County-level Analysis of Perinatal Health Indicators Within a Single Health System Catchment

Background: Adverse perinatal health outcomes are disproportionally impacted in rural communities. Social determinants of health (SDoH) defined by nonclinical social, behavioral, and economic factors may impact up to 90% of health outcomes in rural communities. Objective: To evaluate county-level perinatal patterns in health outcomes, health behaviors, socioeconomic vulnerability, and healthcare providers across rural and non-rural Florida counties within a single health system catchment. Methods: Socioeconomic vulnerability metrics, digital connectivity, licensed provider metrics, and behavioral data and were obtained from Floridahealthcharts.com and the County Health Rankings. County-level birth and perinatal health outcome data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital in Alachua county between June 2011 and April 2017. County-level rurality was determined by Florida Statutes 288.0656 rurality designations. Results: The UFHPCA included three non-rural and ten rural counties that represented more than 64,000 deliveries over a 5-year 9-month period. We found that nearly 1 in 3 infants resided in a rural county (n=20,899), and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Nine counties reported maternal death rates that were between 1 and 4-fold higher than the statewide rate, and rural counties generally reported neonatal mortality and preterm birth rates that were higher than the statewide averages. We found maternal smoking rates (range 6.8% – 24.8%) were above the statewide rate (6.2%) for all counties in the catchment. Except for Alachua county, breastfeeding initiation rates (range 54.9% - 81.4%) and access to household computing devices (range 72.8% - 86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3% - 36.9%) in our catchment was above the statewide rate (18.5%), except for Suwanee and Columbia counties.Conclusions: The health burden of the UFHPCA is characterized by both rural and non-rural counties with increased maternal and neonatal death and preterm birth, as well as adverse health behaviors that include smoking during pregnancy and lower levels of breastfeeding.

Leidraad voor de screening en detectie van perinatale depressieve en angststoornissen tijdens de zwangerschap tot 1 jaar na de bevalling

A protocol for the screening, detection and treatment of perinatal anxiety and depressive disorders Importance. With a prevalence of 20%, mental health problems are considered as one of the most frequent complications during pregnancy and the postnatal period. Despite their high prevalence, these mental health problems often remain underdiagnosed and undertreated. Objective. The protocol aims to offer perinatal health care workers (health care and mental health care workers) a framework helping them to detect and discuss depressive and anxiety complaints of women during the perinatal period (up to 1 year after childbirth) and to refer them for treatment. Evidence acquisition. The protocol, which was based on international guidelines and recent scientific evidence, was developed by an interdisciplinary task force taking into account concerns about its daily practicability and current perinatal health care. Results. The protocol guides staff through a psychosocial assessment, a stepped screening, a clinical assessment and treatment steps. It is currently being implemented throughout Flanders (Belgium) with support of the Flemish Ministry of Welfare, Public Health and Family. Conclusion. Integrating mental health screening and treatment in standard perinatal care will improve the mental health care for women, their partners and their offspring.