Now is the Perfect Time to Discuss Folic Acid!

by Jennifer Vickery, NCPHC Western Region Coordinator (pictured)

Let’s face it, life can be crazy! Lots of twists and unexpected turns and with these twists and turns life often presents numerous exciting adventures. For some people these exciting adventures may include having children some point along the way. Whether you or your partner are planning to become pregnant in the coming months or years, did you know all women of childbearing age, which are roughly ages 14 through 44, are encouraged to take a daily multivitamin? Women of childbearing age should take a multivitamin with 400 micrograms (mcg) of folic acid every day. This daily consumption of folic acid can greatly reduce your chances of having a baby born with a neural tube defect.

If taken before pregnancy, folic acid can prevent up to 70 percent of neural tube defects (NTDs), a group of serious birth defects including spina bifida and anencephaly. NTDs happen when the neural tube, which forms the brain and spine, fails to close properly around the fourth week of pregnancy. Often before some women are even aware they are pregnant. This can result in physical abnormalities, with varying degrees of disability, and can even be fatal. NTDs are common birth defects that occur in about 200 pregnancies each year in North Carolina.

Research suggests that folic acid may help decrease risks for birth defects of the heart, urinary tract and cleft lip/palate. Additional studies have found that folic acid may have other health benefits, including reducing the risk of cardiovascular disease, stroke, Alzheimer’s, cervical and colon cancer, and depression. Folic acid, along with many of the other vitamins in a daily multivitamin, is essential for a healthy body on the inside and out. Because folic acid is responsible for cell growth, for many people multivitamins can make a big difference in the health of your hair, nails, and skin.

A multivitamin with folic acid helps women maintain good health, whether or not they are planning a pregnancy. Two-thirds of women in the United States don’t consume enough folic acid and/or folate. Folate and folic acid are forms of a B9 vitamin. Folate occurs naturally in food, and folic acid is the synthetic form of this vitamin. Since 1998, folic acid has been added to cold cereals, flour, bread, pasta, bakery items, cookies, crackers, and nutrition bars, as required by federal law. Foods naturally high in folate include leafy green vegetables (spinach, broccoli, and lettuce), orange juice, beans (especially black-eyed peas), avocado, kiwi, cantaloupe, paprika, tahini, and arugula.

However, even if you eat healthy every day, it’s almost impossible to obtain the recommended amount of folic acid or folate from food alone. In addition, folate absorption depends on the food itself, how it is cooked and the individual’s ability to metabolize it. For example, in order to obtain your daily amount of folate from food alone, you would need to eat 14 cups of broccoli or one loaf of bread or drink an entire container of orange juice to get the proper amount of folate daily. Obviously consuming this much broccoli, bread, or orange juice would be unhealthy and counterproductive to achieving your overall health goals. Therefore, the easy solution is to take a daily multivitamin to achieve the recommended folic acid dosage.

Because our bodies can only absorb about half of the folate we consume, a multivitamin is the best way to get folic acid into your body. A daily multivitamin makes up for what women lack in daily nutrition. Check the bottle label to make sure the multivitamin has 400 mcg of folic acid. Generic multivitamins work just as well as brand names – but cost half the price!

Understanding the great impact folic acid has in the health of women and babies in North Carolina, the March of Dimes NC Preconception Health Campaign and NC Division of Public Health Women’s Health Branch partnered to provide multivitamins with folic acid to women through health departments and other safety net providers. The program includes the purchase and distribution of multivitamins, training for the local health department and community health center staff and technical assistance for participating agencies as they set up this program. For more information about NCPHC, please click here.

Jennifer Vickery is the Western Regional Coordinator for the March of Dimes NC Preconception Health Campaign and a Preconception Health Education Coordinator at Mission Health Fullerton Genetics Center.

PARTNER HIGHLIGHT

NCPHC recently held a scholarship contest which provided the winner the opportunity to attend the Perinatal Mental Health Postpartum International Training in April 2018. Congrats to our winner: Elizabeth Weidner of the HOPE Women and Family Support team! Below is her winning entry.

1. Why is perinatal mood disorder awareness important?

While having a child is an exciting event in a woman’s life, it also brings a great deal of pressure, stress, and anxiety, as her hormones fluctuate in different directions during her pregnancy and postpartum, or fourth trimester, period.  Though this is a normal occurrence in the biological system, a new mother may not have the ability to identify and control such swings and handle a crying or colicky newborn at the same time.  Identifying and preparing for this during this period in the mother and the newborn’s life can help to make things go easier.  Support is key in aiding the mother in both nursing and caring for the baby.  Many women have no idea to what degree her emotions will change within a day or a few hours and being coached through this by someone who knows and is trained is key as this condition can and does impact her ability to care for her newborn and affects how she is able to nurse and provide the nutrition the baby needs.  This can cause a domino effect of added stress of being a failure at being a mother and as a human being!  Is there support for the mother during this time?  She needs help through this initial period of parenthood, does she have it within the family?  If not, this can have a detrimental impact on both the mother and child, along with the entire family.  Confusion, depression, loss of control of her emotions are all conditions that need sensitive and caring support from a trained doula that understands the condition and can be an invaluable coach.  Good nutrition, rest, exercise, and educating the mother ahead of the birth can also help her to understand and prepare for crazy times during the fourth trimester.

2. Describe your interest/experience in perinatal mood and anxiety disorders (PMAD).

My interest in this situation is from personal experience with postpartum depression with 2 of my three children.  It is a dark and scary time for the mother compound the hormone fluctuation and mood swings, depression, this can cause havoc in this delicate time in an infant’s life.  I had a very supportive husband, but he was not aware of the hormonal changes that occurred, he also was not able to coach me through these bouts and we both ended up with real struggles in getting along and maintaining peace within the home for all family members.   Nursing was a struggle and at times failure, nights were long, and tempers were short.  By my third child, my husband and I became a team to be reckoned with, but there was a learning curve.  Depression and emotions are very difficult to control at times.

3. How you will use this information in your daily work?

As a team member with the new organization in Greenville, NC called, HOPE, Women and Family support, I will be a postpartum doula for new mothers in Pitt County when needed.  I will also be working with the others in HOPE with information and public awareness of this crucial time in a family and the service we will be providing for the families in Pitt County and surrounding areas.  The information that I wish to obtain from this two-day postpartum certificate program will enable me to be a supportive coach and doula for new mothers and the next generation to come.

By Kweli Rashied-Henry, March of Dimes Director of Health Equity 

Frederick Douglass once said “If there is no struggle, there is no progress.” As a country, we have made tremendous strides in the health of all populations since this famed abolitionist spoke these words in the mid-19^th century. Overall life expectancy has increased and infant death before the age of one has declined. However, health is still experienced disproportionately in the United States.

Nearly twenty years ago, April was established as National Minority Health Month to encourage health and health equity partners and stakeholders to work together on initiatives to reduce disparities, advance equity, and strengthen the health and well-being of all Americans. In the U.S., racial and ethnic disparities (or inequities) in preterm birth are worsening. Black women are about 50 percent more likely to give birth prematurely compared to other women and their babies are more than twice as likely to die before their first birthday compared to babies born to white women. This stark reality signals the need for health equity, which means that everyone has a fair and just opportunity to be as healthy as possible. It also signals the need for healthy moms before, during and after pregnancy.

Being healthy across the course of one’s life is essential for having a healthy baby in the future. Most of us recognize the importance of prenatal care during pregnancy. Experts also advise screenings for medical and social risk factors, providing health education, and delivering effective treatment or prevention plans as a set of practices that could improve health prior to conception. Women and men of reproductive age who improve their preconception health can increase their likelihood of having a healthy baby if and when they desire. In short, healthy moms and dads can lead to stronger babies. Yet disparities can be stubborn and may require more than simply changing behavior.

According to the Office of Minority Health, your zip code can be a predictor of your health. In other words, your place of birth, where you work and play, your income and education, and a host of other factors – in addition to the choices you make each day about what to eat, when to work out and whether or not to see a doctor can impact your health. These factors are often referred to as the “social determinants of health,” and they contribute to health disparities among racial and ethnic minorities in America. “Addressing the social determinants is key to ensuring that every baby is born healthy regardless of wealth, race or geography.”

According to the Pew Research Center, rapid growth among minority populations is projected by 2050.  If this trend holds, many of tomorrow’s parents will come from communities that share a disproportionate burden of preterm birth and infant death. Although advances in medicine and technology were likely responsible for much of the improvements in these health outcomes in the U.S. over the years, it is also likely that the collective actions of everyday people has helped us realize that better health is not just for ourselves but for future generations. Looking back on this progress can surely help us look forward to what it will take for our babies to continue to grow and thrive.  National Minority Health Month is a special occasion for us to acknowledge the struggles that continue to evade us and what’s needed to support future generations.

This article was shared with the permission of the author. View the original post on the March of Dimes News Moms Need Blog

For more than 30 years, Belinda has worked in public health, creating positive change for North Carolina’s women and children.

Since November 1995, she has been with the North Carolina Division of Public Health, Women’s and Children’s Health Section (Title V) working in multiple capacities, including Program Manager for Healthy Beginnings and Healthy Start Baby Love Plus (3 federally funded perinatal disparities programs), and just before becoming Head of the Women’s Health Branch, Belinda served for 12 years as the Perinatal Health and Family Support Unit Supervisor.

In her role as Branch Head, Belinda provides oversight and guidance to the state’s maternal health, family planning, preconception health, teen pregnancy prevention, sickle cell, tobacco use, and numerous programs focused on equity in birth outcomes.

Belinda has been successfully leading the Perinatal Strategic Plan since 2016.  The plan is a collaboration from partners around NC working to improve the health of women and men of childbearing age, babies, and address infant mortality and maternal health in NC.

She has served on and chaired several national and state committees, including the Association of Maternal and Child Health Programs (AMCHP) Workforce Leadership Committee, Centers for Disease Control and Prevention Expert Panel on Preconception Health and Healthcare, and NC Collaborative Improvement and Innovation Network (CoIIN).

In addition, she co-chairs the Perinatal Health Committee of the Child Fatality Task Force (CFTF) within the state.  The CFTF is a legislative study commission directed by the NC General Assembly. Belinda serves on the board of AMCHP and the National Healthy Start Association Board of Directors.

Belinda received her Masters of Public Health degree from the University of North Carolina in Chapel Hill and undergraduate degrees from the University of North Carolina in Greensboro.

by Brenda Stubbs, Triad Regional Coordinator & Jennifer Vickery, Western Regional Coordinator

When thinking about addressing mental health, it’s important to note that our minds and bodies are not separate systems and that often when the body experiences a mental health complication or disorder there are co-occurring physical symptoms as well. The “mind-body connection” is an often underestimated phenomena as even the language used to discuss health and wellness refers to the “mind” and “body” as distinct entities; however, a growing number of researchers are now finding that adverse health conditions such as diabetes, heart disease, and obesity can also be linked to depression.  Depression can be the result of experiencing childhood trauma or adverse childhood experiences. We know through the Adverse Childhood Experiences (ACE) study that high ACE scores have a direct correlation with higher rates of depression, substance abuse, tobacco use, and obesity. In short, people who have high ACE scores may turn to self-medicating and/or risky behaviors to deal with their trauma. Often these are the very behaviors that can lead to adverse health conditions and adverse birth outcomes.

Using obesity as an example, clinicians and researchers have been aware for some time that victims of childhood abuse are twice as likely to experience depression as adults, and further, there is a strong correlation between depression and obesity. This does not necessarily mean that all obese adults experienced abuse in their childhood nor does it mean that all obese adults can be diagnosed with depression; however, it does begin to shed light on how certain lifestyle decisions that contribute to obesity such as overeating and a sedentary lifestyle can serve as coping mechanisms, much like drugs and alcohol, to deal with childhood trauma.  Turning our focus to maternal obesity, according to the March of Dimes, entering pregnancy overweight or obese (or using drugs or tobacco) carries lifelong health complications for both mother and baby.

As mentioned previously, our minds and bodies function as an integral system and are not distinct entities; therefore, the statistics are even more alarming when discerning the impact of maternal mental and physical health on birth outcomes. In example, a recently published study in the Journal of Depression and Anxiety has shown that diabetes and postpartum depression are occurring more simultaneously than initially thought. The largest population-based study to date conducted by Michael E. Silverman, PhD, assistant professor of psychiatry at the Icahan School of Medicine at Mount Sinai in New York City, found that first time mothers that did not have a history of depression significantly increased their risk for developing postpartum depression if diagnosed with gestational diabetes. The mothers with a previous comorbid diagnosis of gestational diabetes and depression increased their risk for postpartum depression by an alarming 70%. Dr. Silverman states, “Most practitioners think of these as two isolated and very different conditions, but we now understand gestational diabetes and postpartum depression should be considered together.

Furthermore, there is also growing evidence that women who experience preconception gynecological morbidities such as endometriosis, dysmenorrhea (painful periods), and abnormal uterine bleeding have an increased risk for developing postpartum depression. A nationwide study in Japan conducted from 2011-2014 by the Japanese Environment and Children’s Study Group (JECS) found that women with endometriosis and menstrual problems were at increased risk of developing postpartum depression. This study suggests a perinatal mental health screening is needed for predisposed women.

According to Healthy People 2020’s leading indicators for maternal and child health, medical experts are seeing more and more that the mental, behavioral, and socio-economic conditions of the mother are having a huge impact on birth outcomes.  It is these conditions, after all, that subsequently have a huge impact on the mother’s physical health.  The bottom line is that when we are screening women of childbearing age for risk factors like smoking, diabetes, obesity, and hypertension, we also need to be assessing their mental health status.  Doing so will help ensure healthier women, healthier babies, and healthier families.

Sources:

https://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Mental-Health-and-Heart-Health_UCM_438853_Article.jsp#.WREeqtIzWcw

https://www.ncbi.nlm.nih.gov/pubmed/12119573?dopt=Abstract

https://www.dailymail.co.uk/sciencetech/article-2026108/Childhood-abuse-victims-twice-likely-suffer-lifetime-depression.html

https://www.cdc.gov/violenceprevention/acestudy/about.html

https://www.marchofdimes.org/pregnancy/weight-gain-during-pregnancy.aspx

www.postpartum.net

www.2020mom.org

https://nyti.ms/2pVHWf9

Affect Disord. 2017 Aug 1;217:34-41. doi: 10.1016/j.jad.2017.03.049. Epub 2017 Mar 30.  Preconception gynecological risk factors of postpartum depression among Japanese women:  The Japanese Environment and Children’s Study (JECS)

Silverman, M.E. (2017) The risk factors for postpartum depression: A population based study. Depression and Anxiety, 34, 178-187. DOI: 10.1002/da.22597

by Brenda Stubbs, Triad Regional Coordinator & Jennifer Vickery, Western Regional Coordinator

Smoking status, alcohol and drug use, folic acid intake, chronic health conditions like diabetes, hypertension, asthma, STIs…these are all things that are routinely screened for and monitored in the preconception or early prenatal period because they can lead to poor birth outcomes.  However, screening for mental health status is often glossed over or skipped altogether.  Why is that such a big concern?  Poor maternal mental health – namely perinatal mood and anxiety disorders (PMADs) – are the #1 complication of pregnancy and childbirth AND a leading cause of premature birth.  They affect about 15% of women (and some medical experts say 20%) – nearly 1 million women nationwide each year.  Yet only about 15% of women are screened for mental health status.  Compare that to gestational diabetes, another leading complication of pregnancy, which affects only 3-5% of women but is universally screened for during prenatal visits.  More women will develop a PMAD than all of the other pregnancy complications combined, but unfortunately these disorders are highly misunderstood and under-diagnosed.

It’s important to note that while many women who develop a PMAD have never experienced any mental health issues prior to pregnancy, more than half – about 54% — had a pre-existing mental health disorder in their preconception years.  These can include depression, anxiety, OCD and bipolar disorder, and they can put the women who have these pre-existing conditions at much greater risk of developing a PMAD during pregnancy and in the postpartum period.  In addition, a woman who experienced a PMAD or postpartum depression with a previous pregnancy is also at a higher risk.  So, if we could identify and treat mental health issues in the preconception (and interconception) period, it would be a big step toward reducing the risk/incidence of PMAD.  All preconception health visits with women of childbearing age should include an assessment of their mental health status, and once pregnant, a woman should be screened for PMADs as a routine part of prenatal care.

As health professionals, we need to help women understand that PMADs are very treatable and there IS a light at the end of the tunnel.  “Becoming a mother is…one of the most significant physical and psychological changes a woman will ever experience,” (Dr. Daniel Stern, The Birth of a Mother) but by normalizing and validating the many feelings a new mother may have – guilt, shame, disappointment, extreme worry or fear – we can help reduce the stigma associated with PMAD/postpartum depression.  Consider the fact that 400,000 babies are born each year to mothers who are already experiencing depression, and this number does not include the babies born to mothers who will become depressed or develop a PMAD in the postpartum period.  And since we know that poor maternal mental health can lead to poor maternal physical health, premature birth, and poor mother-baby attachment (which can cause problems/delays with the child’s emotional, social and cognitive development), the benefit of identifying and addressing maternal mental health issues becomes quite clear.

There is much more to discuss about this important topic.  Part two of “The Intersection of Physical and Mental Health and Its Impact on Birth Outcomes” will be posted Oct. 12.  Receive an alert from us by joining our mailing list!

Sources:

https://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Mental-Health-and-Heart-Health_UCM_438853_Article.jsp#.WREeqtIzWcw

https://www.ncbi.nlm.nih.gov/pubmed/12119573?dopt=Abstract

https://www.dailymail.co.uk/sciencetech/article-2026108/Childhood-abuse-victims-twice-likely-suffer-lifetime-depression.html

https://www.cdc.gov/violenceprevention/acestudy/about.html

https://www.marchofdimes.org/pregnancy/weight-gain-during-pregnancy.aspx

www.postpartum.net

www.2020mom.org

https://nyti.ms/2pVHWf9

Affect Disord. 2017 Aug 1;217:34-41. doi: 10.1016/j.jad.2017.03.049. Epub 2017 Mar 30.  Preconception gynecological risk factors of postpartum depression among Japanese women:  The Japanese Environment and Children’s Study (JECS)

Silverman, M.E. (2017) The risk factors for postpartum depression: A population based study. Depression and Anxiety, 34, 178-187. DOI: 10.1002/da.22597

We’re happy to welcome our new Eastern Regional Coordinator, Danielle Little, to the March of Dimes NCPHC Team!

Danielle believes in the value of health education and the impact it can have on the overall well-being and success of growing families.

As a certified Lactation Counselor and Childbirth Educator for over ten years, Danielle has seen the impact NCPHC has made in communities, specifically through the March of Dimes collaborative initiative Healthy Babies are Worth the Wait® (HBWW).

HBWW has educated families about the benefits of waiting until at least 39 weeks before giving birth and equipped them with the ability to better dialogue with their healthcare providers about the best decision for their specific family needs. As a result, Danielle witnessed the induction and cesarean rates decrease within the last five years at a Wake County hospital.

Danielle resides in Garner, NC and holds a bachelor’s degree in Child Development from Peace College. In her spare time, she enjoys binge-watching Law & Order and all things Disney, reading to her children, visiting NC beaches, and spending time in her herb garden. Danielle is currently pursuing a master’s degree in Education from Strayer University.

By Brenda Stubbs, Triad Regional Coordinator

As both a Regional Program Coordinator for the March of Dimes and the mother of a 15 year old son who was born prematurely, the issue of adolescent mental health is a passion of mine, and has, admittedly played a much larger role in my life than I would have ever imagined.  Though mental health is not always an easy topic to discuss – for many a stigma still exists – I have spent much of my son’s life acting as a sponge on the topic…absorbing every bit of credible information that I can in order to better understand my son and how his beautiful mind works.

My son was born prematurely, at 35 weeks – which wasn’t considered “that early” by many at that time. At 5 lbs, he was certainly the largest and “healthiest” baby during his 10-day stay in the NICU.  Once we brought him home, he seemed perfectly “physically” healthy those first few years, other than being delayed reaching many of the early milestones.  He began struggling with mental/behavioral health issues at age 3, and for a while we put off going to the doctor because so many well-intended people around us said, “He’s 3!  Haven’t you ever heard of the ‘terrible 3s’?!”  But after he was kicked out (yes, kicked out!) of multiple day-care centers, and after therapists who were coming into our home to help us work with him told us that he wasn’t responding to therapy, we started taking him to various specialists for evaluation.  Our child was now being labeled “special needs.”

Fast forward 12 years…my son has been evaluated by some of the best specialists in the state and over the years has had a multitude of diagnoses.  Everything from possible high-functioning autism/Asperger’s Syndrome, to ADHD, ODD (Oppositional Defiant Disorder), Episodic Rage Disorder, Pervasive Developmental Delayed…and the list goes on.  At his tender age, he has already struggled with severe depression, anxiety, suicidal ideation and homicidal thoughts (although thankfully, the latter two have subsided).  He has been on a wide range of medications since age 4 and still remains on several daily meds – something I curse and feel guilty about at times, and something I thank God for at others.  Up until 6^th grade, he had an IEP through the school system and was categorized as “severely emotionally/behaviorally delayed.”  At one very low point, he was assigned a “shadow” during school hours in case he had to be physically restrained.  I can’t describe the feeling you have as a parent watching your child…a little boy, MY angel…being restrained by a large 250 lb man who is telling you that you cannot interfere even though your child is crying for you.

Here’s the thing:  my son, intellectually, is off the charts.  His IQ is unbelievably high – I mean this kid could be a Nobel Peace Prize winner or the President of the USA one day!  And I will do whatever I can to make sure he reaches his fullest potential.  He has always scored in the top 1% of his grade in the school district and is in all academically gifted programs.  In 7^th grade, he scored higher than 65% of all high school seniors nationwide on the SAT exam!  But there-in also lies the difficulty…you have a child that is about 3 years ahead intellectually and about 3 years behind mentally, emotionally and behaviorally.  That is the constant struggle for those of us trying to educate, parent and help mold him into a fine young man.  And it is a constant struggle in his own mind, as well.

For the last 12 years, I have asked “Why is this happening to him? To us?”  Of course, no one can deny the genetic factor regarding mental health disorders, and in fact, both his father and I have family histories of mental health issues that go way back.  And we both have our own struggles with anxiety and depression.  But I always felt there was more to it.

Shortly after I began working for the March of Dimes in 2012, and we introduced “Healthy Babies are Worth the Wait,” a consumer education curriculum focusing on the 39 Weeks Initiative, I started connecting some dots.  The curriculum emphasizes that the last few weeks of pregnancy, specifically 35 to 39 weeks, are a crucial development period for the baby’s brain.  In addition, the last – and therefore the most vulnerable part of the baby’s brain to develop is the frontal lobe, which is responsible for impulse control, critical thinking, and judgment.  Was there a link between the challenges my son is facing and his prematurity?  In my quest for knowledge and understanding, I have read numerous medical journal articles that link mental and behavioral health problems to premature birth and low birth weight.  I can’t say for sure if this applies to my son, but research has shown, and many medical experts agree on the following:

• At 35 weeks gestation, a baby’s brain is still developing crucial “connections” that are needed for learning, coordination and social functioning. The cortex volume, as well as the actual weight and size of the baby’s brain nearly doubles between 35 and 39-40 weeks.  The myelin sheath, which is like a protective coating over the nerves, fibers, and synapses in the brain  and is essential for proper functioning of the central nervous system, also increases five-fold during this time.  The myelin sheath affects how neurons in the brain fire, or mis-fire as the case may be, which is why some medical professionals believe that babies born before this crucial development occurs are permanently “wired differently.”
• Babies born prematurely, even just a few weeks early, have more learning and behavior problems in childhood than babies born at 39-40 weeks. These problems can become more apparent or escalate over time without intervention.  For example (albeit an extreme example), Oppositional Defiant Disorder (ODD) in a child can evolve into Conduct Disorder (CD) in a teenager or young adult, which is many times linked with anti-social or even criminal behavior.  Proper diagnosis and treatment – and the earlier the better – can often keep the disorder from escalating to that point.
• Evidence suggests that both premature birth (PMB) and low birth weight (LBW) are significant risk factors for mental health problems among children and adolescents. Although the physical problems for LBW and premature babies have long been extensively studied and documented, the behavioral and mental health problems associated with these babies have been much less so until recent years.  Moreover, these are issues that are typically not apparent at birth – they often don’t manifest themselves until several years after birth.

In the 2011-2012 National Survey of Children’s Health (NSCH) 85,535 children between 2 and 7 years of age were studied for the prevalence of several mental health outcomes, including:  moderate to severe behavioral and emotional problems, depression, anxiety, ADD/ADHD, Autism Spectrum Disorders, Oppositional Defiant Disorder, developmental delays, learning disabilities, and intellectual disabilities.

The significant findings from the study’s authors were that:

• Mental health problems were prevalent in 22.9% of children born prematurely and 28.7% of those born with low birth weight (as compared to < 15% for term/normal birth weight children.
• Children born prematurely had 61% higher odds of serious emotional/behavioral problems, 33% higher odds of depression, 58% higher odds of anxiety as compared to full term children. In addition, these children had 2.3 – 3.2 higher odds for Autism/ASD, 2.9 – 5.4 higher odds of developmental delay, and 2.7 – 4.4 higher odds of intellectual disability.
• Socio-economic status, race/ethnicity, and household structure were also significant predictors of mental problems in premature and LBW children, just as they are in the general population.
• Neurodevelopmental conditions (i.e. Autism/ASD, developmental delays, ADHD) account for the relationship between perinatal conditions (prematurity, LBW) and the increased risk of mental health conditions as children grow (depression, anxiety and conduct problems).

Not only does this issue need to be studied more in depth, but there also needs to be increased monitoring and mental health screening of children who were born prematurely or with LBW.  This would provide an opportunity for early diagnosis and intervention.

I wonder, if I had known 15 years ago what I know now – regarding all the increased risks for babies born prematurely, mentally and behaviorally – would I have fought harder for my baby to stay in-utero longer?  At the time, I didn’t even know the right questions to ask my OB.  Our HBWW education program teaches pregnant women why it’s so important to reach at least 39 weeks of pregnancy due to the crucial brain development occurring in those last few weeks of pregnancy.  We encourage women to allow labor to begin on its own IF both mom and baby are healthy and there are no medical complications.  It also teaches them the right questions to ask their provider should they find themselves in a situation where they and their doctor need to make some tough decision.  In my case, it was a medical complication that required an emergency C-section, but still, I wonder….

In the meantime, I will treasure my incredibly smart, differently wired, challenging-but-oh-so-worth-it, loving, affectionate child with the smile and dimples that melt my heart.

Brenda Stubbs is the Triad Regional Program Coordinator for the March of Dimes/NC Preconception Health Campaign.  To reach her, email: bstubbs@marchofdimes.org

Sources:

1. March of Dimes “Healthy Babies are Worth the Wait” Toolkit: prematurityprevention.org
2. “Mental Health Outcomes in US Children and adolescents born prematurely or with low birthweight.” Depression Research and Treatment, Volume 2013, Article ID 570743.
3. https://phys.org/news/2011-01-brain-wiring-babies.html

Revised MAY 2017, BWS

by Martina Sconiers-Talbert, MPH, Cape Fear Regional Coordinator

We have likely all heard the hype concerning the increase of sexually transmitted infections across the U.S. According to the Huffington Post, chlamydia, gonorrhea and syphilis rates are at an all-time high. In 2014 chlamydia cases were high, but the rates have increased even more. A 6% increase in 2015 resulted in 1.5 million cases of chlamydia being reported. There were 395,000 cases of gonorrhea in 2015 which is up 13% from 2014, and at 24,000 cases, syphilis is up 19% from 2014 (Huffington Post, 2016). Local health departments can provide services to individuals to address these issues, but education is still a top concern for many communities.

But what does this mean for pregnant women?

Many may be unaware of the fact that rates of congenital syphilis ― when a pregnant woman passes the infection on to her baby ― have also increased. Congenital syphilis, which can result in pregnancy loss as well as bone deformations, blindness and deafness in newborns have increased by six percent (Huffington Post, 2016). Women who are pregnant can become infected with the same STDs as women who are not pregnant so for a healthier pregnancy, the Centers for Disease Control (CDC) suggests women ask their doctor about STD testing.

Early prenatal care is essential to having a healthy pregnancy but nearly 50% of all pregnancies are unintended. Therefore, counseling women BEFORE they become pregnant about the connections between their current health risks and future birth outcomes is vital. Much of a fetus’s structural development occurs in the early stages, and the health choices of the mother in beginning weeks can affect the risks of birth defects. Unfortunately, most women do not get into prenatal care until most the fetus development is complete (North Carolina Preconception Health Campaign).

So where’s the support?

March of Dimes supports preconception health efforts across the nation and here in North Carolina, the efforts are in full swing with North Carolina Preconception Health Campaign. Efforts through the Campaign promote preconception health in all women to include men and emphasize the importance of yearly exams and self-care prior to pregnancy. The Campaign supports CDC’s recommendation of having a Reproductive Life Plan (RLP), including the encouragement to all men and women to have a reproductive life plan which is the first on the list. Reproductive life planning allows both men and women to evaluate the dreams, goals and aspirations to include being physically, emotionally and financially secure before pregnancy. A RLP considers the who, what, when, where, why and even “if” of family planning. Everyone should have a reproductive life plan, regardless if they want to have children or not (Every Woman NC).

Regional coordinators are working hard to provide education to providers through webinars and face-to-face trainings across the state. Coordinators are also educating the community through campaign developed curriculums for middle schoolers called “Healthy Squared: Now and Later” and high schoolers called “Healthy Before Pregnancy”. Our goal is to educate men and women on the importance of self-care and preconception health. For more information about our campaign, visit  everywomannc.org/about. You can also learn more about your Regional Coordinators visit everywomannc.org/about/meet-the-coordinators.

References

Every Woman North Carolina (2017). “Reproductive Life Planning: What is reproductive life planning?” Retrieved from /your-health/rlp/

March of Dimes North Carolina Preconception Health Campaign presentation (2014). “Reproductive Life Planning Strategies to help your patients plan ahead.”

The Huffington Post (2016). “Lifestyle Healthy Living Chlamydia, Gonorrhea and Syphilis Rates Are At An All-Time High In The U.S.” Retrieved from https://www.huffingtonpost.com/entry/std-rates-in-the-us-rise_us_5807bcf6e4b0b994d4c36002

by Brenda Stubbs, Triad Regional Coordinator

Do you know the old adage, “If you want to go fast, go alone. If you want to go far, go together?”

Having worked in health and human services for over 20 years – specifically in maternal and child health I have seen much progress in how community agencies work to bring about positive change in the health and health behaviors of its residents. It seems like years ago, although many programs and agencies had the overall common goal of improving the health of the community, each of these entities operated in a silo, focusing on their specific health issue; not really communicating with each other or sharing information, data or resources – in some instances, even being “territorial” over such things. Some of this could be explained by the fact that many of these programs were competing over the same funding dollars because their work overlapped in certain areas.

Fast forward to 2017, and it’s a new (and better) reality! Different agencies and programs not only recognize, but embrace the overlap in their work – and there seems to have been a call to action of sorts to collaborate and work together across programs with different specialties to affect change. There has been a realization that we can no longer look at or address just one phase of a person’s health or life in a vacuum and expect interventions to have positive impact on a population level. We really need to be looking at a person’s health from the “whole life” or “life course” perspective, and acknowledge that things can happen in one phase of a person’s life that could put them and their health on a completely different trajectory in a subsequent phase of their life.

Community agencies and programs are learning to come together and bring their expertise in different areas to the table, and be thoughtful and deliberate in their strategies to improve health. For example, the mission of the March of Dimes is to prevent premature birth, and one of our strategies in accomplishing that is to provide education about and promote good preconception health in women and men of childbearing age. A noble goal, yes – but if we are looking at it from a “whole person, whole life” perspective, it is clear that there are several other factors, socioeconomic and otherwise, that can impact a woman’s preconception health and ultimately her birth outcome. The idea of Collective Impact is to bring together experts whose programs each address a specific health issue: i.e. mental/behavioral health, substance use disorders, domestic violence, early childhood development, job training, financial self-sufficiency, trauma-informed care and so on ⁽²⁾– issues that may not specifically be in the March of Dimes’ wheelhouse, but that can definitely impact a woman’s preconception health and her risk for having a preterm or low birthweight baby. Collectively, we can better identify and execute interventions that can address and improve health in ALL of these areas.

Allow me to paint a picture of how this all translates in the real world:

Over one-third of children will experience at least one — and in many cases, more than one — potentially life-altering trauma as listed on the ACE (Adverse Childhood Events) screening tool before the age of 16 ⁽¹⁾. Some examples of ACE include being the victim of abuse, neglect or assault; growing up in a home where there is domestic violence or substance abuse; abandonment by a parent through death, divorce, incarceration, or simply being absent from the child’s life. It’s important to note that the brain is “use-dependent” ⁽³⁾. which means that it physiologically changes in response to specific patterns of experiences, like ongoing exposure to trauma or chronic stress.

Likewise, people with higher ACE scores are much more likely to use tobacco, develop mental health or substance use disorders, and chronic health conditions. These health problems could be presenting themselves during the preconception period, as women and men are going into their prime childbearing years, which means that these women are more likely to ­­­enter pregnancy with significant risk factors for poorer birth outcomes – preterm birth, low birthweight, and birth defects. Keep in mind that research has shown that 50% of all infant mortality and morbidity is directly related to the health of the mother prior to conception ⁽⁴⁾.

We also know that babies born prematurely – even just a few weeks early – are at much higher risk of developing behavioral and mental health disorders, as well as neurodevelopmental delays. This is due to the fact that crucial brain development in the baby occurs between 35 and 39 weeks gestation, with the frontal lobe being the last to develop. Babies born prior to 39 weeks miss some of this critical period of development and so are more vulnerable to certain disorders and delays that can result from an early birth.

We’ve learned that if mothers experience perinatal mood disorders, including postpartum depression – especially if it is severe – it can hinder critical bonding and attachment with the baby, which in turn can hinder cognitive, social and emotional development of the child. Some of these children may go on to experience adverse childhood events, for example, if mom is self-medicating with alcohol or other substances, or if the child is subjected to harassment or bullying due to his or her developmental delays.

And the cycle continues, sometimes perpetuating from generation to generation if no intervention occurs. Thus, there is a strong need for health and human service professionals with expertise in different areas of a person’s life and health to work collectively to positively impact the overall health of the community.

So, let’s urge one another as health field educators and workers to continue the progress that collective impact encourages by embracing the overlap in our work to ensure communities with healthier futures. For to care for the whole person from a whole life perspective – that is the way to affect change.

References

1. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
2. https://ssir.org/articles/entry/collective_impact
3. https://childtrauma.org/wp-content/uploads/2013/11/Neurodevel_Impact_Perry.pdf
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592246/