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Biomedical subjects

Joyce A Martin

Publications and source records attributed to Joyce A Martin.

At least 19 recordsLinked to original sources
PubMed2006

Births: final data for 2004.

OBJECTIVES: This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented. Denominators for population-based rates are post-censal estimates derived from the U.S. 2000 census. RESULTS: In 2004, 4,112,052 births were registered in the United States, less than 1 percent more than the number in 2003. The crude birth rate declined slightly; the general fertility rate increased by less than 1 percent. Childbearing among teenagers and women aged 20-24 years declined to record lows. Rates for women aged 25-34 and 45-49 years were unchanged, whereas rates for women aged 35-44 years increased. All measures of unmarried childbearing rose in 2004. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate jumped 6 percent to another all-time high, whereas the rate of vaginal birth after previous cesarean fell by 13 percent. Preterm and low birthweight rates continued their steady rise. The twinning rate increased, but the rate of triplet and higher order multiple births was down slightly.

Adolescent↗
PubMed2005

Births: preliminary data for 2004.

OBJECTIVES: This report presents preliminary data for 2004 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, tobacco use, prenatal care, cesarean delivery, preterm births, and low birthweight (LBW) are also presented. METHODS: Data in this report are based on 99.1 percent of births for 2004. The records are weighted to independent control counts of all births received in State vital statistics offices in 2004. Comparisons are made with 2003 data. RESULTS: The crude birth rate declined 1 percent to 14.0 births per 1,000 population. The fertility rate, however, rose slightly to 66.3 births per 1,000 women aged 15-44 years. Birth rates for teenagers 15-19 years declined modestly. The rate in 2004 was 41.2 births per 1,000 females aged 15-19 years, 1 percent lower than in 2003. Rates declined 1 percent each for teenagers 15-17 and 18-19 years. The rate for 10-14 year-olds increased slightly. The birth rate for women aged 20-24 years declined 1 percent to 101.8, a record low for the Nation. The rate for women aged 25-29 years remained essentially unchanged at 115.5 per 1,000. The birth rate for women aged 30-34 years rose less than 1 percent to 95.5 per 1,000, whereas the rates for women aged 35-39 and 40-44 years increased 3 to 4 percent each. The rate for women aged 45-49 years rose to 0.6 per 1,000. Childbearing by unmarried women rose to a record high of almost 1.5 million births in 2004, a 4-percent increase from 2003. The proportion of all births to unmarried women increased to 35.7 percent. Smoking during pregnancy declined slightly in 2004, to 10.2 percent of mothers in the 40-State reporting area. There was no improvement in timely receipt of prenatal care. In 2004, 83.9 percent of mothers in the 41-State reporting area began care in the first trimester. A record high cesarean delivery rate was reported in 2004, at 29.1 percent of all births, a 6-percent increase from 2003. The primary cesarean rate rose 8 percent, whereas the rate of vaginal birth after cesarean delivery declined 13 percent. Preterm and LBW rates each increased in 2004. More than 500,000 infants were born preterm, a rate of 12.5 percent. The LBW rate increased to 8.1 percent.

Adolescent↗
PubMed2005

Births: final data for 2003.

OBJECTIVES: This report presents 2003 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, and tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.09 million births that occurred in 2003 are presented. Denominators for population-based rates are derived from the U.S. 2000 census. RESULTS: In 2003 there were 4,089,950 live births reported in the United States, 2 percent more than the number in 2002. The crude birth rate (CBR) and general fertility rate (GFR) rose slightly. Childbearing among teenagers declined for the 12th straight year to another historic low. Birth rates for women aged 20-24 years also declined, whereas rates for women aged 25-44 years increased 2-6 percent, reaching highs not reported since the mid- to late 1960s. All measures of unmarried childbearing increased considerably in 2003, but smoking during pregnancy continued to decline. Timely initiation of prenatal care improved slightly. The cesarean delivery rate jumped another 5 percent to another all-time high, and the rate of vaginal birth after previous cesarean dropped 16 percent, an all-time low. Key measures of birth outcome-the percentages of preterm and low birthweight (LBW) births-rose. The twinning rate increased, but the rate of triplet and higher order multiple births was essentially stable.

Adolescent↗
PubMed2005

Explaining the 2001-02 infant mortality increase: data from the linked birth/infant death data set.

The U.S. infant mortality rate increased from 6.8 infant deaths per 1,000 live births in 2001 to 7.0 in 2002, the first increase in more than 40 years. From 2001 to 2002 infant mortality rates increased for very low birthweight infants as well as for preterm and very preterm infants. Although infant mortality rates for very low birthweight infants increased, most of the increase in the infant mortality rate from 2001 to 2002 was due to a change in the distribution of births by birthweight and, more specifically, to an increase in infants born weighing less than 750 grams (1 lb 10 1/2 oz). The majority of infants born weighing less than 750 grams die within the first year of life; thus, these births contribute disproportionately to the overall infant mortality rate. Increases in births at less than 750 grams occurred for non-Hispanic white, non-Hispanic black, and Hispanic women. Most of the increase occurred among mothers 20-34 years of age. Although multiple births contributed disproportionately, most of the increase in births at less than 750 grams occurred among singletons. Three hypotheses were evaluated to assess their possible impact on the increase in less than 750-gram births: first, possible changes in the reporting of births or fetal deaths; second, possible changes in the risk profile of births; and third, possible changes in medical management of pregnancy. Although each of these factors may have contributed to the increase, the relative effects of these and other factors remain unclear. More-detailed studies are needed to further explain the 2001-02 infant mortality increase.

Birth Weight↗
PubMed2005

Annual summary of vital statistics--2003.

The crude birth rate rose slightly in 2003 to 14.1 births per 1000 population, from 13.9 in 2002. The 2002 rate was the lowest ever reported for the United States. The total number of births and the fertility rate (66.1) also increased. The birth rate for teenaged mothers dropped 3% to another record low in 2003, to 41.7 per 1000 females aged 15 to 19 years. The teenage birth rate has fallen by one third since 1991. The birth rate declined for women 20 to 24 years old but rose for women aged 25 to 44 years. The number, rate, and proportion of births to unmarried women all increased in 2003. Smoking during pregnancy declined to 11%, down from 19.5% in 1989. Prenatal care utilization improved slightly for 2003; 84.1% of women began care in the first trimester of pregnancy. The cesarean delivery rate jumped 6% to 27.6% for another US high. The primary cesarean rate rose 6%, and the rate of vaginal birth after a previous cesarean delivery plummeted 16% from 2002 to 2003. The percent of infants delivered preterm continued to rise (12.3% in 2003). The preterm birth rate is up 16% since 1990. The percentage of children born at low birth weight rose slightly in 2003 to the highest level reported since 1970 (7.9%). The twinning rate increased, but the rate for triplet/+ births declined slightly between 2001 and 2002. Multiple births accounted for 3.3% of all births in 2002. The infant mortality rate rose to 7.0/1000 live births in 2002 from 6.8 in 2001, marking the first increase in this rate in >4 decades. Increases were distributed fairly widely across age, racial/ethnic groups, and geographic areas. The rise in infant mortality was attributed to increases in <750-g births in both singleton and multiple deliveries. Although the downward trend in infant mortality rates in many developed nations may have stabilized, the United States still ranked 27th among these nations in 2001. Expectation of life at birth reached a record high of 77.3 years for all gender and race groups combined in 2002. Death rates in the United States continue to decline. Between 2001 and 2002, death rates declined for the 3 leading causes of death: diseases of heart, malignant neoplasms, and cerebrovascular diseases. Death rates for children 1 to 19 years old decreased by 8% for suicide; the death rate for chronic lower respiratory diseases increased by 33% in 2002. Rates for unintentional injuries and homicide did not change significantly for children aged 1 to 19 years. A large proportion of childhood deaths continues to occur as a result of preventable injuries.

Adolescent↗
PubMed2005

Supplemental analyses of recent trends in infant mortality.

U.S. preliminary data for 2002 show a significant increase in the infant mortality rate to 7.0 infant deaths per 1,000 live births, the first rise in the infant mortality rate since 1958. The increase in infant mortality was concentrated in the neonatal period, particularly in deaths occurring within seven days of birth. Partially edited fetal death data suggest that the increase in neonatal mortality was accompanied by a decline in the late fetal mortality rate, and thus it appears that the 2002 perinatal mortality rate will remain level. Potential explanatory factors for the changes in the infant mortality rate are examined, including causes of infant death, percentage of births that are preterm, and low birthweight. Data from the 2002 linked birth and infant death file will allow an assessment of the contribution of maternal and infant factors such as multiple births and management of labor and delivery.

Fetal Death↗
PubMed2005

Explaining the 2001-2002 infant mortality increase in the United States: data from the linked birth/infant death data set.

The U.S. infant mortality rate (IMR) increased from 6.8 infant deaths per 1,000 live births in 2001 to 7.0 in 2002, the first increase in more than 40 years. From 2001 to 2002, IMR increased for very low birthweight infants as well as for preterm and very preterm infants. Although IMR for very low birthweight infants increased, most of the increase in IMR from 2001 to 2002 was due to a change in the distribution of births by birthweight and, more specifically, to an increase in infants born weighing less than 750 grams. The majority of infants born at less than 750 grams die within the first year of life; thus, these births contribute disproportionately to overall IMR. Increases in births at less than 750 grams occurred fornon-Hispanic white, non-Hispanic black, and Hispanic women. Most of the increase occurred among mothers 20 to 34 years of age. Although multiple births contributed disproportionately, most of the increase in births at less than 750 grams occurred among singletons. Three hypotheses were evaluated to assess their possible impact on the increase in less than 750-gram births: possible changes in (1) the reporting of births or fetal deaths, (2) the risk profile of births, and (3) medical management of pregnancy. Although each of these factors may have contributed to the increase, the relative effects of these and other factors remain unclear. More detailed studies are needed to further explain the 2001-2002 infant mortality increase.

Birth Rate↗
PubMed2004

Births: preliminary data for 2003.

OBJECTIVES: This report presents preliminary data for 2003 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, tobacco use, prenatal care, cesarean delivery, preterm births, and low birthweight are also presented. METHODS: Data in this report are based on nearly 99 percent of births for 2003. The records are weighted to independent control counts of all births received in State vital statistics offices in 2003. Comparisons are made with 2002 final data. RESULTS: The crude birth rate rose to 14.1 births per 1000 population in 2003, an increase of 1 percent from 2002 (13.9). The fertility rate also rose in 2003 by 2 percent to 66.1 births per 1000 women aged 15-44 years. Since 1994, the rate has ranged from 63.6 to 66.1. The birth rate for teenagers continued to decline in 2003 to 41.7 births per 1000 women aged 15-19 years, 3 percent lower than in 2002. Rates fell for teenagers in all race and Hispanic origin groups, in many cases marking new record lows for the Nation. Birth rates for teenagers 15-17 and 18-19 years continued to steadily decline. The rate for ages 15-17 was 22.4 per 1000 in 2003, down 3 percent from 2002 and 42 percent from 1991, the recent peak. The rate for older teenagers 18-19 years in 2003 was 70.8 per 1000, also 3 percent lower than in 2002 and 25 percent lower than in 1991. The birth rates for women in their twenties were 102.6 per 1000 for women aged 20-24 years and 115.7 for women aged 25-29 years, a decrease of 1 percent and an increase of 2 percent, respectively, compared with 2002. The birth rate for women aged 30-34 years increased 4 percent to 95.2 births per 1000 women compared with 2002. The rate rose 6 percent for women aged 35-39 years, between 2002 and 2003, and 5 percent for women aged 40-44 years. The rate for women aged 45-49 years remained unchanged. The birth rate for unmarried women increased by 3 percent in 2003, from 43.7 to 44.9 per 1000 unmarried women aged 15-44 years. The proportion of births to unmarried women also increased in 2003 to 34.6 percent, compared with 34.0 percent in 2002. The proportion of mothers smoking during pregnancy continued to steadily decline in 2003, from 11.4 percent in 2002 to 11.0 percent. The percent of women who received prenatal care within the first 3 months of pregnancy edged upward for 2003, to 84.1 percent, compared with 83.7 percent in 2002. In 2003, 27.6 percent of all births were delivered by cesarean delivery, a marked rise of 6 percent over the 2002 level, and one-third higher than that for 1996. The primary cesarean rate also rose 6 percent between 2002 and 2003 while the rate of vaginal birth after previous cesarean (VBAC) dropped by 16 percent. Preterm and low birthweight rates both rose between 2002 and 2003. The preterm rate increased from 12.1 to 12.3 and low birthweight rate rose from 7.8 to 7.9 percent.

Adolescent↗
PubMed2004

Births to 10-14 year-old mothers, 1990-2002: trends and health outcomes.

OBJECTIVES: This report presents the number and rate of U.S. births for 10-14 year olds, for 1990-2002 by race and Hispanic origin and by State. Pregnancy risk factors and outcomes by selected maternal and infant characteristics are shown. METHODS: Tabular and graphical descriptions of births and infant deaths to 10-14 year olds are presented based on information reported on birth and death certificates for the United States and each State. RESULTS: 7,315 females aged 10-14 years delivered a live birth in 2002. The rate of births to 10-14 year olds was 0.7 per 1,000 in 2002, half of the rate during 1989-94. This rate peaked in 1989 (1.4 per 1,000). For 1990-94 the rate remained at 1.4, and then began a steady decline to 0.7 per 1,000 in 2002. Large declines in young teenage childbearing were seen among all racial and ethnic subgroups, as well as almost all States. These young mothers were least likely to receive timely prenatal care compared with mothers of older age groups. Compared with infants of mothers aged 20-39 years, infants of the youngest mothers experienced almost twice the rates of preterm delivery (21.3 percent) and low birthweight (12.6 percent). The infant mortality rate (15.4 per 1,000) was two to three times higher than that for infants of mothers aged 20-44 years.

Adolescent↗
PubMed2003

Births: final data for 2002.

OBJECTIVES: This report presents 2002 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco, and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.022 million births that occurred in 2002 are presented. Denominators for population-based rates are derived from the 2000 U.S. census. Rates for 1991-2001 may differ from those published previously based on the 1990 U.S. census. RESULTS: There were 4,021,726 live births in 2002, essentially unchanged from 2001. The birth rate, fertility rate, and total fertility rates all declined 1 percent in 2002. The teenage birth rate dropped 5 percent, reaching another record low. The birth rates for women 20-24 years declined, whereas the rate for women 25-29 years was stable. The birth rate for women 30-34 years declined, but the rate for women 35-44 years continued to rise. Births to unmarried women changed very little. Smoking during pregnancy was down again. The timeliness of prenatal care continued to improve. The cesarean delivery rate climbed to the highest level ever reported in the United States (26.1 percent) and the rate of vaginal birth after previous cesarean plummeted 23 percent to 12.6 percent. Preterm and low birthweight levels both rose for 2002. The twin birth rate continued to climb, but the rate of triplet/+ births was down slightly.

Adolescent↗
PubMed2003

Births: preliminary data for 2002.

OBJECTIVES: This report presents preliminary data for 2002 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, preterm births, and low birthweight are also presented. METHODS: Data in this report are based on nearly 98 percent of births for 2002. The records are weighted to independent control counts of all births received in State vital statistics offices in 2002. Comparisons are made with 2001 final data. RESULTS: The crude birth rate was 13.9 per 1,000 population in 2002, a decrease of 1 percent from 2001 (14.1). This is the lowest birth rate reported for the United States since national data have been available. The fertility rate was also down 1 percent in 2002 to 64.8 births per 1,000 women aged 15-44 years. Since 1990, this rate has declined 9 percent. The birth rate for teenagers continued to decline in 2002, dropping 5 percent to 42.9 births per 1,000 women aged 15-19 years. The teenage birth rate has dropped 28 percent since 1990. The rate for younger teenagers 15-17 years fell 6 percent from 24.7 per 1,000 in 2001 to 23.2 in 2002. The rate for older teenagers 18-19 years declined 4 percent from 76.1 per 1,000 in 2001 to 72.7 in 2002. Since 1990, the rate for teenagers 15-17 years has fallen 38 percent and the rate for teenagers 18-19 years, 18 percent. The birth rate for women aged 20-24 years declined by 3 percent to 103.5 per 1,000 in 2002 compared with 2001, whereas the rate for women aged 25-29 years was essentially unchanged (113.6). The birth rate for women aged 30-34 years decreased slightly from 91.9 per 1,000 in 2001 to 91.6 in 2002. Birth rates for women aged 35-39 years and 40-44 years continued to rise, increasing 2 percent for both. Childbearing among women over 45 years of age was unchanged. The birth rate for unmarried women was down slightly in 2002 to 43.6 births per 1,000 unmarried women aged 15-44 years. The number of births to unmarried women increased by 1 percent in 2002; however births to unmarried teenagers declined by 4 percent. Prenatal care utilization continued to slowly but steadily improve; 83.8 percent of women began prenatal care in the first trimester of pregnancy in 2002 compared with 83.4 in 2001. More than one fourth of all births (26.1 percent) were cesarean deliveries in 2002, the highest rate ever reported in the United States; the primary cesarean rate jumped 7 percent to 18 percent and the rate of vaginal births after previous cesarean delivery plummeted 23 percent to 12.7 percent (figure 1). Preterm (12.0 percent) and low birthweight (7.8 percent) rates were up slightly for 2002. The low birthweight rate is the highest reported in more than three decades.

Adolescent↗
PubMed2003

Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000.

OBJECTIVE: To examine trends in multiple births conceived using assisted reproductive technology (ART) in the United States between 1997 and 2000 and to estimate the proportion of all US multiple births attributable to ART use. METHODS: We analyzed population-based data of 109 519 live-born infants who were conceived in the United States using ART and born between 1997 and 2000 and population-based data of 15 856 809 live-born infants who were delivered in the United States between 1997 and 2000. Multiple birth rates (the number of live-born infants delivered in multiple gestation pregnancies per 1000 live births) and the proportion of all US multiple births attributable to ART were evaluated. RESULTS: The twin rate for ART patients increased between 1997 and 2000, reaching 444.7 per 1000 live births in 2000, whereas the triplet/+ rate declined substantially from 134.3 to 98.7 per 1000 live births from 1997-2000. From 1997-2000, the proportion of multiple births in the United States attributable to ART increased from 11.2% to 13.6%, whereas the proportion attributable to natural conception decreased from 69.9% to 64.5%. In 2000, the proportion of triplet/+ births attributable to ART and to natural conception was 42.5% and 17.7%, respectively. The contribution of ART to multiple births increased substantially with maternal age, from 11.6% for triplet/+ infants born to women aged 20 to 24 to 92.8% for women aged 45 to 49 years. CONCLUSIONS: The contribution of ART to twin birth rates continues to increase, but the contribution of ART to triplet/+ birth rates has declined.

Adult↗
PubMed2002

Births: final data for 2001.

OBJECTIVES: This report presents 2001 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco, and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.026 million births that occurred in 2001 are presented. Denominators for population-based rates are derived from the 1990 U.S. census. As a result, rates are generally larger than would be the case if 2000-based estimates were used. The magnitude of the overestimate will vary by population subgroup; overestimates are likely greatest for those of Hispanic origin. RESULTS: The number of births, the birth rate, fertility rate, and total fertility rates all declined 1 percent in 2001. The teenage birth rate reached another historic low. Birth rates for women in their twenties declined slightly, whereas rates for women aged 30 to 44 years continued to rise. Births to unmarried women changed very little. Smoking by pregnant women was down again. Women were more likely to begin care in the first trimester of pregnancy (83.4 percent). The cesarean delivery rate rose for the fifth consecutive year to 24.4 percent; the primary cesarean rate was up 5 percent and the rate of vaginal births after a previous cesarean fell 20 percent. Preterm and low birthweight levels both rose for 2001. The twin birth rate continued to climb, and following 2 years of decline, the rate of triplet/+ births also increased.

Adolescent↗
PubMed2002

Births: preliminary data for 2001.

OBJECTIVES: This report presents preliminary data for 2001 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented. METHODS: Data in this report are based on more than 96 percent of births for 2001. The records are weighted to independent control counts of all births received in State vital statistics offices in 2001. Comparisons are made with 2000 final data. RESULTS: The number of births, the crude birth rate, and the fertility rate all declined slightly between 2000 and 2001. The number of births was down by less than 1 percent, the crude birth rate declined 1 percent to 14.5 per 1,000 population, and the fertility rate was down slightly to 67.2 births per 1,000 women aged 15-44 years. Teenagers were less likely to give birth in 2001; the teen birth rate continued to fall, dropping 5 percent between 2000 and 2001 to 45.9 births per 1,000 females aged 15-19 years, another record low. The teen birth rate has fallen 26 percent since 1991. The birth rate for teenagers 15-17 years fell 8 percent, and the rate for teenagers 18-19 years was down 4 percent for 2000-2001. Since 1991 rates have fallen 35 percent for teenagers 15-17 years, and 20 percent for teenagers 18-19 years. Birth rates for women aged 20-24 declined by 2 percent, whereas rates for women 25-44 years increased. Childbearing among women aged 40-54 years was stable. The birth rate for unmarried women decreased modestly to 44.9 births per 1,000 unmarried women 15-44 years in 2001, still remaining below the peak reached in 1994. The number of births to unmarried women was up very slightly, but births to unmarried teens were down. The proportion of women who began prenatal care in the first trimester of pregnancy improved slightly to 83.4 percent, but the rate of low birthweight held at 7.6 percent. The total cesarean delivery rate jumped 7 percent between 2000 and 2001 to 24.4 percent of all births, the highest level ever reported from this data source; the primary rate of cesarean deliveries rose 5 percent, and the rate of vaginal births after previous cesarean delivery tumbled 20 percent.

Adolescent↗
PubMed2002

Births: final data for 2000.

OBJECTIVES: This report presents 2000 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.059 million births that occurred in 2000 are presented. RESULTS: The number of births rose 3 percent in 2000; birth and fertility rates rose 1 to 2 percent. The total fertility rate was above "replacement" for the first time in almost 30 years. Teenage birth rates continued to fall while birth rates for women aged 20-24 years rose slightly, and rates for women in their late twenties and thirties rose 3 to 5 percent. Births to women in their forties and early fifties were also up for 2000. The number of births to unmarried women, the birth rate, and the percent of births that were to unmarried women rose 1 to 3 percent, but birth rates for unmarried teenagers declined. Smoking by pregnant women was down again. The cesarean delivery rate rose 4 percent to 22.9, the fourth consecutive increase; the primary cesarean rate was up and the rate of vaginal births after a previous cesarean was down. The number and rate of twin births continued to rise, but the triplet/+ birth rate declined for the second year in a row. For the first year in almost a decade the preterm birth rate declined (to 11.6 percent); the low birthweight rate, however, was unchanged at 7.6 percent.

Adolescent↗
PubMed2002

Trends and characteristics of induced labour in the United States, 1989-98.

Induction of labour is one of the fastest growing medical procedures in the United States. In 1998, 19.2% of all US births were a product of induced labour, more than twice the 9.0% in 1989. Induction of labour has been efficacious in the management of post-term pregnancy and in expediting delivery when the mother or infant is sufficiently ill to make continuation of the pregnancy hazardous. However, the recent rapid increase in induction, and particularly the doubling of the induction rate for preterm pregnancies (from 6.7% in 1989 to 13.4% in 1998), has generated concern among some clinicians. The present study uses vital statistics natality data to examine the epidemiology of induced labour in the US. Multivariable analysis is used to examine the probability of having an induced delivery in relation to a wide variety of socio-demographic and medical characteristics, and also in relation to relative indications and contraindications for induced labour as outlined by the American College of Obstetricians and Gynecologists (ACOG). Induction rates were higher for women who were non-Hispanic white, college educated, born in the US, primaparae and those with intensive prenatal care utilisation. Induction rates were also higher for women with various medical conditions including hypertension, eclampsia and renal disease. For non-Hispanic white women with singleton births, 59% of the increase in the preterm birth rate from 1989 to 1998 can be accounted for by the increase in preterm inductions. The adjusted odds ratio for neonatal mortality among preterm births with induced labour was 1.20 [95% confidence interval 1.11, 1.31]. The rapid increase in induction rates, particularly among preterm births, marks a shift in the obstetric management of pregnancy. More detailed studies are needed to examine physician decision-making protocols, particularly for preterm induction, and to assess the impact of these practice changes on patient outcomes.

Adult↗
PubMed2002

Vital statistics as a data source.

A focus group convened at a National Institutes of Health (NIH) Stillbirth Conference discussed issues related to vital statistics as a data source on fetal mortality. Fetal death is a tragic occurence and part of the continuum of pregnancy outcomes. A primary source of data is the National Vital Statistics System fetal death component, which is routinely used to track mortality trends and to provide the context for nonrepresentative investigations. The data are also used to examine differentials in mortality by characteristics and to evaluate data quality. Issues concerning how to improve the vital statistics data include culture and context; data instrument; persons providing information; what information is available to the information provider; processing issues; and use of data. Perhaps most important is to enhance recognition of fetal death both for the individual confronting a loss and to promote research. Other studies are needed to augment the information obtainable through vital records.

Culture↗