Week 5: Maternal/Child Health: Disease Screening

Infant Mortality Rate

Number of infant deaths for every 1,000 live deaths

• Indicator of health status of a population/society

• More than double in African Americans compared to whites

  • Indicate health disparity

• 2022: infant mortality rate in US: 5.6 deaths/1,000 live births

• Any death in the first year of life

Social risk factors for poor infant health and infant mortality

• Poverty; low SES (Number 1 social risk factor)

• Low Education

• Decreased health literacy

• Limited access to healthcare and nutritious food

• Hygiene in rural communities

Why does low SES increase risk for poor infant health and infant mortality?

• Environmental hazards

• Poor nutrition

• Maternal risk behaviors (smoking, alcohol, illegal drugs)

• Social factors (young maternal age, violence, stress, lack of social support

• Lack of prenatal care

High Risk Women

Poor

Young (<20 years old)

Minority

Unpartnered women of low SES

• Infants are susceptible to low SES disadvantages

Weathering

Chronic stress of racism and discrimination accelerates the biological aging process, leading to early onset of age-related health conditions like HTN and T2D, even at younger chronological ages

Leading causes of infant mortality

• Congenital defects: congenital malformations, deformations and chromosomal abnormalities

• Premature birth: disorders related to short gestation and low birthweight

• Sudden infant death syndrome (SIDS)

Interventions to Prevent Birth Defects

FDA Regulation of:

• Terotogenic drugs

• Warnings against alcohol for pregnant women at bars and on beverage containers

• Warnings on tobacco product labels

• Reduction of prescribed pain medications during pregnancy

• Rubella vaccine

• Folic acid: dietary supplements recommended for all women of child bearing age to reduce neural tube defects (anencephaly and spina bifida)

  • 1998 - FDA requires flour, corn meal, pasta, rice fortification

• Genetic and newborn screening: for detection and early tx

Interventions to Prevent Low Birth Weight

• Prenatal care

• Reduction of adolescent pregnancy

• Recent evidence suggests that gum disease is associated with preterm births

• Periodontal treatment may reduce risk

Cause of low birth weight is not well understood

Interventions of Prevent SIDS

Safe to Sleep Campaign: learning about safe sleep surfaces and other features of a safe sleep environment for baby

Interventions to Prevent Infant Mortality

Prenatal care: most public health-oriented kind of care the medical professional provides (may be the only source of the following)

• Education to pregnant women during and after pregnancy

• Health care services: problems are diagnosed early

• Social Support: Provides options to be linked with social services

• Most states try to remove financial barriers

• State and federal governments collect prenatal care data

Community-Based Initiatives

• Healthy Start: program that invests in communities to improve health outcomes before, during, and after pregnancy

  • Tailor to communities to help reduce difference in rates of infant death and maternal health outcomes

Controversy of including comprehensive sex education in schools to discourage teenage pregnancy

Critics often oppose it based on moral or religious objections to premarital sex, while proponents argue that comprehensive education, which includes information on contraception and safe sex practices, is more effective at reducing unintended pregnancies than abstinence-only programs, which have been shown to be ineffective and can contain medically inaccurate information

Prevention of Teen Pregnancy

Most effective reduction of teen pregnancy: comprehensive sex education

• More effective than abstinence-only education in reducing teen pregnancies

Affordable Care Act (ACA): requires insurance companies to cover birth control at no cost, increasing access

Government programs that ensure adequate maternal and child nutrition

1. Breastfeeding Support

2. Women, Infant, and Children (WIC)

3. Supplemental Nutrition Assistance Program (SNAP)

4. Children Nutrition Programs

Breastfeeding Support

• Teaches people how to breast feed

• Leads to healthier child and mother

• Healthy Baby Initiative developed by WHO and UNICEF

  • 2007, only 2.92% of U.S. births occurred in Baby-Friendly designated facilities

  • 2022 approximately 25% of births in roughly 600 Baby-Friendly designated facilities

• GOAL: To increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies

Women, Infants, and Children (WIC)

Provides vouchers for nutritious foods for pregnant women, lactating mothers, and children <5

• Very effective

Supplemental Nutrition Assistance Program (SNAP)

Based on household size and income

E-card to buy nutritious food at grocery stores

Examples of Children Nutrition Programs

Summer Food Service Program

Nutritional School Lunch Program

School Breakfast Program

Child and Adult Care Food Program

Importance of childhood immunization

For Children Health and Safety

• Immunizations are required for entry to school

• Vaccination of younger children: free to poor and uninsured

• HPV vaccine to prevent HPV related cancers– although acceptance rates were low, they are improving (61%)

• Health screenings in schools to reach children who do not receive wellness care (screenings for TB, vision/hearing, scoliosis)

Congenital defects

Major cause of death and disability in infants and children

• Abnormalities:

  • May be inherited/genetic

  • Due to birth injury

  • Mother’s exposure to toxins or infections during pregnancy

Role of public health in prevention of congenital defects

• Preventing maternal exposure to chemical and infectious agents (teratogens) that cause birth defects

• Screening programs: prevent genetic diseases or can minimize the ill effects of these diseases on children by identifying diseases at birth

  • Opportunity for early treatment

• Education with screening ahead of having children (Tay-Sachs, sickle-cell)

  • Tay-Sachs: condition causing paralysis, dementia, and blindness

    • Death by age 3-4

Environmental Teratogens

• Infectious pathogens (ex. syphilis, rubella, toxoplasmosis)

• Environmental chemicals (ex. Mercury)

• Medications (ex. Accutane, thalidomide, hormones)

• Alcohol

• Cocaine and heroin

Role of newborn screening as a public health service

GOAL: prevent death and disability caused by genetic diseases

• Early intervention to:

  • Eliminate/reduce symptoms

  • Limit lifetime disability

• Test a drop of blood from each infant metabolic diseases that can be treated if diagnosed soon after birth

NOT a diagnostic test cannot confirm or rule out a condition

IDENTIFIES individuals who MAY have the condition and prompts definitive follow-up testing

Examples of Newborn Screening Tests

Hearing screening (CDC recommends screening for profound hearing loss)

Pulse oximetry screening for critical congenital heart defects

Sickle-cell disease, HIV screening

Screening for metabolic disorders that can be treated soon after birth

One dried blood-spot is used to test > 20 metabolic disorders

Phenylketonuria (PKU): genetic inability to break down amino acid phenylalanine → risk of brain damage or death

• Found to be the cause of mental retardation in majority of institutionalized adults

• Treatment: low phenylalanine diet to prevent brain damage

Congenital Hypothyroidism: deficiency of thyroid hormones affecting proper growth and development, leading to mental retardation and dwarfism

• Treatment: thyroid hormones