to Preterm Birth: the Inflammatory Response </li></ul><ul><li>Abruption-induced Preterm Delivery Elicits Functional Endometrial Progesterone Receptors </li></ul><ul><li>Progesterone Receptor Dysregulation and Preterm Birth </li></ul><ul><li>Cytokines from Periodontal Disease Induce Premature Birth </li></ul>
    • 54. PTB Risk Factors Revisited <ul><li>The strongest risk factors for PTB suggest a maternal or fetal genetic predisposition </li></ul><ul><li>Women born preterm are more likely to deliver preterm </li></ul><ul><li>~20% of women who deliver preterm have recurrence with the same partner </li></ul><ul><ul><li>changing partners reduces the risk by one third </li></ul></ul><ul><li>The heritability of PTB is estimated to be 17%-36% </li></ul><ul><li>18 studies reviewed on genetic polymorphisms showed that polymorphisms in TNF alpha showed the most consistent increase in PTB </li></ul><ul><li>Environmental factors such as infection, stress, and obesity suggest that environmental and genetic RF might operate and interact through related pathways. </li></ul>Crider, et al. Genetic variation associated with preterm birth: a HuGE Review. Genetics in Med 7(9) 593-604, 2005.
    • 55. Gene Clue to Premature Birth <ul><li>A genetic marker that could help to predict the risk of an unexpected preterm birth has been discovered </li></ul><ul><ul><li>may also help explain why AfAm women seem to be more at risk of having a preterm birth than other women </li></ul></ul><ul><ul><li>AfAm babies were 3 times more likely than babies of European descent to carry the key genetic variant, </li></ul></ul><ul><li>SERPINH1 controls production of the protein collagen, a key component of many body tissues, including cartilage, ligaments, tendons, bone and teeth </li></ul><ul><ul><li>variation of the gene can result in reduced amounts of collagen which could lead to weakened fetal membranes, increasing the chance of rupture triggering preterm birth. </li></ul></ul><ul><ul><li>The SERPINH1 T allele population attributable risk of PPROM is estimated to be 12.3% </li></ul></ul><ul><li>“ With better understanding of this genetic variation, we hope to be able to identify pregnancies at great risk of preterm birth and intervene to prevent it”, Jerome Strauss, MD </li></ul>Wang, et al. “A Functional SNP in the Promoter of the SERPINH1 Gene Increases Risk of PPROM in African Americans” Online Proceedings of the National Academy of Sciences, Aug 2006
    • 56. Khoury M and Romero R. AJOG (2006) 195, 1503–5
    • 57. Uninsured Women US, 2003-2005 Average Source: US Bureau of the Census. Data prepared for the March of Dimes using the Current Population Survey.
    • 58. Uninsured Children US, 2003-2005 Average Source: US Bureau of the Census. Data prepared for the March of Dimes using the Current Population Survey.
    • 59. Closing the Black-White Gap in Birth Outcomes: A 12-Point Plan <ul><li>Provide interconceptional care to women with prior adverse pregnancy outcomes </li></ul><ul><li>Increase access to preconception care for African American women </li></ul><ul><li>Improve the quality of prenatal care </li></ul><ul><li>Expand healthcare access over the life course </li></ul><ul><li>Strengthen father involvement in African American families </li></ul><ul><li>Enhance service coordination and systems integration </li></ul><ul><li>Create reproductive social capital in African American communities </li></ul><ul><li>Invest in community building and urban renewal </li></ul><ul><li>Close the education gap </li></ul><ul><li>Reduce poverty among Black families </li></ul><ul><li>Support working mothers and families </li></ul>M Lu, UCLA, 2006
    • 60. <ul><li>Undo Racism </li></ul><ul><ul><li>Internalized </li></ul></ul><ul><ul><li>Personally mediated </li></ul></ul><ul><ul><li>Institutionalized </li></ul></ul>
    • 61. www. gucchd.georgetown.edu/nccc
    • 62. PREEMIE Act (S. 707) Passes Congress <ul><li>Dec. 9, 2006-- Dr.. Howse, president of the March of Dimes, made the following statement as the Congress sent the “PREEMIE” Act to President Bush for his signature: </li></ul><ul><li>“ Congress has responded to the growing crisis of premature birth by approving a bill that will increase federal support for research and education on prematurity.  On behalf of 3 million active volunteers and 1400 staff of the March of Dimes working in every state, the District of Columbia and Puerto Rico, I thank the United States Congress for approving the “PREEMIE” Act. </li></ul><ul><li>In one of it’s most important provisions,  the bill authorizes a Surgeon General’s conference at which scientific and clinical experts from the public and private sectors will sit down together to formulate a national action agenda designed to speed development of prevention strategies for preterm labor and delivery. </li></ul>
    • 63. March of Dimes www.marchofdimes.com

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