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From the President: Emerging Issues

 From the CEO

By Lori Tremmel Freeman, BS, MBA
Chief Executive Officer, AMCHP

The March of Dimes Prematurity Campaign, launched in 2003, has stimulated widespread action and attention around the problem of premature birth. Premature birth is the #1 killer of babies, and one in 10 U.S. babies (that's 380,000 babies) are born preterm. The goals of the campaign are to a) raise public awareness of the problems of prematurity; and b) decrease the rate of preterm birth in the United States. Over the course of the campaign, the March of Dimes set ambitious goals for reducing the number of babies born prematurely and have rallied others to join them. AMCHP has proudly served as one of six national partners that comprise the Prematurity Partners in support of the overall campaign. There also are dozens of other national and international alliance members. The Prematurity Partners meet monthly and, together, speak out for legislation that improves care for moms and babies. Through the annual Premature Birth Report Card, another project of the campaign, the March of Dimes demonstrates its progress and focuses the nation's attention on the serious problem and the work ahead. You'll soon be hearing more about this year's reports cards in preparation for November's Prematurity Awareness Month.

Last month, we had a special call of the March of Dimes Prematurity Partners where Dr. Ed McCabe, senior vice president and medical director at the March of Dimes, discussed the National Center for Health Statistics (MCHS) changes in the measurement of gestational age. This was a very informative presentation that is critical to understanding some of the reporting related to prematurity. The NCHS changed its measurement of gestational age from last menstrual period (LMP) to obstetric estimate (OE). This is significant because the LMP measurement is consistently shorter than the OE measurement, the LMP tends to underestimate gestational age, and the consequence of this underestimation is higher pre-term birth rate. Dr. McCabe noted that OE is used by all other highly developed countries. NCHS changed its primary measure of gestational age with the 2014 preliminary data. This change has major implications for national and state pre-term birth rates and in fact is responsible for a 2 percent decline from 12 percent to 10 percent in the national data. This alone resulted in a global position change from 131st to 89th in rankings for the United States. Other major implications for national and state preterm birth rates include that the United States has met the 9.6 percent 2020 preterm birth goal, seven years early and all states have lower preterm birth rates.

Nevertheless, the March of Dimes and its partners remain focused on the message that no one should mistake this as a victory, the number of babies born preterm is still too large, and the March of Dimes goal to reduce prematurity remains urgent and aggressive. In fact, earlier this summer, the March of Dimes Board of Trustees approved a resolution to declare a 2030 target for the rate of preterm birth not to exceed 5.5 percent in the United States. AMCHP stands strong in its support of this target. This would place the United States in the top 10 percent of highly developed countries with the lowest preterm birth rates and rightfully where we should be ranked. The savings to our nation should this goal be reached by 2030 is an estimated $80 billion!

Perhaps the most important component of the message to relay is that the preterm successes noted to date were not shared equally. Our attention still needs to be laser focused on this issue because not all babies have the same opportunity to be born full term. Health inequities remain significant and non-Hispanic black and Native American babies are far more likely to be preterm than their non-Hispanic white and Asian counterparts. The March of Dimes, with the help of its partners like AMCHP, need to drive further reductions in the preterm birth rate for all racial and ethnic groups and all geographic areas.

Having just attended several block grant reviews, including the U.S. Virgin Islands, New York, and Puerto Rico, I know this issue remains front and center in your states and territories. I applaud you for your steadfast diligence and continued efforts to address preterm births and reduce infant mortality and AMCHP strives to support your good work as we all strive toward these new goals.

If you'd like to learn more of Dr. McCabe and the March of Dimes work on the 2030 prematurity target, please consider reading "Fighting for the Next Generation: U.S.

Prematurity in 2030," Edward R.B. McCabe, MD, PhD, Gerard E. Carrino, PhD, MPH, Rebecca B. Russell, MSPH, and Jennifer L. Howse, PhD, www.pediatrics.org/cgi/doi/10.1542/peds.2014-2541.