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Maternal and Child Health Alert 10/15/04

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Expand view Topic review: Maternal and Child Health Alert 10/15/04

Re : Maternal and Child Health Alert 10/15/04

Post by denise » Fri Oct 15, 2004 11:32 am


This is nice to see a further study being done as this is something I've heard alot about in the past.

Thanks Laura!

Co-coordinator for WI
Denise (28)
Jason (32)
Ariana (16 months)-born 5/3/03 at 35 weeks due to HELLP


Maternal and Child Health Alert 10/15/04

Post by laura » Fri Oct 15, 2004 09:54 am

MCH Alert
Tomorrow's Policy Today

National Center for Education in Maternal and Child Health
Search past issues of the MCH Alert and other MCH Library resources at

October 15, 2004

1. Journal Focuses on Children of Immigrant Families
2. Compilation of School Health Guidelines Released
3. Report Highlights Progress in Meeting Healthy People 2010 Goals for
Smoking During Pregnancy
4. Article Describes Study to Investigate Relationship Between Periodontal
Disease and Early Spontaneous Preterm Birth
5. Authors Examine Effects of Early Preventive Dental Visits on Subsequent
Utilization and Costs
6. Study Assesses Effectiveness of a Breastfeeding Promotion Class for



The Fall 2004 issue of The Future of Children, titled Children of
Immigrant Families, examines the strengths and challenges that set
children of immigrant families apart from the mainstream population. The
journal, published by the David and Lucile Packard Foundation, includes
articles that summarize research on demographic shifts, economic and labor
market trends, and child health and development. It also includes a series
of responses from experts on how policymakers, advocates, stakeholders,
and practitioners can respond strategically and proactively to demographic
change and increasing diversity to promote the healthy development,
productivity, and well-being of immigrant children in the future. The
journal is available at



Health, Mental Health and Safety Guidelines for Schools is an online
compendium designed to help community and school leaders determine the
breadth of school health, mental health, and safety issues and set
priorities for future action. The compendium was developed by health,
education, and safety professionals from more than 30 different national
organizations; parents; and other supporters. The American Academy of
Pediatrics and the National Association of School Nurses served as lead
agencies, with support from the Maternal and Child Health Bureau. The
compendium draws upon published guidelines on specific components of
school health and safety programs and on overall coordination of these
programs. Topics include overarching school health and safety issues,
family and community involvement, health and mental health services,
health and safety education, nutrition and food services, physical
education, physical environment and transportation, social environment,
and staff health and safety. References, a subject index, and keyword
search functions are also provided. The compendium is intended for use by
school administrators and others who play a role in the assessment,
planning, or improvement of school health and safety programs or in
advocacy efforts related to school health and safety programs. It is
available at http://www.nationalguidelines.org.



"Since 1990, maternal smoking for females aged 15-19 years has
fluctuated," state the authors of a report published in the October 8,
2004, issue of Morbidity and Mortality Weekly Report. The Healthy People
2010 objectives target an increase in smoking cessation among pregnant
smokers during the first trimester to 30% and abstinence from cigarettes
to 99% of all pregnant women. The report summarizes results of analyses to
assess progress toward meeting these national health objectives.

Data for the analyses were drawn from birth certificates reported by 49
states, the District of Columbia , and New York City to the National Vital
Statistics System during the period 1990-2002. Two years of available data
on smoking during pregnancy among adolescents ages 15-19 were averaged and
compared for three periods: 1990-1991, 1995-1996, and 2001-2002.

The authors found that

* During the study period, smoking during pregnancy decreased by 38% among
all women giving birth in the United States (from 18.4% in 1990 to 11.4%
in 2002).

* All states and jurisdictions with comparable data for the entire study
period reported significant declines in smoking during pregnancy; however,
declines were variable, ranging from 5.8% in West Virginia to 68.0% in

* Every year from 1996-2001, a higher percentage of adolescents ages 15-19
smoked during pregnancy than women in any other age group. In 2002, the
percentage of adolescents ages 15-19 who smoked during pregnancy was the
same as that for women ages 20-24, with the highest percentage observed
among adolescents ages 18-19.

* Of the 45 states and jurisdictions in which the percentages of women who
smoked during pregnancy could be calculated for adolescents ages 15-19 for
both 1995-1996 and 2001-2002, 10 had a complete trend reversal (i.e., from
a significant decrease between 1990-1991 and 1995-1996 to a significant
increase between 1995-1996 and 2001-2002).

* Thirteen states had consistent and significant declines in smoking among
pregnant adolescents ages 15-19, both from 1990-1991 to 1995-1996 and from
1995-1996 to 2001-2002; however, 4 states had significantly higher
percentages in 2001-2002 compared with 1990-1991.

"Although the widespread public health message to abstain from smoking
during pregnancy has helped decrease maternal smoking, to reduce
prevalence further, implementation of additional interventions are
required," the authors conclude.

Mathews TJ, Rivera CC. 2004. Smoking during pregnancy -- United States,
1990-2002. Morbidity and Mortality Weekly Report 53(39):911-915; available
at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5339a1.htm.

Readers: More information is available from the MCH Library's annotated
bibliography, Smoking During Pregnancy, at



"The results of our study demonstrate an association between severe
periodontal disease and spontaneous preterm birth at less than 32 weeks of
gestation," state the authors of an article published in the October 2004
issue of Obstetrics and Gynecology. Although recent studies in the United
States have demonstrated an association between maternal periodontal
disease and multiple adverse pregnancy outcomes, the mechanisms by which
periodontal disease and pregnancy outcomes are associated are not clear.
The article examines the relationship between maternal periodontal disease
and both early spontaneous preterm birth and selected markers of upper
genital tract inflammation.

The study population was a convenience sample of women enrolled in an
ongoing study of risk factors for preterm birth at the Perinatal Emphasis
Research Center at the University of Alabama at Birmingham. A periodontist
conducted a dental examination for 59 women who had experienced a
spontaneous preterm birth at less than 32 weeks of gestation, for a
control population of 36 women who had experienced an indicated preterm
birth (delivery for maternal or fetal indications) at less than 32 weeks
of gestation, and for 44 women who had experienced an uncomplicated term
birth. Cultures of the placenta and umbilical cord blood, cord
interleukin-6 levels, and histopathologic examination of the placenta were
performed for all women. A trained obstetric research nurse recorded
maternal demographic, intrapartum, delivery, and postpartum information.

The authors found that

* The spontaneous preterm birth group had significantly more extensive
periodontal disease than the term birth group (i.e., more areas of the
mouth were affected).

* The spontaneous preterm birth group had more extensive periodontal
disease than the indicated preterm birth group, but the threshold was not
statistically significant.

* The spontaneous preterm birth group had higher rates of severe
periodontal disease than the indicated preterm birth group or the term
birth group.

* After controlling for maternal age, race, education, insurance status,
parity, history of a spontaneous preterm birth, and smoking, women with
severe periodontal disease were almost three times as likely to experience
a spontaneous preterm birth as those without severe periodontal disease.

* There was no association between markers of upper genital tract
inflammation at the time of birth and moderate-to-severe periodontal
disease in cases of spontaneous preterm birth, indicated preterm birth, or
term birth.

* Organisms that are known periodontal pathogens were identified by
placental culture in only five women.

The authors conclude that "further investigation into the potential
etiology of the association between periodontal disease and preterm birth
is warranted."

Goepfert AR, Jeffcoat MK, Andrews WW, et al. 2004. Periodontal disease and
upper genital tract inflammation in early spontaneous preterm birth.
Obstetrics & Gynecology 104(4):777-783.

Readers: More information is available from the National Maternal and
Child Oral Health Resource Center's prenatal/perinatal bibliography at



"Oral health anticipatory guidance has not been the subject of systematic
investigation but, as in the case of pediatric medicine, there are good
reasons to hypothesize that early parental education and timely
intervention and/or referral can lead to improved health outcomes and
reduced costs," state the authors of an article published in the October
2004 issue of Pediatrics Electronic Pages. Early childhood caries --
dental decay among infants and children from birth to age 5 -- is
prevalent among infants and children from families with low incomes and
has far-reaching effects beyond the consequences of decayed teeth. The
American Academy of Pediatric Dentistry and the American Dental
Association recommend that the first dental visit should occur no later
than age 12 months. However, the authors note, no reported cost studies
have addressed the timing of the initial dental visit for high-risk
children. The article describes a study to determine the relationship
between early preventive dental visits and subsequent use and costs.

The study sample was drawn from a cohort of 53,591 children born in 1992
in North Carolina who were enrolled in Medicaid. The children were
monitored longitudinally to age 5. Approximately 17% of the initial cohort
were enrolled in Medicaid continuously during the 5-year study period
(N=9,204). Maternal age, education, marital status, and race were obtained
from composite birth records. A work force variable was defined as the
number of dentists per 10,000 population according to county of residence
(DPCR). Claims filed through Medicaid for oral health care services were
categorized according to the type of subsequent visits (preventive,
restorative, or emergency) and dental-related costs. Age at the first
preventive dental visit was also assessed.

The authors found that

* Children who had their first preventive dental visit by age 12 months
were more likely to have subsequent preventive visits but were not more
likely to have subsequent restorative or emergency visits.

* Minority children were less likely to have subsequent preventive visits,
restorative visits, or emergency visits, compared with non-minority

* Children from counties with greater DPCRs were more likely to have
subsequent visits of all types.

* The child's age at the first preventive visit had a positive and
significant influence on cost. Over the course of the study period, the
average dental-related costs per child according to age at the first
preventive visit were as follows: before age 12 months, $262; between ages
1 and 2, $340; between ages 2 and 3, $492; and between ages 3 and 4, $547.

The authors conclude that these findings underscore "the wisdom of the
recommendations of the recently adopted American Academy of Pediatrics
policy, which urges pediatricians to embrace oral health guidance during
well-child visits starting at 6 months of age."

Savage MF, Lee JY, Kotch JB, et al. 2004. Early preventive dental visits:
Effects on subsequent utilization and costs. Pediatrics Electronic Pages

Readers: More information is available from the MCH Library and the
National Maternal and Child Health Resource Center (OHRC).

The knowledge path, Oral Health and Children and Adolescents, is available
at http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html.

The organizations resource list, Oral Health, is available at

The Bright Futures Oral Health Toolbox is available at



"We hypothesize that the [breastfeeding promotion] class worked by
educating expectant fathers about the value of breastfeeding; the fathers
then worked to convince their partners to choose that mode of feeding,"
write the authors of an article published in the September 2004 issue of
the American Journal of Obstetrics and Gynecology. The benefits of
breastfeeding are well known, the authors state, and the perceptions and
preferences of a woman's support system, and especially the father's
perceptions and preferences, have a tremendous effect on her feeding
preference. However, no research has tested an intervention that
specifically targets the father's demonstrably influential role in the
mother's decision-making process. The purpose of the study described in
this article was to test such an intervention: to eliminate misconceptions
through education, to teach fathers how to advocate on behalf of
breastfeeding, and to teach them how to work with their partners to make
breastfeeding successful.

The authors developed a breastfeeding class for expectant fathers in which
fathers could test their beliefs about breastfeeding and then experiment
with the message of the class, which was that men can be advocates for
their partner and the health of their newborn by facilitating their
partner's decision to breastfeed. Classes were held approximately every 2
weeks, with intervention and control classes held on different evenings.
The control class taught general parenting skills. Fifty-nine couples
attended the classes. Breastfeeding initiation and duration were measured
immediately after delivery and to 8 weeks.

The authors found that

* Mothers whose partners attended the breastfeeding class were
significantly more likely to initiate breastfeeding than those whose
partners attended the parenting class.

* There was no significant difference between groups in the duration of

* The mother's intention to breastfeed during the first month of her
infant's life, the infant's maternal grandmother's belief that the infant
should be breastfed, and the infant's father's belief that the infant
should be breastfed were all associated with an increased incidence of
breastfeeding in a regression analysis that controlled for whether the
expectant father attended the breastfeeding class or the parenting class.

* Women who were predisposed to breastfeed were more likely to breastfeed
if their partner attended the breastfeeding class than if their partner
attended the parenting class.

The authors conclude that "we hope our data will serve as an invitation to
breastfeeding advocates to include fathers in programs that promote
breastfeeding and to test innovative educational programs that are
designed to increase the incidence and duration of breastfeeding."

Wolfberg AJ, Michels KB, Shields W, et al. 2004. Dads as breastfeeding
advocates: Results from a randomized controlled trial of an educational
intervention. American Journal of Obstetrics and Gynecology

Readers: More information is available from the MCH Library's annotated
bibliography, Breasfeeding Promotion, Support, and Education, at
and from the organizations resource list, Breastfeeding, at


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Health and Georgetown University. MCH Alert is produced by MCH Library
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National Center for Education in Maternal and Child Health
Georgetown University
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