Fresno County was recently selected as one of six sites nationwide to take part in UC San Francisco’s 10-year, $100 million global Preterm Birth Initiative. Our Central Valley Health Policy is just one of the many organizations on a steering committee created to guide the preterm initiative in Fresno County. The Fresno Bee recently published a story detailing this latest news and how it could positively impact Valley residents. We wanted to share that story, published on May 30, 2015, as written by health reporter Barbara Anderson.
Every year, more than 1,500 babies are born too early in Fresno County.
On average, 10% of the babies who are delivered in the county are preterm. That rate ranks among the highest in the state and rivals some underdeveloped countries.
It’s a distinction with heart-wrenching consequences.
Babies are fully developed at 39 weeks and preemies, considered those born at less than 37 weeks gestation, are at higher risk for birth complications and death. Newborns born at less than 29 weeks especially face a struggle for survival, and can have lifelong physical or other disabilities. And the cost of medical care for tiny babies can devastate families: It costs 12 times more, on average, to care for a preemie than for a healthy newborn, according to the March of Dimes.
Nitasha Rahman, 33, of Fresno, did everything before and during her pregnancy to be healthy. She took prenatal vitamins, ate right, didn’t drink alcohol or smoke, but daughter Kayla was born about seven weeks early at 2 pounds, 7 ounces. “It’s hard to find something that would cause it,” Rahman said.
Kayla spent more than a month in the hospital, coming home on Mother’s Day. “She’s gaining weight,” Rahman said of a recent doctor’s appointment when her daughter tipped the scales at 4 pounds.
Over the years, Fresno County has had little luck in making more than a dent in preterm births, but community leaders now hope participation in a 10-year, $100 million global preterm birth initiative will deliver more full-term babies. Just how much money would come to Fresno County is yet to be determined. Called the UC San Francisco Preterm Birth Initiative, the effort aims to improve birth outcomes in Fresno County, San Francisco, Oakland and three sub-Saharan African countries — Kenya, Uganda and Rwanda.
“This is a big opportunity here to focus on the health and well-being of young women,” said John Capitman, executive director of the Central Valley Health Policy Institute at Fresno State.
Capitman is among health, education, business and other community leaders on a steering committee created to guide the preterm initiative in Fresno County. The initiative is using a collective impact model, which gathers leaders from various sectors of a community to solve a specific health or social problem.
The partnership between the community and the University of California at San Francisco is a major change in the way UCSF has approached medical issues and social conditions. Rather than research based solely in a laboratory, the preterm project is centered in communities.
“This entire opportunity is unique,” said Dr. Larry Rand, director of perinatal services at the UCSF Benioff Children’s Hospital San Francisco Fetal Treatment Center and the initiative’s principal investigator and co-director.
Fresno County was a perfect choice for the preterm initiative, Rand said. Not only was the need great, but community members were willing to invest time and resources. “What really drives me is seeing the people in Fresno understand and be part of this team,” he said.
The county has a widespread preterm problem, but pockets in the urban core and some rural areas are hardest hit, Rand said. Racial and ethnic disparities persist: African-American mothers are the most likely to experience preterm birth with almost one out of six babies born prematurely.
In addition to the preterm birth initiative, an effort to reduce black infant mortality has been taking shape this year with funding from First 5 Fresno County, Capitman said. A group of about 35 people are looking at prematurity along with infant deaths, he said. The goal is to have a town hall meeting this summer to share information and recommendations.
Reducing the county’s preterm birth rate will take more than medical solutions, Rand said. “Preterm birth is a complex medical and social problem,” he said.
Air pollution, for example, is a potential preterm risk factor, and the Valley’s dirty air provides a setting for research. The San Joaquin Valley Children’s Health and Air Pollution Study, a collaborative effort of researchers at UC Berkeley School of Public Health, Stanford Medical School and UCSF-Fresno, is looking at exposure to particulate pollution and prematurity, among other health effects.
Poverty and lack of access to primary care also could contribute to preterm births in Fresno County, but often reasons pregnant women go into labor early are elusive.
“There’s no single factor or smoking gun that if we could only change this, we could solve the problem,” Capitman said.
Research at the Central Valley Health Policy Institute, however, could help narrow the focus: Mothers in Fresno County who experience preterm births between 33 and 37 weeks have higher rates of obesity, diabetes and asthma than women who deliver after 37 weeks and before 33 weeks. Both obesity and diabetes are widespread in the county and central San Joaquin Valley.
The research also found mothers don’t go to doctors until they’re pregnant, Capitman said. “It kind of creates a picture that we need to pay more attention to the preconception health of young women before they get pregnant.”
Unplanned pregnancies are another risk factor for preterm births. Perinatologists who see women with high-risk pregnancies in Fresno County said unplanned teen pregnancies too often are followed in quick succession by subsequent unplanned pregnancies, which increase the risk of preterm births. Fresno County has one of the higher teen pregnancy rates in the state.
Unplanned pregnancies also occur later in life, and women in their 40s who become pregnant are at increased risk of twins. Multiple births increases a mother’s risk for preterm delivery.
Areas of the country where women have access to pregnancy planning have seen preterm birth rates drop, Capitman said.
A significant predictor of preterm birth is a previous preterm delivery: Any mom who had a preterm birth the first time doubles her risk of having a second preterm birth, said Victoria Lombardo, the March of Dimes associate state director of program services.
Medicine is available that can reduce the risk of a second preterm delivery, but too often women aren’t offered the drugs or are unaware of the benefit to request them. Pregnant women who get a weekly shot of 17-hydroxyprogesterone beginning at the 16th week of pregnancy and continuing to the 36th week reduce their risk of preterm births, research has shown. The drug is covered by private insurance and Medi-Cal, the state-federal insurance for low-income families.
Five years ago, Matikus Hayes, 29, of Fresno, delivered her first daughter at 29 weeks. She was referred to a doctor for progesterone shots during her second and third pregnancies, but didn’t get them.
She was concerned about possible side effects. The shots are considered safe, but Hayes said her doctor did not take the time to explain the medication. “If he would have sat down and really discussed how these shots worked, I probably would have said, ‘Yes.’”
Her second daughter was born healthy, but at 37 weeks.
Earlier this month, Hayes gave birth to a third daughter who was healthy and full-term. Hayes, who had high blood pressure during the pregnancy, credits attendance at a Black Infant Health support group for helping her have a healthy pregnancy.
“I wanted this time around to be a little different,” she said.
A friend told her about the group, offered through the Fresno County Department of Public Health. She learned about healthy eating tips, child safety tips, information about breastfeeding and techniques for reducing stress, she said.
“They should get the class out there to more African American women so they can join in,” Hayes said.
The UC San Francisco Preterm Initiative will be open to interventions that work, Rand said.
In the end, Fresno County women will steer where the preterm initiative goes, he said. “No one else can be in their shoes, even community organization leaders. We have to get to the women themselves to know where the focus needs to be.”
One thing though, is clear, he said: “There’s no question we need to invest in Fresno.”