PBH 805: Week 3 Slides

| http://online.mcphs.edu
Week 3
Chapter 7, Part 1
Instructor: Gina Crosley-Corcoran, MPH
PBH 805 – Maternal & Child Health

Chapter 7
Maternal And Neonatal Outcomes
Epidemiology And Reproductive Risk

Definitions, Point Estimates, and Trends
 Reproductive and perinatal outcomes represent a
spectrum of events spanning from the pre-pregnancy
period through birth outcomes and infant and maternal
morbidity and mortality.
 Outcomes associated with maternal and infant health
provide information about risk factors and the role context
(environment) plays in women and children’s health.
 Risk factors may be causal, directly leading to the
outcome.
 Risk markers, in contrast, are indicators that rates are
higher or lower in specific groups with no assumption of
causality (e.g., race/ethnicity).

Risk Factors
 Key reproductive and perinatal outcomes include low
birth weight, preterm delivery, fetal death, infant
death, perinatal mortality, birth defects, and maternal
death.
 Risk factors affecting reproductive and/or perinatal
outcomes could be:
 Individual health: maternal health status, previous pregnancy outcomes
 Behaviors: smoking, nutrition, substance use
 Psychosocial: stress, anxiety, depression
 Health system: access to well-women, prenatal, and postpartum care
 Barriers to care: childcare, transportation, patient provider relationships
 Structural: residential, segregation, poverty, institutional racism, climate
change

Low Birth Weight: Being Born Small,
Being Born Early
 An indicator of infant health and well-being in childhood and
adulthood.
 Leading cause of infant death
 Associated with health complications such as necrotizing
enterocolitis, respiratory distress syndrome, infant morbidities,
developmental delay, intellectual and development disabilities,
diabetes heart disease and obesity
 However, not all LBW babies have poor outcomes
 Classified into
a. Very LBW (<1,500 g)
b. Moderately LBW(1,500–2,499 g)
c. Extremely LBW (<1,000 g)
 The risk of adverse events is higher as BW decreases

Fetal Growth: SGA and IUGR
 Small-for-Gestational age (SGA) when birth weight distribution at a given week of
gestation is less than the 10th percentile
 Intrauterine Growth Restriction (IUGR) is pathological growth restriction
associated with greater risk of adverse outcomes
 Growth restricted fetuses are at risk of infant morbidity and mortality,
neurodevelopmental sequelae in childhood, diabetes, cardiovascular disease in
adulthood
 IUGR could be symmetric or asymmetric
 Asymmetric which occurs later in pregnancy due to complications affecting blood
flow in favor of vital organs. Thin infants with head circumference preserved.
Mainly seen in higher wealth nations
 Symmetric: seen in resource constrained settings, occurs early in pregnancy. Head,
length, and weight are decreased proportionally

Fetal Growth: Macrosomia
 Macrosomia refers to birth weight >4,000g, 4,500g or
5,000g or large-for-Gestational age (LGA) > 90th, 95th or
97th for infant’s gestational age
 Risk factors: maternal obesity, glucose
intolerance/diabetes, large pregnancy weight gain, post-
term pregnancy
 Complications include
a. Birth trauma
b. Shoulder dystocia leading to brachial plexus injury
c. Asphyxia
d. Meconium aspiration
e. Hypoglycemia

Gestational Age
 Preterm birth (PTB) refers to delivery before 37 completed
weeks of gestation
 PTB major cause of LBW
 PTB classified as
a. Early: < 34 completed weeks (usually associated with severe morbidity and mortality)
b. Late: 34-36 completed weeks (comprise majority of PTB)
 Could also be spontaneous (70-80%) or medically indicated (20-
30%)
 Associated risks of PTB: neonatal morbidity and mortality and
longer-term outcomes such as neurodevelopmental disabilities
 Impacts on mental, emotional, financial well-being
 Delivery before 20 weeks is miscarriage/spontaneous abortion

Fetal Death (Stillbirth)
 Defined as spontaneous intrauterine death of a fetus at any time
during pregnancy
 Significant burden on black families
 U.S. state laws requires reporting of stillbirths even though
definitions vary by states
 Fetal mortality: number of fetal deaths per 1000 live births and fetal
deaths.
 Ealy fetal death: number of fetal deaths at 20–27 weeks of gestation
divided by total live births and early fetal deaths 20–27 weeks
 Late fetal death: number of fetal deaths >28 weeks of gestation
divided by total live births and early fetal deaths >28 weeks
 HP 2020 goal for fetal deaths is 5.6 per 1,000 live births and fetal
deaths.
 Fetal death rates have remained steady since 2006.

Infant Death
 Refers to the death of infants during the first year of life
(rate of infant deaths per 1,000 live births)
 Indicator of society’s well-being and a barometer for
society’s commitment to health and well-being of women,
children, and families
 Classified as neonatal or postneonatal
a. Neonatal mortality during the first 27 days of life
b. Postneonatal mortality refers to death from the first 28 days to 1 year
of life
 A more precise measure of infant death is the cohort
mortality rate, which describes death of infants in a birth
cohort for a given calendar year and is measured through
linkage to birth and death certificates.

Infant, Neonatal and Postneonatal Mortality Rates, U.S., 1995–2017
<Insert Figure 7-4>

Birth Defects
 Refers to a structural abnormality present at birth
 Birth defects have different morphogenesis and, hence,
are heterogenous.
 Malformations due to with poor tissue formation: clefts
and congenital heart defects
 Deformations due to unusual forces on normal: clubfeet
and congenital hip dislocations
 Disruptions involving breakdown of normal tissue:
amniotic bands and gastroschisis
 Incidence is 1 in 33 births in the U.S.
 Congenital heart defects (CHD) are the most common.

Birth Defects
 Most prevalent specific birth defects are clubfoot, Down
syndrome, cleft lip with or without cleft palate, and pulmonary
valve atresia and stenosis
 Congenital malformation leading cause of infant mortality in U.S.
 Causes: could be genetic (10–25%), multifactorial (65–80%),
environmental (3–7%)
 Teratogens include infectious agents (rubella, syphilis), drugs
(prescription and nonprescription) nutritional deficiencies
(folate and zinc), environmental agents (mercury and radiation)
 The effect of these depends on the timing of exposure to the
embryo and fetus
 The riskiest time is the first 12 weeks of pregnancy

Birth Defects
 Advisory Committee on Heritable Disorders in Newborns
and Children established under Public Health Service Act,
Title XI and amended by the Newborn screening Saves
Lives Reauthorization Act of 2014
 Recommend every newborn screening program to include
uniform screening panel to screen for 35 core disorders
and 26 secondary disorders
 Four most commonly screened are phenylketonuria,
congenital hyperthyroidism, galactosemia, and sickle cell
disease
 Pulse oximetry screening after 24 hours for detection of
critical congenital heart diseases based on low blood
oxygen levels

Maternal Morbidity and Mortality
 Maternal mortality, a sentinel measure of maternal health, quality of
reproductive health care, and progress made by countries towards
attainment of development goals
 Maternal mortality as defined by WHO as “deaths that occurred during
pregnancy or within 42 days of termination of pregnancy from “any
cause related to, or aggravated by, the pregnancy or its management
but not from accidental or incidental causes.”
 44% global reduction in maternal mortality rates between 1990 and
2015
 However, current U.S. maternal mortality rate is 3–4 times higher than
in high wealth countries. Women of color are 4–5 times more likely to
die than White women.
 For each maternal death are 50–100 more women with life-threatening
pregnancy complications.

Severe Maternal Morbidity
 Continuum of pregnancy outcome: normal/health 
pregnancy severe morbidity  death
 Severe maternal morbidity (SMM) includes massive
hemorrhage, cardiac arrest, organ system failure, stroke,
massive transfusion, extended hospital state,
hysterectomy, and other major interventions.
 60,000 women/year experience severe morbidity (CDC).
 Rates of SMM increasing
 Women of color also at much higher risk than White women
 National sources of data to measure maternal deaths are
CDC’s National Vital Statistics System (NVSS) and
Pregnancy Mortality Surveillance Systems (PMSS).

Data Sources
 NVSS: official data source, based on death certificates and
assigns ICD codes to identify maternal deaths based on WHO
definition
 Pregnancy Mortality Surveillance Systems (PMSS) developed in
1986 by CDC and ACOG in order to determine and explain causes
of pregnancy-related deaths up to 1 year after pregnancy by
linking death certificates to live birth and fetal death records
(where possible)
 PMSS produces pregnancy-related mortality ratio (PRMR),
defined as the number of pregnancy-related deaths per 100,000
live births, which extends the period for capturing maternal
deaths from 42 days to 1 year after termination of pregnancy.
 PMSS uses information sent by states, DC, and NYC to determine
cause of death and its relation to pregnancy.

Week 3 Assignments
Discussion Board
Quiz on Chapter
Plagiarism Quiz

PBH 805: Week 3 Slides

Recommended

Recommended

More Related Content

Similar to PBH 805: Week 3 Slides

Similar to PBH 805: Week 3 Slides (20)

More from Gina Crosley-Corcoran

More from Gina Crosley-Corcoran (20)

Recently uploaded

Recently uploaded (20)

PBH 805: Week 3 Slides