Health and Wellness for all Arizonans Arizona Birth Defects Monitoring Program (ABDMP)
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Transcript of Health and Wellness for all Arizonans Arizona Birth Defects Monitoring Program (ABDMP)
Health and Wellness for all Arizonans
Arizona Birth Defects Monitoring Program
(ABDMP)
Health and Wellness for all Arizonans
ABDMP
• 3 Components:– Surveillance– Prevention– Referral to Services
Health and Wellness for all Arizonans
Surveillance
Health and Wellness for all Arizonans
Surveillance
Goals: Timely, Accurate, Complete Data
• Bureau of Public Health Statistics
• CDC and National Birth Defects Prevention Network– standards and recommendations
• Data calls for CDC, NBDPN, Birth Defects Research publication; multi state research projects; cluster studies
Health and Wellness for all Arizonans
ABDMP Surveillance
• 33 categories of defects• Population based registry• Active surveillance• Sources:– Hospital Discharge data– Hospital Discharge Indices– Birth and Fetal Death Certificates
Health and Wellness for all Arizonans
Significance in Arizona• Arizona: 1,500 children are born with serious birth defects
every year– the reportable birth defect rate for Arizona is 7.9 cases per 1,000
live and still births.
• In 2009, children (0-17) with birth defects accounted for about 13.3% of all pediatric hospitalizations.
• Birth defects are a leading cause of death for infants (>28 days; < 365 days)– 20% of all infant deaths– Each year, more infant deaths are attributed to birth defects than
prematurity and SIDS/SUIDS combined
Health and Wellness for all Arizonans
Arizona Totals
2006 2007 2008 2009 2010 20110
100
200
300
400
500
600
700
800
900
1000
758 782
908
771
680
456
653 677
769
696
609
412
Total birth defect cases and defects, Arizona, 2006-2011
total re-portable de-fects
total re-portable cases
Health and Wellness for all Arizonans
Arizona
• The most common type of anomalies are congenital heart defects (CHDs).
• The most common specific anomalies observed for 2010 are Down syndrome, oral clefts, pulmonary valve atresia/stenosis, and gastroschisis.
• AZ has higher than average rates of oral cleft defects, and slightly higher rates of spina bifida
Health and Wellness for all Arizonans
Home Births and Birth Defects• 2000-2011: 1-5 homebirths of children with birth defects per year
• Anomalies noted vary greatly; include:– Down Syndrome– Cleft lip with and without cleft palate/Cleft palate– Various CHDs
• Tetralogy of Fallot• Coarctation of Aorta• Transposition of the Great Arteries
– Gastroschisis– Congential Diapragmatic Hernia– “Lethal” anomalies
• Anencephaly; Trisomy 13, 18• Families with “lethal” diagnoses may choose to delivery at home or birthing centers to
limit medical intervention/interference and to improve quality of time with child
Health and Wellness for all Arizonans
*Important Notes*
Health and Wellness for all Arizonans
Anen-cephalus
CL with and without CP
Gastroschisis Lower limb reduction
Upper limb reduction
Spina Bifida Down Syndrome
30
31
32
33
34
35
36
37
38
39
40
Mean Gestational Ages at Birth live births only, select ABDMP
defects, 2008-2011
2008
2009
2010
2011*
Wee
ks g
esta
tion
AZ all births mean
Health and Wellness for all Arizonans
Associations• Down Syndrome– Higher rates of heart defects, hearing loss,
• Oral Clefts– Midline defect– Syndromes– Feeding issues
• CHDs– 25% are not diagnosed prenatally– May not present for several days or even months – Pulse oximetry screening
Health and Wellness for all Arizonans
Prevention
Health and Wellness for all Arizonans
Prevention
• Primary – Prevent Birth Defects• Secondary – Prevent Morbidity & Quality of Life
Issues• Tertiary – Preventing Birth Defect Related Deaths
Health and Wellness for all Arizonans
Secondary and Tertiary Prevention
• Newborn Screening• Hearing Screening• Pulse Oximetry Screening• Secondary Issues/ Associations– standard screenings– genetics
Health and Wellness for all Arizonans
Primary Prevention:The causes of 65-75% of birth defects
are unknown.
Known causes include:• Genetics 15-25%• Environmental 10%– Maternal Conditions– Infections– Exposures
Health and Wellness for all Arizonans
Areas for Intervention
Preconception/Prenatal/Interconception
Health
Health and Wellness for all Arizonans
• Folic acid– CDC recommends 400 mg daily for women of childbearing age– Taking folic acid before pregnancy can reduce the risk of NTDs by up to 70%– Inadequate folic acid also linked to increased risk of oral clefts, Down
syndrome, autism…
• Interpregnancy Intervals– 18-24 months between end of pregnancy and conception of next
• Regardless of outcome: miscarriage, preterm, stillbirth; live birth
– 40% increase in low birth weight babies– Potential increased risk of miscarriage, preterm birth, low birth weight, birth
defects, maternal death
• Alcohol and other drug exposure– Alcohol exposure during pregnancy is the leading preventable cause of birth
defects, cognitive disabilities, and neurobehavioral disorders. – Alcohol affects whatever organ or system that is currently growing, including:
• Brain, heart, bones, kidneys, eyes, ears, face
Health and Wellness for all Arizonans
Referral to Services
Health and Wellness for all Arizonans
Referral
• Medical Treatment– Babies with birth defects born at home were seen
at hospitals same day-months after delivery• Support Programs – Social workers– Community groups with hospital visitation
Health and Wellness for all Arizonans
Resources• http://www.azdhs.gov/phs/phstats/bdr/resources.htm– ADHS website: A to Z Index: B: Birth Defects
Monitoring Program• Sharing Down Syndrome• Down Syndrome Network• Spina Bifida Association of Arizona• Feeding Matters• Mended Little Hearts
Health and Wellness for all Arizonans
Dianna ContrerasArizona Birth Defects Monitoring Program Manager
[email protected] 542 7335