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Maternal, Child and Adolescent Health:
A Partnership in
Reducing Congenital Syphilis
Diana E. Ramos, MD, MPH
Director, Reproductive Health Los Angeles County
Department of Public Health
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Objectives:
• Highlight the importance of MCAH collaboration • Identify opportunities for provider engagement
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• ~130,000 births per year in LAC
• 1 in 4 births in California
• 1 in 30 births in the U.S.
Background: Los Angeles County (LAC)
~500,000 Births in California
State of California, Department of Public Health, Birth Records, 2013 Los Angeles Mommy and Baby Study (LAMB), 2012
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Number of Female Syphilis Cases and Probable Congenital Syphilis Cases
LAC 2005-2015
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Congenital Syphilis in Los Angeles County, California: Understanding the Outbreak Susie Baldwin, MD, MPH;
Monica Munoz, PHN, MPH; Aineeh Montano, PHN; Raquel Fernandez, PHN; and Ryan Murphy, PhD, MPH
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Preconception Care
Prenatal
Care
Inter- Conception
Care
Well Woman Care
Pregnancy
MCAH Framework Opportunities for Intervention
Social Determinants
of Health
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Nurse Family Partnership
SIDS/FIMR
Black Infant
Health
MCAH
Preconception Health
CLPPP: Lead
Comprehensive Perinatal Services
Epidemiology
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Maternal Characteristics (Congenital Syphilis Cases 2015 –June 30 2016)
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Asian
Congenital Syphilis in Los Angeles County, California: Understanding the Outbreak Susie Baldwin, MD, MPH;
Monica Munoz, PHN, MPH; Aineeh Montano, PHN; Raquel Fernandez, PHN; and Ryan Murphy, PhD, MPH
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Homeless During Pregnancy LAMB 2012: 4.6%
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AA, 13.8
Latina, 5.5
White, 1.1 Asian, 0.3
AA Latina White Asian
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Black Infant Health: Goal: Eliminate the health disparity for
African American infants
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• Pregnant and parenting African American women>18 yo
• Prenatal • Post-partum • Up to 300 participants
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• Home visitation program • Medi-Cal eligible • 75% Hispanic • <28 weeks pregnant to child is 2yo • Up to 900
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Goals: •Improve Pregnancy Outcomes •Improve Child Health and Development •Improve Mother’s Life Course
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Maternal Characteristics (Congenital Syphilis Cases 2015 –June 30 2016)
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No PNC 1
2
Asian
3
Congenital Syphilis in Los Angeles County, California: Understanding the Outbreak Susie Baldwin, MD, MPH;
Monica Munoz, PHN, MPH; Aineeh Montano, PHN; Raquel Fernandez, PHN; and Ryan Murphy, PhD, MPH
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• Enhanced prenatal Medi-Cal services • 420 providers in Los Angeles County • From conception through 60 days postpartum,
CPSP services include: – Obstetric – Nutrition – Psychosocial – Health education
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Components of Care
•Annual exams
•Genetic counseling
•Recommending folic acid
•Providing vaccines •Managing diabetes & high blood pressure
•Discourage alcohol, drugs & smoking
Pre/Interconception Care
CPSP
•Nutrition, Health Behavior, Psychosocial,
Genetic counseling •Developing “care plan”
• Interventions & referrals
•Re-assessing each trimester
•Re-assessing post-partum
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Maternal Characteristics (CS Cases 2015 –June 30 2016
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Congenital Syphilis in Los Angeles County, California: Understanding the Outbreak Susie Baldwin, MD, MPH;
Monica Munoz, PHN, MPH; Aineeh Montano, PHN; Raquel Fernandez, PHN; and Ryan Murphy, PhD, MPH
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Interconception Guidelines
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Percent of congenital syphilis cases, by
maternal age at delivery: LAC 2015 Majority <29 years old
[VALUE]
47%
23%
5% 7% 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
<20 20-29 30-39 40-44 45-54
Age
19
N=24 N=97 N=47 N=10 N=15
% c
ases
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Unintended/Mistimed Pregnancy LAMB 2012: 46.8%
24.3
55.7 61.9
31.7
0
10
20
30
40
50
60
70
White Latina AA Asian PI
20
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Using Birth Control When Became Pregnant
LAMB 2012: 28.9%
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33.6 29.8
31.7
0
5
10
15
20
25
30
35
40
White Latina AA Asian PI
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• 97% own a cell phone1
• 73% send and receive text messages1
• 72% seek health information online2
1. PewResearchCenter, Cell phone ownership hits 91% of adults, June 2013.
2. PewResearch Center, Health Fact Sheet. December 2013
Cell Phone Technology & Pregnant women
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Objectives:
• Highlight the importance of MCAH collaboration • Identify opportunities for provider engagement
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•Well-woman visits • Gestational diabetes screening • HPV DNA testing for women 30 years and older • STI counseling • HIV screening and counseling • FDA-approved contraception methods /counseling • Breastfeeding support, supplies & counseling • Domestic violence screening & counseling
• Prevention benefits without
co-pays, co-insurance or deductibles
• Plans that start on or after August 1, 2012
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Effective Communication
Public Health
Consumers
Healthcare Professionals
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Public Information Campaign
Public Health
Mother Family
Postpartum Care
Delivery Hospitals
Prenatal Care
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Congenital Syphilis
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vesiculobullous rash
http://www.merckmanuals.com/professional/pediatrics/infections-in-neonates/congenital-syphilis
lytic lesions Wimberger Sign
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Provider Opportunities: Congenital Syphilis
• 20%-50% inadequately treated due to provider error
• 10% cases preventable with third trimester screening
Congenital Syphilis in Los Angeles County, California: Understanding the Outbreak Susie Baldwin, MD, MPH; Monica Munoz, PHN, MPH; Aineeh Montano, PHN; Raquel Fernandez, PHN; and Ryan Murphy, PhD, MPH
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Shared Vision: Prevent Congenital Syphilis
Health Systems
Prenatal Care
Providers
Public Health
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Just the Beginning
• Collaboration • Maximize health visits • Improve maternal health and perinatal outcomes