National Healthy Start Association

National Healthy Start Association's MCH & Social Services Updates

August 18, 2008

The National Healthy Start Association regularly reviews research materials and other pertinent information regarding infant mortality, low birthweight, racial disparities in perinatal outcomes and other topics that relate to the field. Below are some recent findings from our review.

Key Findings from Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Survey, 1999-2006

• The percentage of infants who were ever breastfed increased from 60% among infants who were born in 1993-1994 to 77% among infants who were born in 2005-2006.
• Breastfeeding rates increased significantly among non-Hispanic Black women from 36% in 1993-1994 to 65% in 2005-2006.
• Breastfeeding rates in 1999-2006 were significantly higher among those with higher income (74%) compared with those who had lower income (57%).
• Breastfeeding rates among mothers 30 years and older were significantly higher than those of younger mothers.
• There was no significant change in the rate of breastfeeding at 6 months of age for infants born between 1993 and 2004.

McDowell MA, Wang C-Y, Kennedy-Stephenson J. Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Surveys 1999-2006. NCHS data briefs, no. 5, Hyattsville, MD: National Center for Health Statistics. 2008.
NCHS Data Brief No 5, April 2008. Go to http://www.cdc.gov/nchs/data/databriefs/db05.htm for the full brief.

Teen Birth Rates Up, Researchers Say

Nationally, birth rates for White, Black and Hispanic teens all increased in 2006, says the latest research from the 2008 edition of Child Trend’s annual Facts at a Glance databook, which notes that most teens having sex are using some form of birth control. The report, which is based primarily on Child trends’ analyses of data from the national Center for Health Statistics, also includes national and city-level trends in teen childbearing. The report contains the latest national and state-level data on teen birth rates, as well as data on the percentage of teens in grades 9-12 who abstain from sex or use contraception.

Among the findings:

• On the national level, 52% of students in grades 9-12 in 2007 reported that they never had sex.
• Of those teens in grades 9-12 who were sexually active in 2007, 62% reported using a condom at last sex and 16% reported using birth control pills.
• Teens in the states with the lowest teen birth rates were more likely to either abstain from sex or to use contraception than were teens in the states with the highest teen birth rates

Child Trends is a nonprofit, nonpartisan research center that studies children at all stages of development. For more information, go to: www.childtrends.org/_pressrelease_page.cfm?LID=07ADF06E-F9DA-4428-A3EA53A01E43A17B.

Children & Youth Funding Report, August 8, 2008.

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Hypertension, Other Risk Factors Identified for Small-for-Gestational-Age Births

In pregnant women, chronic hypertension, young or older maternal age and recurrent early spontaneous abortions are associated with an increased risk for small-for-gestational-age (SGA) births, according to the results of a large, population-based, Danish study reported in the August issue of Obstetrics & Gynecology.

"Evidence relating chronic hypertension to risk of...SGA births is conflicting," write Janet M. Catov, PhD, from the University of Pittsburgh in Pennsylvania, and colleagues. "To identify factors associated with SGA that may involve a placental pathogenesis, we related chronic hypertension and other maternal factors that may be markers of endothelial dysfunction to preterm compared with term SGA births.” [The endothelial is a layer of cells that lines the inside of certain body cavities, for example, blood vessels.]

In the Danish National Birth Cohort (N = 81,008), chronic hypertension, diabetes, body mass index, age and subfertility were related to the risk for term and preterm SGA births, defined as those with a birthweight adjusted for gestational age greater than two standard deviations (SDs) below the mean on the basis of fetal growth curves.

In women with definite chronic hypertension, the risk for preterm SGA infants was 5.5-fold higher (95% confidence interval [CI], 3.2 - 9.4), and the risk for term SGA infants was 1.5-fold higher (95% CI, 1.0 - 2.2). Factors associated with a higher risk for preterm SGA but not for term SGA infants were maternal age younger than 20 years (odds ratio [OR], 2.8; 95% CI, 1.1 - 6.8) or maternal age older than 36 years (OR, 2.0; 95% CI, 1.3 - 3.1) and a history of 2 or more early spontaneous abortions (OR, 2.0; 95% CI, 1.3 - 3.3).

Other factors associated with a greater risk for term and preterm SGA infants were smoking, parity [the number of times a woman has given birth], time to pregnancy greater than 12 months and underweight status, whereas overweight status, obesity and maternal diabetes were unrelated to either subtype of SGA.

Limitations of this study include a predominantly White study population, limiting generalizability to other ethnic groups; reliance on self-report for some study variables; and inability to distinguish cases of transient hypertension during pregnancy. "Chronic hypertension, young or older maternal age, and recurrent early spontaneous abortions increased risk for preterm SGA," the study authors write. "These factors may involve abnormal placentation and likely represent a pathogenesis distinct from that leading to term SGA."

The National Heart, Lung and Blood Institute supported this study. The Danish National Research Foundation established the Danish Epidemiology Science Centre and supports the Danish National Birth Cohort, which is also supported by the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation. The study authors have disclosed no relevant financial relationships.

Medscape from WebMD, www.medscape.com; August 8, 2008; Obstet Gynecol. 2008;112:290-296.

Teens with Single Elevated Blood Pressure Reading at Risk for Hypertension

Roughly 7% of adolescents who have prehypertension, or blood pressure readings over 120/80 mm Hg, will progress to hypertension a year later, according to the study, “Blood Pressure Variability and Classification of Prehypertension and Hypertension in Adolescence.” Researchers compared blood pressure readings of 8,535 adolescents ages 13 to 15 with repeated blood pressure measurements two and four years later. Of the 1,470 teenagers who had a single blood pressure reading in the prehypertensive range, 14% of boys and 12% of girls progressed to blood pressure levels that were considered hypertensive two years later. Of those with hypertension at the first measurement, 31% of boys and 26% of girls continued to have hypertension, and 47% of boys and 26% of girls had prehypertension two years later. A high body mass index contributed to progression to hypertension. The authors suggest that adolescents identified with prehypertension would benefit from treatments such as lifestyle changes.

Ed. Note: Hypertension during pregnancy can cause low birthweight or premature delivery of the baby.

American Academy of Pediatrics’ News Briefs, www.aap.org, August 4, 2008.

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Visit Our Information for Healthy Start Projects Page

Click: Information for Healthy Start Projects and, then, scroll down for a list of potential funding opportunities.
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August Health Observances (partial list)

Coming in September (partial list)

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RESOURCE SECTION: The following are
resources that might be of interest to you.
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Go to http://www.cdc.gov/Features/Parenting/InfantsToddlers.html for Babies & Toddlers: Learn Some Positive Parenting Tips to discover (or rediscover) positive ways that parents can help their baby or toddler learn and develop.

Preventing Intimate Partner Violence and Sexual Violence in Racial/Ethnic Minority Communities: CDC's Demonstration Projects: Intimate partner violence (IPV) and sexual violence (SV) are serious public health problems that disproportionately affect racial and ethnic minorities. Recognizing the need for programs that address prevention in minority populations, the Centers for Disease Control and Prevention (CDC) funded 10 demonstration projects in 2000 to develop, implement and evaluate culturally competent IPV/SV prevention strategies targeted for specific racial/ethnic minority groups. Preventing Intimate Partner Violence and Sexual Violence in Racial/Ethnic Minority Communities: CDC's Demonstration Projects summarizes the work of the funded projects. The purpose of the document is to describe the approaches projects developed and highlight challenges and lessons learned in the development, implementation and evaluation of IPV/SV prevention programs for racial/ethnic minority populations. http://www.cdc.gov/ncipc/dvp/PreventingIntimatePartnerViolence.htm or http://www.cdc.gov/ncipc/dvp/Preventing_IPV_SV.pdf.

Each year since 1997, the Federal Interagency Forum on Child and Family Statistics has published a report on the well-being of children and families. The Forum alternates publishing a detailed report, America's Children: Key National Indicators of Well-Being, with a summary version that highlights selected indicators. This year, the Forum is publishing America's Children in Brief; it will publish the more detailed report in 2009. The Forum updates all indicators and background data on its website (http://childstats.gov) every year. The Forum fosters coordination and integration among 22 Federal agencies that produce or use statistical data on children and families. The America's Children series provides an accessible compendium of indicators drawn from the most reliable official statistics across topics; it is designed to complement other more specialized, technical, or comprehensive reports produced by various Forum agencies.

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