Support group helps reduce infant deaths


Staff Reports



Preemie deaths down statewide

In an effort to combat infant mortality and improve outcomes for women with the highest risk of early premature birth, the Ohio Department of Medicaid and the Ohio Department of Health partnered with the Ohio Perinatal Quality Collaborative (OPQC), a voluntary quality improvement network dedicated to advancing perinatal health in Ohio.

According to the March of Dimes, the leading nonprofit organization for pregnancy and baby health, babies born more than two months premature account for more than half of all infant deaths in Ohio, which ranks among states with the highest rates of premature births and infant mortality.

“The goal of our project is reduce premature births in Ohio by 10 percent by assuring that progestogen supplementation therapy is available for every woman at risk,” said Dr. Jay Iams, Professor Emeritus in the Department of Obstetrics and Gynecology at The Ohio State University Wexner Medical Center and obstetrics clinical lead of OPQC.

The project led to a 20 percent reduction in premature births before 32 weeks of gestation for Ohio women insured by Medicaid. Results are reported in the February issue of Obstetrics & Gynecology, the journal of the American College of Obstetricians & Gynecologists.

“The reduction in early premature births we saw during this project is very encouraging,” Iams said. “Every pregnant woman should ask her prenatal caregiver about her risk of premature birth so that, if needed, preventive treatment can begin as soon as possible.”

OPQC was founded in 2007 to conduct statewide projects in Ohio aimed at assuring optimal care for pregnant women and their newborn infants. Previous successful projects led to fewer infections in premature newborns and a significant decline in scheduled births before 39 weeks of pregnancy that lacked a medical indication.

Beginning in 2014, OPQC worked for 26 months with prenatal care clinics at 20 large maternity hospitals, Ohio Medicaid and Medicaid insurers to improve care coordination among prenatal care providers, pharmacies and home healthcare services. The network identified 2,562 women who had a previous early premature birth and accelerated preventive treatment.

Clinicians and quality improvement experts throughout Ohio participated in the project, which is now being disseminated to all Ohio prenatal clinics and providers.

Funding from the Ohio Department of Medicaid and the Ohio Department of Health supports this ongoing research.

COLUMBUS – In the U.S., infant deaths have consistently declined over the years, yet the rate among African Americans remain twice as high as that of whites. Infant mortality rates (IMRs) are defined as the number of live born infants dying within the first year of life per 1,000 live births.

Medical and social determinants associated with maternal and infant health are complex, and social factors known to increase the risk of infant deaths include living in poverty with related food insecurity, poor housing, neighborhood and domestic violence, financial problems, smoking, drugs, alcohol and mental illness, among others.

In an effort to reduce infant deaths in high-risk neighborhoods in central Ohio, a group of academic health care providers and local civic and public health leaders came together and designed a weekly, two-hour group intervention curriculum to improve birth outcomes by providing education, case management and social and medical support to pregnant women.

Results of a recent study published online in Maternal Child Health Journal found utilization of the Moms2B program was associated with significant growth in maternal and infant health in an impoverished neighborhood.

“Our team examined maternal and infant health characteristics in an impoverished urban community before and after implementation of Moms2B,” said Dr. Patricia Gabbe, a professor of pediatrics and an infant mortality researcher at The Ohio State University Wexner Medical Center.

From 2011 to 2014, 195 pregnant women attended one or more Moms2B sessions, and 75 percent were African American with incomes below the poverty level and with significant medical and social stress. Outcomes from 2007 to 2010 (before Moms2B) showed 442 births and six infant deaths, an IMR of 14.2/1,000. There were 339 births and only one infant death, within the first four years of Moms2B (2011–2014), for an IMR of 2.9/1000.

“That’s nearly a five-fold reduction in the rate of an infant death. We also saw an improvement in breastfeeding rates after the introduction of Moms2B,” said Gabbe, who was also the founder of Moms2B.

Moms2B sessions focused on nutrition, pregnancy and parenting education-individual reviews of social factors influencing health and connecting women to necessary services. Follow-up text messages and telephone calls were made throughout the week to build positive relationships with expecting mothers. In addition, the rotating six-month curriculum covered mental health, pregnancy, reproductive health, parenting and infant safety topics and interventions.

“Teaching the pregnant and parenting woman was based on small, interactive messages, while fostering a two-way learning environment. We found that short, 10 to 15-minute discussions with good visual learning tools is the most effective way to engage and relate to our mothers. Colorful easy-to-read handouts are used with each lesson,” Gabbe said.

In addition, during group sessions, supervision was provided for the children who were present. Volunteer physical therapists conducted sessions with the infants, and child development students planned activities for toddlers and older children who were in attendance with their mothers. Before the session ended, a healthy meal was offered and served to all.

“We are growing our Moms2B program and have expanded to three more locations, and are seeing a decrease in smoking and preterm births,” Gabbe said.

“In order to continue to empower women to improve their health and social conditions, we need more stable housing and healthy food, additional transitional jobs and transportation, and also involved fathers, as well as more prenatal care clinics and medical system integration with Moms2B.”

Other Ohio State researchers involved in this study were Rebecca Reno, Carmen Clutter, Twinkle Schottke, Tanikka Price, Katherine Calhoun, Jamie Sager and Courtney D. Lynch.

MORE HIGHLY SPECIALIZED PROTEINS FOUND DURING LIFE-THREATENING PRENATAL DISEASE

COLUMBUS, Ohio – Experts describe one of the world’s most deadly pregnancy-related conditions as “mysterious” because it’s terribly difficult to understand the cause, which makes it extraordinarily challenging to diagnose, while it has a major impact on global health.

Preeclampsia, which affects 5 to 8 percent of pregnancies worldwide, is characterized by high blood pressure and protein in the urine. The disorder is the number one reason physicians decide to deliver babies prematurely and is responsible for approximately 18 percent of maternal deaths in the U.S.

Hemolysis Elevated Liver enzymes Low Platelets (HELLP) syndrome, a rare but deadly form of preeclampsia, causes hemorrhaging, ruptures in the liver and stroke in mothers.

If undetected, preeclampsia can lead to eclampsia, one of the top five causes of maternal and infant illness – including seizures and coma – and the cause of 13 percent of maternal deaths globally. Pregnant women may deliver early, even if there’s just suspicion of preeclampsia. Premature birth is a concern because it increases the risk of learning disabilities, cerebral palsy and blindness in newborns.

In an effort to better understand each disease and to ultimately reduce morbidity among expecting mothers and their unborn children, maternal-fetal medicine and perinatal physician-researchers from The Ohio State University Wexner Medical Center and Nationwide Children’s Hospital, wanted to characterize levels and activity of two particular cellular proteins – proteasome and immunoproteosome – in women with preeclampsia. Proteosomes are like trash collectors designed to eliminate abnormal proteins. Immunoproteosomes are more highly specialized machines that degrade or breakdown damaged proteins.

“Through our research, we wanted to understand proteasome levels and activities in a variety of pregnancy conditions, as this has never before been studied,” said Dr. Kathryn Berryman, first author of the study and a fellow in the division of maternal-fetal medicine in the department of obstetrics and gynecology at Ohio State’s Wexner Medical Center.

The results, which were recently published in the American Journal of Obstetrics & Gynecology, are unique and an important step to understanding the condition, according to the researchers.

They enrolled 139 women: non-pregnant women; healthy pregnant women; women with chronic hypertension; women with gestational hypertension; non-hypertensive women with spontaneous preterm births; women with preeclampsia; and women with HELLP. Blood samples were taken and proteasome levels and activity were analyzed. The placentas of these women were stained to look for proteasome.

Researchers found that preeclampsia is characterized by a significant increase in proteasome levels and activity with a more aggressive switch to immunoproteasome hyperactivity in HELLP. Both conditions are stimulated by inflammation.

“Each study builds upon previous work in the study of preeclampsia. We now have a better understanding of mechanisms behind this disease, which remains poorly understood,” Berryman said.

Along with researchers from Ohio State’s College of Medicine, other colleagues from the Center for Perinatal Research at Nationwide Children’s Hospital participated in this study.

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Staff Reports

Preemie deaths down statewide

In an effort to combat infant mortality and improve outcomes for women with the highest risk of early premature birth, the Ohio Department of Medicaid and the Ohio Department of Health partnered with the Ohio Perinatal Quality Collaborative (OPQC), a voluntary quality improvement network dedicated to advancing perinatal health in Ohio.

According to the March of Dimes, the leading nonprofit organization for pregnancy and baby health, babies born more than two months premature account for more than half of all infant deaths in Ohio, which ranks among states with the highest rates of premature births and infant mortality.

“The goal of our project is reduce premature births in Ohio by 10 percent by assuring that progestogen supplementation therapy is available for every woman at risk,” said Dr. Jay Iams, Professor Emeritus in the Department of Obstetrics and Gynecology at The Ohio State University Wexner Medical Center and obstetrics clinical lead of OPQC.

The project led to a 20 percent reduction in premature births before 32 weeks of gestation for Ohio women insured by Medicaid. Results are reported in the February issue of Obstetrics & Gynecology, the journal of the American College of Obstetricians & Gynecologists.

“The reduction in early premature births we saw during this project is very encouraging,” Iams said. “Every pregnant woman should ask her prenatal caregiver about her risk of premature birth so that, if needed, preventive treatment can begin as soon as possible.”

OPQC was founded in 2007 to conduct statewide projects in Ohio aimed at assuring optimal care for pregnant women and their newborn infants. Previous successful projects led to fewer infections in premature newborns and a significant decline in scheduled births before 39 weeks of pregnancy that lacked a medical indication.

Beginning in 2014, OPQC worked for 26 months with prenatal care clinics at 20 large maternity hospitals, Ohio Medicaid and Medicaid insurers to improve care coordination among prenatal care providers, pharmacies and home healthcare services. The network identified 2,562 women who had a previous early premature birth and accelerated preventive treatment.

Clinicians and quality improvement experts throughout Ohio participated in the project, which is now being disseminated to all Ohio prenatal clinics and providers.

Funding from the Ohio Department of Medicaid and the Ohio Department of Health supports this ongoing research.