West Virginia study published in Pediatric Research on prenatal alcohol exposure in late pregnancy

Local researchers published a study in Pediatric Research estimating the most recent prenatal alcohol exposure prevalence data for the state of West Virginia (WV) and associated factors.

Researchers tested  newborn residual dried blood spots and used data from the states PROJECT Watch program to find that the prevalence of prenatal alcohol exposure for all births in WV was 8.10%. This is higher than previously shown for West Virginia.

Read Journal Article Here:
Prevalence of alcohol use in late pregnancy

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Mothers, Babies Overlooked in the Drug Crisis

By Gaby Galvin, U.S. News & World Report Staff writer  |  December 30, 2019  | Read Original Story at U.S. News & World Report News

The U.S. drug epidemic is evolving – and physicians say mothers and babies may be left behind in its latest wave.

Pregnant women who are addicted to opioids often struggle to access treatment and services, and their challenges have received relatively little attention despite being a targeted group in the nation’s response to the opioid epidemic. Now, doctors say the emerging problem of polysubstance use – when people use more than one type of drug, such as opioids and methamphetamine – is being overlooked among pregnant women, with unknown long-term consequences for mothers and babies alike.

“We have put a lot of time and money and energy into opioids, which is awesome,” says Dr. Katrina Mark, an OB-GYN and medical director of the University of Maryland Medical Center’s women’s health clinic. “But we really need to have a wider view and realize that a lot of these women with opioid use disorder have polysubstance use (issues), and even the ones who aren’t using opioids are using other substances.”

West Virginia, for example, long considered an epicenter of the opioid crisis with one of the highest overdose death rates in the country, has been awarded $70.7 million in federal grants to combat the epidemic. Several hospitals have established separate neonatal intensive care units for babies suffering from opioid withdrawal, while in 2018, West Virginia became the first state approved to authorize centers that provide services for these babies and their families through Medicaid.

In 2016, the state made it easier for hospitals to track opioid exposure among newborns. The following year, 50.6 babies per 1,000 births were born with neonatal abstinence syndrome, which occurs when an infant suffers opioid withdrawal as a result of the mother’s use while pregnant, causing symptoms such as trembling, irritability and dehydration. Nationally, that rate was 7 per 1,000 in 2016, the most recent year for which data is available, according to the Healthcare Cost and Utilization Project.

But now a new trend is apparent. After surging in western states, meth-related overdose deaths have been climbing in states like West Virginia in recent years, and it’s unclear how mothers and babies have been affected.

“I think opioids are the past, or are going to be soon, because there are so many treatment programs for them that I think we’re trying to get a handle on it,” says Dr. Stefan Maxwell, pediatrics chief at Charleston Area Medical Center’s Women and Children’s Hospital in West Virginia. “Meth seems to be more of a problem, and I’m concerned because I don’t really know what that’s going to lead to.”

In addition to opioids, West Virginia recently began tracking other substances babies were exposed to in utero, Maxwell says, but it will be six months to a year before that data is meaningful. Few other states, if any, have similar tracking tools, he says.

Some data suggests the polysubstance abuse trend is occurring among mothers nationwide. Across the U.S. in 2018, 5.4% of pregnant women reported using any illegal drug in the last month, down from 8.5% in 2017, according to a federal health survey. That decrease – representing about 66,000 women – was driven in part by a 31.3% decline in the number of pregnant women who reported using opioids, from about 32,000 to 22,000. Yet pregnant women who said they had used meth doubled from 3,000 to 6,000.

A survey of nearly 16,000 people entering treatment for opioid use disorder between 2011 and 2018, meanwhile, showed an 85% uptick in the number of people who said they’d also used meth in the last month. More than 90% of people who used opioids had also used at least one other illegal drug.

Adding to the concern is the fact that meth today, mostly imported from Mexico, is far more potent than two decades ago, experts say. Studies indicate women who use meth during pregnancy are more likely to have infants who are small for their gestational age and are born with low birthweight, but the stimulant’s long-term developmental effects on babies are unclear. And when infants are born exposed to a mix of drugs, it’s harder for providers to know what their risks are – and how to address them.

“In the early newborn period, we can treat anything,” says Maxwell, former chairman of the West Virginia Perinatal Partnership. “But the problem is, what happens when they are 5, 7, 9 years of age and going into school, and they’ve been exposed to these complex amounts of drugs in utero – how did that affect their developing brain?”

Shifting drug use patterns are often first reflected in births, and pinning down the number of babies born exposed to specific substances could offer a fuller picture of the current status of the U.S. drug epidemic than the number of overdose deaths. That information gap means it’s challenging for policymakers to allocate funding and develop programs to support these newborns and their families.

“As we continually focus on the death side of (the drug epidemic), we don’t understand the living side,” says Dr. Daniel Ciccarone, a drug researcher and professor at the University of California-San Francisco School of Medicine. “The living side of it – no matter how deadly the drug is – naturally is much bigger. It’s the base of the pyramid.”

Policymakers are beginning to address the issue. The federal spending package finalized this month includes legislation that will allow states to use some of their billions in federal opioid funding to address the surge in meth and cocaine use, The New York Times reported.

The Food and Drug Administration, meanwhile, recently held a conference to discuss whether drugs could be developed to treat addiction to stimulants like cocaine and meth. Medication-assisted treatment – a combination of counseling and medication that blunts withdrawals – is the standard treatment for opioid addiction, and providers currently rely on behavioral therapies alone to treat other substance use disorders.

“With opioids, you have medication-assisted treatment, which is great, and it works really well,” Mark says. “It is effective, it is safe and we have good protocols for how to do that. But with a lot of the other drugs, like cocaine and methamphetamine, we don’t have that, and so we’re sort of lagging behind on exactly how to treat for those things.”

Addiction treatment for mothers is lagging in general. Just 19 states have drug treatment programs specifically for pregnant women, according to the Guttmacher Institute, and it’s not always accessible. Across West Virginia, Kentucky, North Carolina and Tennessee in 2017, opioid addiction treatment providers were less likely to take a new patient if she was pregnant, according to a Vanderbilt University study.

Some opioid treatment programs, meanwhile, kick women out if they test positive for other substances, while stigma or fear of legal repercussions may also keep women from disclosing their drug use to providers. In 23 states, substance use during pregnancy is considered child abuse, according to Guttmacher.

“I understand why those policies exist, but it also becomes a really big problem in that people that have polysubstance use can’t find good treatment sometimes,” Mark says.

Screening women for drug use and helping them find accessible treatment early in – or before – pregnancy could help curb the number of babies born affected by substances like opioids or meth, Mark says. And Ciccarone notes that mothers and children should be one focus of a comprehensive plan to address the ever-shifting drug use patterns in the U.S.

“All of a sudden, there’s a small wave of affected babies, and, of course, that makes us concerned,” Ciccarone says. “But it’s part of the whole thing – that’s why we call it a crisis, because there’s a lot of moving parts and a lot of places to be concerned about.”

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Perinatal health experts encourage less smoking, more breastfeeding for southern West Virginia

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Perinatal health experts encourage less smoking, more breastfeeding for southern West Virginia

Photo by: Rick Barbero

Smoking and breast feeding are two major areas for perinatal health improvement in southern West Virginia.

As part of Wednesday’s conference “Focus on Perinatal Health — Strengthening Regional Partnerships to Improve Outcomes,” Candice Hamilton, assistant director of Project WATCH, reviewed a number of statistics for Region 1, which includes Mercer, McDowell, Monroe, Raleigh, Summers and Wyoming counties.

Of the state’s eight regions, Region 1 ranks No. 4 for both pre-term birth and low birth weight.

But the region ranks worst in the state for the number of mothers who breastfeed, the number of mothers who intend to breastfeed, and the number of mothers who smoke.

The data showed more than 27.3 percent of women in Region 1 had smoked during pregnancy.

Smoking during pregnancy isn’t just a southern West Virginia issue — no region throughout the state had a rate of smoking during pregnancy lower than 23 percent.

Dr. Timothy Lefeber, assistant professor of pediatrics at WVU School of Medicine, said 24 percent of pregnant women smoke on average in West Virginia. If the woman is a Medicaid recipient, the average increases to 38 percent.

Nationally, the pregnancy smoking rate is 9 percent.

“We have a state where a lot of people smoke,” Lefeber said. “We need to protect the most vulnerable population — children.”

Lefeber said research shows 22 percent of sudden unexplained infant deaths (SUID) could be prevented if women didn’t smoke while pregnant.

Not only are pregnant women in West Virginia smoking at higher rates than the national average, but so are high school students and adults in general.

The national average for high school smokers are 8.1 percent versus 14.4 percent in West Virginia, and the national average for adults is 14 percent compared to West Virginia’s 26.5 percent.

Vaping or e-cigarettes are also a growing concern, Lefeber said. Nationally, one in 20 middle school kids are currently using e-cigarettes.

He encourages legislation that would increase the legal smoking age to 21. A bill progressed this year in the West Virginia Legislature, but ultimately failed.

Lefeber said it’s easier to never start smoking than it is to quit. On average, it takes a smoker five attempts to quit before they’re successful.

He shared motivational interviewing techniques with attendees to help encourage smokers to quit.

“Interact with a person in a way that increases motivation. That makes them want to change their behavior,” he said. “Don’t make people feel bad about their behavior.”

Lefeber said it’s essential to engage people, to not be judgmental, and to let them tell their story.

• • •

Hamilton, who is also the executive director of the West Virginia Chapter of the American Academy of Pediatrics, said the primary objective of Project WATCH (formerly West Virginia Birth Score) is to coordinate an infant risk screening system to identify babies at greatest risk of death in first year of life, and link them to supports and services.

The “score” is a snapshot of risk factors for a baby’s wellbeing, including information such as birth weight, maternal age, maternal education levels, smoking, substance exposure, gestational diabetes and more.

“This is a unique tool to West Virginia,” she said, noting the program was initially a pilot study from England. “South Carolina has reached out to create a similar program with our methodology.”

If a child has a high birth score, they’re referred to supports. Families who receive Medicaid are referred to Right from the Start, and families with other insurance are referred to HealthCheck. For a child with developmental issues, referrals are made to West Virginia Birth to Three.

Referrals are also made to pediatric physicians.

“The goal is to improve outcomes for these families,” Hamilton said. “You can intervene with services if you know more.”

She said her organization is working to create policies that protect mom and baby, as well as policy around universal screening.

Hamilton noted that while birth score data collection has improved, some hospitals still screen differently. A universal screening method would yield more accurate data.

She encouraged the attendees to provide as much education to families as possible, and to build relationships with area hospitals.

“We’re a small state. We have an opportunity to work close together.”

From May 1, 2018, to April 30, 2019, there were 1,605 births in Region 1, which is home to three birth facilities – Raleigh General Hospital, Bluefield Regional Medical Center and Princeton Community Hospital. These births account for 9 percent of total births in the state — 17,571.

— Email: wholdren@register-herald.com and follow on Twitter @WendyHoldren

Related Resources

  • Report: Accomplishments, 2006-2012

Recent news

Amy Tolliver, Director
West Virginia Perinatal Partnership
(304) 558-0530 ext. 5

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West Virginia Bucks Rising United States Maternal Mortality Trend

By Kara Leigh Lofton, West Virginia Public Broadcasting
See the Original Article

The United States has some of the highest maternal mortality rates in the developed world — and unlike most other first-world countries, our rates are going in the wrong direction.

American women are three times more likely to die during or after birth than women in Great Britain and eight times more likely than women in Scandinavian countries.

But despite the prevalence of major risk factors such as low access to prenatal care, a high poverty rate and a largely rural population, West Virginia, is bucking the maternal mortality trend. Maternal deaths are not only low, they’re also stable.

Part of that may be due to statewide initiatives to improve outcomes.

Lauren Headley

When Lauren Headley was 35, she got pregnant. Her age categorizes her as high-risk, but she is a nonsmoker and was a Zumba teacher at a healthy weight at the time she conceived.

About six months into her pregnancy, though, Headley was diagnosed with gestational diabetes. Her obstetrician was concerned that, as a result, her baby would be born large and wouldn’t fit through her birth canal. So at around 39 weeks, doctors induced labor. The baby girl was born healthy and neither mother or infant had any complications.

Then on the 10th day after she gave birth, Headley woke up bleeding.

“But this was like gushing and red clots of Jell-O,” she said.

She called her doctor’s office and her doctor told her that some bleeding was normal but, if it continued, to go to the emergency department or to call back. So she got into the shower to see if that would calm things down.

“As I’m in the shower, the blood just pours out,” she said. “I mean cups of red Jell-O is what it looks like and it’s just pouring out. And I get really weak and I sit down in the shower and yell for my husband, and he comes in and he looks in there and he’s like ‘Oh dear God, you need to call your doctor back. There’s no way this is normal.’”

Headley was taken by ambulance to the emergency department at Thomas Health, where she was diagnosed with a severe postpartum hemorrhage — which is one of the leading complications that causes maternal mortality in the United States.

Postpartum hemorrhage 10 days after birth is admittedly pretty rare, but how well a hospital is prepared to deal with obstetric emergencies can mean the difference between life and death for someone like Headley.

Which may be part of why West Virginia’s rates are so low.

West Virginia’s rates are low — but why?

West Virginia actually ranks 5th in the country — tied with Hawaii — for least number of maternal mortality deaths in the nation — behind California, Massachusetts, Colorado and Nevada, according to data from the Centers for Disease Control and Prevention.

Maternal deaths in West Virginia related to pregnancy and childbirth have bounced between 1 to 4 deaths a year during the past 11 years. Even though West Virginia is a small state and has few births annually, this is a pretty low rate and surprising because West Virginia is poor, rural and has higher rates of comorbidities, which are all risk factors.

But when you try to dig into the numbers, “it’s hard to know exactly why our rates are lower,” said Amy Tolliver, director of the West Virginia Perinatal Partnership. She said over the last 10 years, they’ve been working closely with all of the hospitals in the state that deliver babies to improve the care they offer to moms.

“We have been implementing different training programs specifically around maternal hemorrhage — that is one of the bigger drivers that we see in regard to maternal morbidity and nationally in terms of maternal mortality,” Tolliver said.

Tolliver said every hospital in the state that delivers babies has a specific set of protocols they are supposed adhere to in the event of complications like uncontrolled postpartum bleeding.

“To have the crash carts available with all of the equipment necessary, to have trainings in place, and to continue doing those staff trainings — we think that’s one of the biggest factors in improving care is practicing for the high-risk patient.”

“I think we also do a good job in this state of accepting the fact that we have a lot of the risk factors that increase the risk for maternal mortality,” said Dr. Ally Roy, an obstetrician at Marshall Health.

Roy delivers babies at Cabell Huntington Hospital. When a patient is admitted there, she says there is a checklist the staff goes through with the patient. If they meet the criteria for moderate or high risk for a postpartum hemorrhage, they receive  interventions at delivery time aimed at reducing their risk. Anecdotally, she said, the protocols have greatly improved outcomes for patients with postpartum hemorrhage.

“When you have an emergency, you want people to be able to react smoothly and seamlessly,” said Tolliver. “There should be no downtime in trying to figure out what they need to do next. It needs to be very quick, very regimented, getting the process in place.”

In an email exchange with Thomas Health, the hospital Headley was taken to, a representative said that Thomas has protocols in place for how to deal with hemorrhage that were developed in conjunction with the statewide initiatives.

But experts working in this field in West Virginia say there’s still work to be done.

In 2008, West Virginia established a maternal mortality review committee made up of experts from across the state that basically looks at all of the data around deaths linked to pregnancy and childbirth and sees what happened. They then make recommendations based on the findings. About half of U.S. states currently have such committees.

“One of the first things that we did find was that some of our women who were postpartum may have presented in an emergency room with a severe headache and other symptoms, but they weren’t caught quickly enough in regard to understanding that that was preeclampsia, for example, that they may have been experiencing,” said Tolliver. “So there were some efforts put together to do some education with our emergency room staffing.”

Preeclampsia is a pregnancy complication that is usually characterized by high blood pressure and, if untreated, can cause organ damage and even death.

Last year, the committee recommended a renewal of those education efforts, so the Perinatal Partnership is getting ready to go out around the state to do more trainings.

Tolliver said the objective is to have caregivers “be prepared to be looking at the patient just a little bit differently [and] to ask the question, ‘Has she given birth recently?’ Those answers to those questions may drive the care in a different direction and get to the bottom of what is going on with her much more quickly,” she said.

So is there anything women could do to protect themselves against dying in childbirth? First, say experts, understand that women can experience life-threatening complications during childbirth, thus they recommend that women listen to their bodies, advocate for themselves, and talk about risk with their care team.

Related Resources

  • Report: Accomplishments, 2006-2012

Recent news

Amy Tolliver, Director
West Virginia Perinatal Partnership
(304) 558-0530 ext. 5

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Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death


See original CNN article: https://www.cnn.com/2019/03/11/health/smoking-infant-sudden-death-risk-study/index.html

See journal article: https://pediatrics.aappublications.org/content/early/2019/03/07/peds.2018-3325

Researchers from the Seattle Children’s Research Institute in Washington analyzed data on smoking during pregnancy from the US Centers for Disease Control and Prevention’s birth/infant death data set between 2007-2011. They recently published their findings in the scientific journal, Pediatrics. They found that the risk of death rises by .07 for each additional cigarette smoked during pregnancy.

For mothers who smoke a pack of cigarettes a day, they found that babies’ risk of unexpected sudden death is nearly tripled compared to infants with mothers who are nonsmokers. The researchers concluded that “every cigarette counts” and prenatal providers should be having conversations about quitting smoking with their patients.