RESUMEN
BACKGROUND: Our study examined the acute and sustained impact of immigration policy changes announced in January 2017 on preterm birth (PTB) rates among Hispanic and non-Hispanic white women in Texas's border and nonborder regions. METHODS: Using Texas birth certificate data for years 2008 through 2020, we used a multiple group interrupted time series approach to explore changes in PTB rates. RESULTS: In the nonborder region, the PTB rate among Hispanic women of any race was 8.64% in 2008 and was stable each year before 2017 but increased by .29% (95% CI [.12, .46]) annually between 2017 and 2020. This effect remained statistically significant even when compared with that of non-Hispanic white women (p = .014). In the border areas, the PTB rate among Hispanic women of any race was 11.67% in 2008 and remained stable each year before and after 2017. No significant changes were observed when compared with that of non-Hispanic white women (p = .897). In Texas as a whole, the PTB rate among Hispanic women of any race was 10.16% in 2008 and declined by .07% (95% CI [-.16, -.03]) per year before 2017, but increased by .16% (95% CI [.05, .27]) annually between 2017 and 2020. The observed increase was not statistically significant when compared with that of non-Hispanic white women (p = .326). CONCLUSIONS: The January 2017 immigration policies were associated with a sustained increase in PTB among Hispanic women in Texas's nonborder region, suggesting that geography plays an important role in perceptions of immigration enforcement. Future research should examine the impact of immigration policies on maternal and child health, considering geography and sociodemographic factors.
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Emigración e Inmigración , Hispánicos o Latinos , Nacimiento Prematuro , Población Blanca , Humanos , Texas/epidemiología , Femenino , Nacimiento Prematuro/etnología , Nacimiento Prematuro/epidemiología , Emigración e Inmigración/legislación & jurisprudencia , Emigración e Inmigración/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Embarazo , Adulto , Población Blanca/estadística & datos numéricos , Análisis de Series de Tiempo Interrumpido , Emigrantes e Inmigrantes/estadística & datos numéricos , Certificado de NacimientoRESUMEN
BACKGROUND: The US still has a high burden of preterm birth (PTB), with important disparities by race/ethnicity and poverty status. There is a large body of literature looking at the impact of pre-pregnancy obesity on PTB, but fewer studies have explored the association between underweight status on PTB, especially with a lens toward health disparities. Furthermore, little is known about how weight, specifically pre-pregnancy underweight status, and socio-economic-demographic factors such as race/ethnicity and insurance status, interact with each other to contribute to risks of PTB. OBJECTIVES: The objective of this study was to measure the association between pre-pregnancy underweight and PTB and small for gestational age (SGA) among a large sample of births in the US. Our secondary objective was to see if underweight status and two markers of health disparities - race/ethnicity and insurance status (public vs. other) - on PTB. STUDY DESIGN: We used data from all births in California from 2011 to 2017, which resulted in 3,070,241 singleton births with linked hospital discharge records. We ran regression models to estimate the relative risk of PTB by underweight status, by race/ethnicity, and by poverty (Medi-cal status). We then looked at the interaction between underweight status and race/ethnicity and underweight and poverty on PTB. RESULTS: Black and Asian women were more likely to be underweight (aRR = 1.0, 95% CI: 1.01, 1.1 and aRR = 1.4, 95% CI: 1.4, 1.5, respectively), and Latina women were less likely to be underweight (aRR = 0.7, 95% CI: 0.7, 0.7). Being underweight was associated with increased odds of PTB (aRR = 1.3, 95% CI 1.3-1.3) and, after controlling for underweight, all nonwhite race/ethnic groups had increased odds of PTB compared to white women. In interaction models, the combined effect of being both underweight and Black, Indigenous and People of Color (BIPOC) statistically significantly reduced the relative risk of PTB (aRR = 0.9, 95% CI: 0.8, 0.9) and SGA (aRR = 1.0, 95% CI: 0.9, 1.0). The combined effect of being both underweight and on public insurance increased the relative risk of PTB (aRR = 1.1, 95% CI: 1.1, 1.2) but there was no additional effect of being both underweight and on public insurance on SGA (aRR = 1.0, 95% CI: 1.0, 1.0). CONCLUSIONS: We confirm and build upon previous findings that being underweight preconception is associated with increased risk of PTB and SGA - a fact often overlooked in the focus on overweight and adverse birth outcomes. Additionally, our findings suggest that the effect of being underweight on PTB and SGA differs by race/ethnicity and by insurance status, emphasizing that other factors related to inequities in access to health care and poverty are contributing to disparities in PTB.
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Certificado de Nacimiento , Nacimiento Prematuro , Recién Nacido , Femenino , Humanos , Embarazo , Etnicidad , Nacimiento Prematuro/epidemiología , Delgadez/complicaciones , Delgadez/epidemiología , Cobertura del Seguro , Parto , California/epidemiologíaRESUMEN
OBJECTIVE: To assess the incompleteness of the Robson Classification variables in the Live Birth Information System (Sistema de Informação sobre Nascidos Vivos - SINASC), in the state of Paraná, and its trend, 2014-2020. METHODS: This was a time-series study that analyzed six variables, according to health macro-regions. Incompleteness was classified (percentage of "ignored" and "blank fields") as follows: excellent (< 1.0%); good (1.0-2.9%); regular (3.0-6.9%); poor (≥ 7.0%). Prais-Winsten regression was used to estimate trends. RESULTS: A total of 1,089,116 births were evaluated. The variable "cesarean section before the onset of labor" was classified as poor in 2014 (39.4%) and 2015 (44.3%) in the state and in all macro-regions, but with a decreasing trend in incompleteness. The variables "gestational age" in the North and Northwest macro-regions, and "parity" and "number of fetuses" in the Northwest macro-region showed an increasing trend. CONCLUSION: Most of the variables evaluated showed low percentages of incompleteness with a decreasing trend, but there is a need to improve the completion of some variables.
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Tasa de Natalidad , Nacimiento Vivo , Femenino , Humanos , Embarazo , Certificado de Nacimiento , Brasil/epidemiología , Cesárea , Embarazo MúltipleRESUMEN
Maternity and neonatal services always have to operate 24 hours a day and 7 days a week, and require well preparedness to guarantee safe deliveries for both mothers and babies. However, the evidence of holiday effect from large-scale data is still insufficient from the obstetrics perspective. We analyzed data of over 21 million births in Japan from January 1, 1979, to December 31, 2018. We revealed that the number of births is lower on holidays, and especially among high-risk births such as low birthweight and preterm births. The frequency of high-risk birth has been increasing over the study period, and the variation by the day of week and between holiday and non-holiday have become more prevalent in recent years.
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Recien Nacido Prematuro , Nacimiento Prematuro , Recién Nacido , Embarazo , Femenino , Humanos , Resultado del Embarazo , Vacaciones y Feriados , Certificado de Nacimiento , Recién Nacido de Bajo Peso , Nacimiento Prematuro/epidemiologíaRESUMEN
A growing number of studies are using birth certificate data, despite data-quality concerns, to study maternal morbidity and associated disparities. We examined whether conclusions about the incidence of maternal morbidity, including Black-White disparities, differ between birth certificate data and hospitalization data. Using linked birth certificate and hospitalization data from California and Michigan for 2018 (N=543,469), we found that maternal morbidity measures using birth certificate data alone are substantially underreported and have poor validity. Furthermore, the degree of underreporting in birth certificate data differs between Black and White individuals and results in erroneous inferences about disparities. Overall, Black-White disparities were more modest in the birth certificate data compared with the hospitalization data. Birth certificate data alone are inadequate for studies of maternal morbidity and associated racial disparities.
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Certificado de Nacimiento , Salud Materna , Morbilidad , Alta del Paciente , Femenino , Humanos , Embarazo , Hospitales , Incidencia , Negro o Afroamericano , BlancoRESUMEN
PURPOSE: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS. METHODS: Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation). RESULTS: Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns. CONCLUSIONS: Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.
Asunto(s)
Servicios de Protección Infantil , Alta del Paciente , Humanos , Recién Nacido , Certificado de Nacimiento , Canadá , HospitalesRESUMEN
Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension contribute to maternal morbidity and mortality. We examined the association of HDP and pre-pregnancy hypertension with subsequent venous thromboembolic (VTE) events. The retrospective cohort study included 444,859 women with ≥1 live, singleton birth in South Carolina (2004-2016). Hospital and emergency department visit and death certificate data defined incident VTE, HDP, and pre-pregnancy hypertension. Birth certificate data also defined the exposures. Adjusted Cox proportional hazards methods modeled VTE events risk. Of the cohort, 2.6% of women had pre-pregnancy hypertension, 5.8% had HDP, 2.8% had both pre-pregnancy hypertension and HDP (both conditions), and 88.8% had neither condition. The risk of incident VTE events within one year of delivery was higher in women with HDP (hazard ratio [HR] = 1.62, 95% confidence interval [CI]: 1.15-2.29) and both conditions (HR = 2.32, 95% CI: 1.60-3.35) compared to those with neither condition as was the risk within five years for women with HDP (HR = 1.35, 95% CI: 1.13-1.60) and for women with both conditions (HR = 1.82, 95% CI: 1.50-2.20). One- and five-year risks did not differ in women with pre-pregnancy hypertension compared to women with neither condition. Compared to non-Hispanic White (NHW) women with neither condition, the incident VTE event risk was elevated within five years of delivery for NHW (HR = 1.29, 95% CI: 1.02-1.63; HR = 1.59, 95% CI: 1.16-2.17) and non-Hispanic Black (NHB; HR = 1.51, 95% CI: 1.16-2.96; HR = 2.08, 95% CI: 1.62-2.66) women with HDP and with both conditions, respectively, and for NHB women with pre-pregnancy hypertension (HR = 1.50, 95% CI: 1.09-2.07). VTE event risk was highest in women with HDP, and the event rates were higher in NHB women than in NHW women in the same exposure group.
Asunto(s)
Hipertensión Inducida en el Embarazo , Prehipertensión , Tromboembolia Venosa , Trombosis de la Vena , Embarazo , Femenino , Humanos , Tromboembolia Venosa/epidemiología , Hipertensión Inducida en el Embarazo/epidemiología , Estudios Retrospectivos , Certificado de NacimientoRESUMEN
BACKGROUND: Systematically recorded smoking data are not always available in vital statistics records, and even when available it can underestimate true smoking rates. OBJECTIVE: To develop a prediction model for maternal tobacco smoking in late pregnancy based on birth certificate information using a combination of self- or provider-reported smoking and biomarkers (smoking metabolites) in neonatal blood spots as the alloyed gold standard. METHODS: We designed a case-control study where childhood cancer cases were identified from the California Cancer Registry and controls were from the California birth rolls between 1983 and 2011 who were cancer-free by the age of six. In this analysis, we included 894 control participants and performed high-resolution metabolomics analyses in their neonatal dried blood spots, where we extracted cotinine [mass-to-charge ratio (m/z) = 177.1023] and hydroxycotinine (m/z = 193.0973). Potential predictors of smoking were selected from California birth certificates. Logistic regression with stepwise backward selection was used to build a prediction model. Model performance was evaluated in a training sample, a bootstrapped sample, and an external validation sample. RESULTS: Out of seven predictor variables entered into the logistic model, five were selected by the stepwise procedure: maternal race/ethnicity, maternal education, child's birth year, parity, and child's birth weight. We calculated an overall discrimination accuracy of 0.72 and an area under the receiver operating characteristic curve (AUC) of 0.81 (95% confidence interval [CI] 0.77, 0.84) in the training set. Similar accuracies were achieved in the internal (AUC 0.81, 95% CI 0.77, 0.84) and external (AUC 0.69, 95% CI 0.64, 0.74) validation sets. CONCLUSIONS: This easy-to-apply model may benefit future birth registry-based studies when there is missing maternal smoking information; however, some smoking status misclassification remains a concern when only variables from the birth certificate are used to predict maternal smoking.
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Certificado de Nacimiento , Fumar , Niño , Femenino , Humanos , Recién Nacido , Embarazo , California/epidemiología , Estudios de Casos y Controles , Neoplasias , Fumar/epidemiología , Fumar Tabaco , Modelos EstadísticosRESUMEN
Abstract Objectives: to analyze the temporal trend in maternal, care and newborns characteristics, in the city of Guarapuava, Paraná, Brazil in the period of 2010 to 2019. Methods: ecological temporal tendency study is based on Sistema de Informações sobre Nascidos Vivos (Live Birth Information System). To verify changes on the topics, the Prais-Winsten generalized linear regression was applied. Results: data from 28,919 live births were analyzed in 2019, 15.9% of the pregnancies were adolescents, 49.8% were cesarean deliveries and 9.2% were premature childbirths. A reduction in teenage pregnancy was observed, with annual percentage variation (APV) for mothers aged ten to 14 being -0.14% (p=0.005) and 15 to 19 years old -0.82% (p=0.004); there was an increase in mothers' schooling, with an APV of 60.09% (p=0.026) for eight to 11 years of schooling and 11.27% (p<0.001) for 12 or more; there was an increase of 15.33% (p<0.001) for seven or more prenatal consultations and a decrease in the Apgar classifications considering the risk, with scores from zero to two in the 1st minute with an APV=-0.12 (p=0.010) and scores from three to five in the 5th minute with APV=-0.07 (p=0.011). Conclusions: The city of Guarapuava presents important decreased tendencies in early pregnancy and an increase in mothers' schooling, besides the changes regarding the conditions in which their children are born and how they are welcomed.
Resumo Objetivos: analisar a tendência temporal de características maternas, assistenciais e dos recém-nascidos do município de Guarapuava-PR no período de 2010 a 2019. Métodos: estudo ecológico de tendência temporal com dados do Sistema de Informações sobre Nascidos Vivos. Para verificar mudanças nas características avaliadas, utilizou-se regressão linear generalizada de Prais-Winsten. Resultados: analisaram-se dados de 28.919 nascidos vivos; em 2019, 15,9% das gestações foram de adolescentes, 49,8% dos partos cesáreos e 9,2% partos prematuros. Observou-se redução da gravidez na adolescência, com variação percentual anual (VPA) para mães com dez a 14 anos sendo -0,14% (p=0,005) e 15 a 19 anos -0,82% (p=0,004); aumento da escolaridade das mães, com VPA de 60,09% (p=0,026) para oito a 11 anos de estudo e 11,27% (p<0,001) para 12 ou mais; aumento de 15,33% (p<0,001) para sete ou mais consultas de pré-natal realizadas pelas gestantes e queda nas classificações de Apgar consideradas de risco, com notas zero a dois no 1º minuto com VPA=-0,12 (p=0,010) e notas três a cinco no 5º minuto com VPA=-0,07 (p=0,011). Conclusões: Guarapuava apresentou importantes tendências de redução da gravidez precoce e aumento de escolaridade das mães, além de mudanças sobre as condições em que nascem seus filhos e sobre como são acolhidos.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Embarazo en Adolescencia/estadística & datos numéricos , Atención Prenatal , Certificado de Nacimiento , Cesárea/estadística & datos numéricos , Trabajo de Parto Prematuro , Factores Socioeconómicos , Brasil , Estudios de Series Temporales , Estudios EcológicosRESUMEN
OBJECTIVE: This study examines improvement in birth certificate accuracy during a statewide quality improvement initiative. STUDY DESIGN: Participating hospitals systematically sampled 10 delivery medical records per month and compared them to corresponding birth certificates for accuracy. Accuracy was computed before implementing the initiative (Aug-Oct 2014), end of phase 1 (July 2015) and end of phase 2 (Nov-Dec 2015). Accuracy data was aggregated and compared across time points using a linear mixed model and by hospital characteristics. RESULTS: 105 hospitals participated. Birth certificate accuracy increased between baseline (89.59%) and end of phase 2 (97.00%, p < 0.001). Percent accuracy at baseline was lowest in hospitals serving at-risk populations (p < 0.01). These hospitals showed relatively greater increases in overall accuracy with no difference in accuracy by the end of the initiative. CONCLUSIONS: A statewide QI effort contributed to improvements in birth certificate accuracy. Hospitals serving at-risk populations exhibited the greatest benefit and improvement.
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Certificado de Nacimiento , Mejoramiento de la Calidad , Humanos , Illinois , Registros Médicos , HospitalesRESUMEN
Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.
Asunto(s)
Partería , Enfermeras Obstetrices , Embarazo , Recién Nacido , Femenino , Humanos , Parto , Certificado de Nacimiento , Evaluación de Resultado en la Atención de SaludRESUMEN
BACKGROUND: During the COVID-19 pandemic, hospitals' decision of not admitting pregnant women's partner or support person, and pregnant women's fear of contracting COVID-19 in hospitals may disrupt prenatal care. We aimed to examine whether prenatal care utilization in South Carolina varied before and during the COVID-19 pandemic, and whether the variation was different by race. METHODS: We utilized 2018-2021 statewide birth certificate data using a pre-post design, including all women who delivered a live birth in South Carolina. The Kotelchuck Index - incorporating the timing of prenatal care initiation and the frequency of gestational age-adjusted visits - was employed to categorize prenatal care into inadequate versus adequate care. Self-reported race includes White, Black, and other race groups. Multiple logistic regression models were used to calculate adjusted odds ratio of inadequate prenatal care and prenatal care initiation after first trimester by maternal race before and during the pandemic. RESULTS: A total of 118,925 women became pregnant before the pandemic (before March 2020) and 29,237 women during the COVID-19 pandemic (March 2020 - June 2021). Regarding race, 65.2% were White women, 32.0% were Black women and 2.8% were of other races. Lack of adequate prenatal care was more prevalent during the pandemic compared to pre-pandemic (24.1% vs. 21.6%, p < 0.001), so was the percentage of initiating prenatal care after the first trimester (27.2% vs. 25.0%, p < 0.001). The interaction of race and pandemic period on prenatal care adequacy and initiation was significant. The odds of not receiving adequate prenatal care were higher during the pandemic compared to before for Black women (OR 1.26, 95% CI 1.20-1.33) and White women (OR 1.10, 95% CI 1.06-1.15). The odds of initiating prenatal care after the first trimester were higher during the pandemic for Black women (OR 1.18, 95% CI 1.13-1.24) and White women (OR 1.09, 95% CI 1.04-1.13). CONCLUSIONS: Compared to pre-pandemic, the odds of not receiving adequate prenatal care in South Carolina was increased by 10% for White women and 26% for Black women during the pandemic, highlighting the needs to develop individual tailored interventions to reverse this trend.
Asunto(s)
COVID-19 , Atención Prenatal , Embarazo , Humanos , Femenino , COVID-19/epidemiología , South Carolina/epidemiología , Pandemias , Certificado de NacimientoRESUMEN
This study aimed to evaluate the evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System (SINASC). It is a time-series study on the completeness of the variable "occurrence of congenital anomaly" and the consistency of gastroschisis diagnosis in SINASC, in biennia from 2005 to 2020, for federative units, region, and Brazil. The consistency was estimated by the ratio between deaths from gastroschisis registered in the Brazilian Mortality Information System (SIM) and the total number of cases recorded in SINASC. Temporal trend was analyzed by joinpoint regression. In the period, 46,574,995 live births and 10,024 cases of gastroschisis were recorded. A total of 5,632 infant deaths due to gastroschisis were identified. The percentage of incompleteness decreased from 6.52% to 1.87%, with an annual percentage variation (APV) of -14.5%, and completeness reached excellence (≤ 5% of incompleteness), except in the Central-West Region. Case/death ratios above 1 were found in the North and Northeast regions and in some federative units in the Central-West, but there was a decrease, approaching the mortality found in studies in the South and Southeast regions. Its reduction was more pronounced until 2009-2010 (APV = -10.7%) and smaller later (APV = -4.4%). The quality of the gastroschisis registry reflects regional differences in the overall quality of SINASC, constituting as a marker for malformations that require complex neonatal care.
O objetivo deste estudo foi avaliar a evolução da completude e da consistência do registro de gastrosquise no Sistema de Informações sobre Nascidos Vivos (SINASC) no Brasil. Trata-se de estudo de série temporal sobre a completude da variável "ocorrência de anomalia congênita" e a consistência do diagnóstico de gastrosquise no SINASC, nos biênios entre 2005 e 2020, para Unidades da Federação, região e Brasil. A consistência foi estimada pela razão entre óbitos por gastrosquise registrados no Sistema de Informações sobre Mortalidade (SIM) e o total de casos registrados no SINASC. A tendência temporal foi analisada por regressão joinpoint. No período, havia registro de 46.574.995 nascidos vivos e 10.024 casos de gastrosquise entre eles. Identificamos 5.632 óbitos infantis por gastrosquise. O percentual de incompletude diminuiu de 6,52% para 1,87%, com variação percentual anual (VPA) de -14,5%, e a completude atingiu a excelência (≤ 5% de incompletude), exceto no Centro-oeste do país. Razão óbito/caso acima de 1 foi encontrada nas regiões Norte e Nordeste e em alguns estados do Centro-oeste, mas houve diminuição, aproximando-se da mortalidade encontrada em estudos no Sul e Sudeste. Sua redução foi mais acentuada até 2009-2010 (VPA = -10,7%) e menor posteriormente (VPA = -4,4%). A qualidade do registro de gastrosquise reflete as diferenças regionais da qualidade geral do SINASC, configurando-se uma condição marcadora para malformações que demandam atenção neonatal complexa.
El objetivo de este estudio fue evaluar la evolución de la completitud y consistencia del registro de la gastrosquisis en el Sistema de Información de los Nacidos Vivos (SINASC) en Brasil. Se trata de un estudio de serie temporal sobre la completitud de la variable "aparición de anomalía congénita" y la consistencia del diagnóstico de gastrosquisis en el SINASC, en los bienios entre 2005 y 2020, en estados, regiones y Brasil. La consistencia se estimó por la razón entre las defunciones por gastrosquisis registradas en el Sistema de Información de Mortalidad (SIM) y el total de casos inscritos en el SINASC. La tendencia temporal se analizó mediante regresión joinpoint. Durante el período, hubo 46.574.995 nacidos vivos y 10.024 casos de gastrosquisis entre ellos. Identificamos 5.632 muertes infantiles por gastrosquisis. El porcentaje de incompletitud disminuyó de 6,52% a 1,87%, con una variación porcentual anual (VPA) de -14,5%, y la completitud alcanzó la excelencia (≤ 5% de incompletitud), excepto en la región Centro-oeste del país. Se encontró una relación defunciones/caso superior a 1 en las regiones Norte y Nordeste y en algunos estados del Centro-oeste, pero hubo una disminución, acercándose a la mortalidad encontrada en estudios en el Sur y Sudeste. Su reducción fue más pronunciada hasta 2009-2010 (VPA = -10,7%) y después menor (VPA = -4,4%). La calidad del registro de gastrosquisis refleja diferencias regionales relacionadas con la calidad general del SINASC, configurando una condición manifiesta de malformaciones que demandan cuidados neonatales complejos.
Asunto(s)
Gastrosquisis , Nacimiento Vivo , Recién Nacido , Lactante , Embarazo , Femenino , Humanos , Nacimiento Vivo/epidemiología , Brasil/epidemiología , Gastrosquisis/epidemiología , Certificado de Nacimiento , Sistemas de Información , Sistema de RegistrosRESUMEN
OBJECTIVE: The purpose of this study is to examine fetal growth outcomes from agricultural worker households. METHODS: Using Arizona 2006 to 2013 birth certificates with parental occupation, we identified N = 623,185 live births by agricultural household status. Logistic regression models estimated adjusted odds ratios (aORs) for macrosomia (>4000 g), postterm birth (>41 weeks), low birth weight (<2500 g), preterm birth (<37 weeks), large for GA, small for GA, and 5-minute APGAR (<7). RESULTS: Newborns of agricultural households (n = 6371) had a higher risk of macrosomia (aOR, 1.15; 95% CI, 1.05-1.26), large for GA (aOR, 1.12; 95% CI, 1.03-1.22), postterm birth (aOR, 1.20; 95% CI, 1.09-1.33), and low 5-minute APGAR (aOR, 1.39; 95% CI, 1.07-1.81), whereas low birth weight (aOR, 0.85; 95% CI, 0.76-0.96) and preterm birth (aOR, 0.82; 95% CI, 0.74-0.92) were inversely related. CONCLUSIONS: Having an agriculture working parent increased the likelihood of fetal overgrowth and low APGAR.
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Diabetes Gestacional , Complicaciones del Embarazo , Nacimiento Prematuro , Embarazo , Femenino , Recién Nacido , Humanos , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Macrosomía Fetal/epidemiología , Macrosomía Fetal/complicaciones , Certificado de Nacimiento , Arizona/epidemiología , Granjas , Complicaciones del Embarazo/epidemiologíaRESUMEN
OBJECTIVE: Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE). METHOD: We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record. RESULTS: In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3. DISCUSSION: PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population.
Children with PSE face environmental risks in the early developmental period. Often in the United States, CPS is relied on to assess and mitigate these risks. Amid calls for a public health response to PSE, it is essential to understand how children with PSE interact with CPS. We describe the incidence and timing of custody interruptions in a large U.S. state, comparing infants with PSE to those investigated by CPS for other reasons. This study extends current understanding by demonstrating the independent risk of custody interruption conferred by PSE status.
Asunto(s)
Maltrato a los Niños , Trastornos Relacionados con Sustancias , Femenino , Humanos , Lactante , Embarazo , Certificado de Nacimiento , California/epidemiología , Servicios de Protección Infantil , Padres , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
PURPOSE: We aimed to describe the distribution of gestational age at birth (GAB) to inform the estimation of GAB when clinical or obstetric estimates are not available for perinatal pharmacoepidemiology studies. METHODS: We estimated GAB (median, mode, mean, and standard deviation) and percentage born at each gestational week in groups based on plurality and other variables for live births in CDC's U.S. birth data. RESULTS: In 2020, 3 617 213 newborns had birth certificates with nonmissing GAB. Among singletons (3 501 693), median and mode GAB were both 39 weeks. Births with lower median GAB were from women with eclampsia (37 weeks) or receiving intensive care (37 weeks); newborns receiving intensive care (37 weeks); newborns with birth weight <2500 g (35 weeks), <1500 g (28 weeks), or <1000 g (25 weeks); and newborns not discharged alive (23 weeks). Among twins (112 633), median GAB was 36 weeks (mode, 37 weeks). Additional noteworthy groups were women with 0-6 prenatal visits (median, 34 weeks) or 7-8 prenatal visits (median, 35 weeks) or aged 15-19 years (median, 35 weeks). CONCLUSIONS: Some maternal and infant groups had distinct GAB distributions in the United States. This information can be useful in estimating GAB when individual-level clinical estimates are not available, such as in database studies of medication use during pregnancy.
Asunto(s)
Resultado del Embarazo , Nacimiento Prematuro , Embarazo , Recién Nacido , Femenino , Lactante , Estados Unidos/epidemiología , Humanos , Masculino , Recien Nacido Prematuro , Recién Nacido de Bajo Peso , Edad Gestacional , Certificado de Nacimiento , Vigilancia de la Población , Técnicas Reproductivas AsistidasRESUMEN
BACKGROUND: Many states link Medicaid claims with birth certificates or other data, often to inform programs and policies aimed at improving maternal and child health (MCH). OBJECTIVES: To develop an up-to-date understanding of the extent of the use of linked Medicaid claims for MCH research by state. RESEARCH DESIGN: We completed a structured literature review, developed an inventory of linkage efforts, and facilitated semistructured discussions with representatives from 9 states with established Medicaid claims data linkages to understand the technical details of linkages, experiences creating and maintaining linkages, and barriers or facilitators to establishing linkages. RESULTS: We identified 45 peer-reviewed journal articles representing 22 states that used linked Medicaid data to study MCH and 33 states and territories that publicly report on Medicaid data linkages for a total of 39 states with any in-scope linkage. Discussions revealed that linkages often arose from the desire to answer a specific question or evaluate a program but then expanded to other use cases and that most states enable external researchers to access data for analysis. Respondents provided a few examples of where linked birth certificate data were used for health outcomes research. CONCLUSION: Additional resources including technical assistance for identifying best practices along with interagency collaboration could overcome barriers and facilitate a coordinated and consolidated approach across states.
Asunto(s)
Certificado de Nacimiento , Medicaid , Niño , Estados Unidos , Humanos , Fuentes de Información , PolíticasRESUMEN
BACKGROUND: In contrast to other high-resource countries, the United States has experienced increases in the rates of severe maternal morbidity. In addition, the United States has pronounced racial and ethnic disparities in severe maternal morbidity, especially for non-Hispanic Black people, who have twice the rate as non-Hispanic White people. OBJECTIVE: This study aimed to examine whether the racial and ethnic disparities in severe maternal morbidity extended beyond the rates of these complications to include disparities in maternal costs and lengths of stay, which could indicate differences in the case severity. STUDY DESIGN: This study used California's linkage of birth certificates to inpatient maternal and infant discharge data for 2009 to 2011. Of the 1.5 million linked records, 250,000 were excluded because of incomplete data, for a final sample of 1,262,862. Cost-to-charge ratios were used to estimate costs from charges (including readmissions) after adjusting for inflation to December 2017. Mean diagnosis-related group-specific reimbursement was used to estimate physician payments. We used the Centers for Disease Control and Prevention definition of severe maternal morbidity, including readmissions up to 42 days after delivery. Adjusted Poisson regression models estimated the differential risk of severe maternal morbidity for each racial or ethnic group, compared with the non-Hispanic White group. Generalized linear models estimated the associations of race and ethnicity with costs and length of stay. RESULTS: Asian or Pacific Islander, Non-Hispanic Black, Hispanic, and other race or ethnicity patients all had higher rates of severe maternal morbidity than non-Hispanic White patients. The largest disparity was between non-Hispanic White and non-Hispanic Black patients, with unadjusted overall rates of severe maternal morbidity of 1.34% and 2.62%, respectively (adjusted risk ratio, 1.61; P<.001). Among patients with severe maternal morbidity, the adjusted regression estimates showed that non-Hispanic Black patients had 23% (P<.001) higher costs (marginal effect of $5023) and 24% (P<.001) longer hospital stays (marginal effect of 1.4 days) than non-Hispanic White patients. These effects changed when cases, such as cases where a blood transfusion was the only indication of severe maternal morbidity, were excluded, with 29% higher costs (P<.001) and 15% longer length of stay (P<.001). For other racial and ethnic groups, the increases in costs and length of stay were smaller than those observed for non-Hispanic Black patients, and many were not significantly different from non-Hispanic White patients. Hispanic patients had higher rates of severe maternal morbidity than non-Hispanic White patients; however, Hispanic patients had significantly lower costs and length of stay than non-Hispanic White patients. CONCLUSION: There were racial and ethnic differences in the costs and length of stay among patients with severe maternal morbidity across the groupings that we examined. The differences were especially large for non-Hispanic Black patients compared with non-Hispanic White patients. Non-Hispanic Black patients experienced twice the rate of severe maternal morbidity; in addition, the higher relative costs and longer lengths of stay for non-Hispanic Black patients with severe maternal morbidity support greater case severity in that population. These findings suggest that efforts to address racial and ethnic inequities in maternal health need to consider differences in case severity in addition to the differences in the rates of severe maternal morbidity and that these differences in case severity merit additional investigation.
Asunto(s)
Parto Obstétrico , Disparidades en Atención de Salud , Morbilidad , Madres , Gravedad del Paciente , Grupos de Población en Estados Unidos , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Asiático Americano Nativo Hawáiano y de las Islas del Pacífico/estadística & datos numéricos , Certificado de Nacimiento , Negro o Afroamericano/estadística & datos numéricos , California/epidemiología , Parto Obstétrico/economía , Parto Obstétrico/estadística & datos numéricos , Poblaciones Minoritarias, Vulnerables y Desiguales en Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Madres/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Estados Unidos/epidemiología , Blanco/estadística & datos numéricos , Grupos de Población en Estados Unidos/etnología , Grupos de Población en Estados Unidos/estadística & datos numéricosRESUMEN
Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.
Asunto(s)
Embarazo en Adolescencia , Embarazo , Femenino , Adolescente , Humanos , Estados Unidos/epidemiología , Edad Materna , Tasa de Natalidad , Certificado de Nacimiento , PartoRESUMEN
BACKGROUND: Limited information is available about neonates' critical conditions data quality. The study aim was to measure the agreement regarding presence of neonatal critical conditions between Medicaid Analytic eXtract claims data and Birth Certificate (BC) records. METHODS: Claims data files of neonates born between 1999-2010 and their mothers were linked to birth certificates in the states of Texas and Florida. In claims data, neonatal critical conditions were identified using medical encounter claims records within the first 30 days postpartum, while in birth certificates, the conditions were identified based on predetermined variables. We calculated the prevalence of cases within each data source that were identified by its comparator, in addition to calculating overall agreement and kappa statistics. RESULTS: The sample included 558,224 and 981,120 neonates in Florida and Texas, respectively. Kappa values show poor agreement (< 20%) for all critical conditions except neonatal intensive care unit (NICU) admission, which showed moderate (> 50%) and substantial (> 60%) agreement in Florida and Texas, respectively. claims data resulted in higher prevalences and capture of a larger proportion of cases than the BC, except for assisted ventilation. CONCLUSIONS: Claims data and BC showed low agreement on neonatal critical conditions except for NICU admission. Each data source identified cases most of which the comparator failed to capture, with higher prevalences estimated within claims data except for assisted ventilation.