Public Health Ground Rounds: Environmental Health and Expecting Women

​Pregnant women are pretty motivated to make changes if it means a better outcome. But how do they get information on what is good for their baby?

OB/GYNs are an important source of information, but they already have
a lengthy checklist of topics that they need to cover in a short patient visit. So it can be tough to add one more topic to their checklist, such as educating the patient on the benefits of a lead-free home.

Katrina Smith Korfmacher, Ph.D.

Katrina Smith Korfmacher, Ph.D.

“They have 15 minutes. They can’t do it all,” said Katrina Smith Korfmacher, an associate professor of environmental medicine at UR Medicine and director of the Environmental Health Science Center’s Community Outreach and Engagement Core. “Our area OB/GYNs already do a really good job of screening women for lead during pregnancy and they seldom find anything, so it’s hard to say to them ‘You need to do more.’”

There are other opportunities to reach pregnant women, however. Recently, Korfmacher connected with Patricia Brantingham, executive director of the Perinatal Network of Monroe County, in the hopes of creating a more robust dialogue with pregnant women on the topic environmental health.

Korfmacher and Brantingham shared their work at a recent Public Health Grand Rounds. The ongoing discussion is part of the Center for Community Health’s “Summer in the City” series, which continues through July.

Group work​

​For several years, Brantingham has been interested in a group model of pregnancy care that delivers health education in a facilitated group discussion.

Patricia Brantingham

Patricia Brantingham

​Women who have an estimated delivery date in the same month meet in a group of 8 – 12. A medical provider takes individual belly measurements privately and the women take and record their own blood pressure and weight. Then they gather in a circle for the rest of the 2-hour session.

​There is a structured curriculum that covers all the health issues that OB/GYNs are expected to address, but the discussion is led by the women.

“So if issues come up that take the group to a slightly different direction than where the discussion was originally intended, then that’s where it goes,” said Brantingham. ”The women learn from one another and share concerns they may never have raised in a quick visit with the OB or midwife.”

​Not only is this model very well-received by both patients and providers, but it has resulted in healthier babies, as premature infants with mothers who participated in group care averaged 400 grams heavier at birth than those with mothers who received standard prenatal care.

Environmental health

With much more time available than at a traditional OB/GYN visit, the groups are able to discuss a wide variety of topics, and Brantingham realized that environmental health should play a prominent role.

“We know that prenatal care today is a whole host of things beyond ‘Don’t smoke and don’t drink alcohol,’” said Brantingham. “The entire environment has an impact on our health throughout our lives.”

The Perinatal Network is funding the transformation of eight OB practices to the group care model, including seven that primarily serve low income women in the city. Korfmacher secured a mini-grant from the Center for Community Health to pilot environmental health education in conjunction with prenatal care groups at Highland Family Medicine.

Korfmacher said that while lead is a starting point, there are several environmental concerns she is hoping to cover as the project moves forward.

“Pregnancy is a window of susceptibility to environmental contaminants,” she said. “But it’s also a window of susceptibility to environmental health messages. We want to leverage that to reduce environmental exposures during pregnancy that may cause lifelong effects.”

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