Cigarette Smoking During Pregnancy: United States, 2016.

Maternal tobacco use during pregnancy has been linked to a host of negative infant and child outcomes, including low birthweight, preterm birth, and various birth defects (1-5). The 2003 revision of the U.S. Standard Certificate of Live Birth included new and modified items on maternal cigarette smoking before and during pregnancy. The 2016 natality data file is the first for which this information is available for all states and the District of Columbia (D.C.). This report presents the prevalence of cigarette smoking at any time during pregnancy among women who gave birth in 2016 in the United States by state of residence as well as maternal race and Hispanic origin, age, and educational attainment.

Annual Summary of Vital Statistics: 2013-2014.

The number of births in the United States increased by 1% between 2013 and 2014, to a total of 3 988 076. The general fertility rate rose 1% to 62.9 births per 1000 women. The total fertility rate also rose 0.3% in 2014, to 1862.5 births per 1000 women. The teenage birth rate fell to another historic low in 2014, 24.2 births per 1000 women. The percentage of all births to unmarried women declined to 40.2% in 2014, from 40.6% in 2013. In 2014, the cesarean delivery rate declined to 32.2% from 32.7% in 2013. The preterm birth rate declined for the seventh straight year in 2014 to 9.57%; the low birth weight rate was unchanged at 8.00%. The infant mortality rate decreased to a historic low of 5.82 infant deaths per 1000 live births in 2014. The age-adjusted death rate for 2014 was 7.2 deaths per 1000 population, down 1% from 2013. Crude death rates for children aged 1 to 19 years did not change significantly between 2013 and 2014. Unintentional injuries and suicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 46.5% of all deaths to children and adolescents in 2014.

Trends in Infant Mortality in the United States, 2005-2014.

KEY FINDINGS: Infant mortality is considered a basic measure of public health for countries around the world (1-3). Over the past decade, the overall infant mortality rate in the United States has improved, declining 15% from 6.86 infant deaths per 1,000 live births in 2005-a recent high-to 5.82 in 2014 (4). Over the years, many efforts have been made to understand and lower infant mortality (4,5). This report examines the 2014 linked birth/infant death data from the National Vital Statistics System (NVSS) to describe trends in infant mortality in the United States by race and Hispanic origin, state, and leading causes of infant deaths from 2005 through 2014.

Births: Final Data for 2015.

Objectives-This report presents 2015 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age and race of father also are shown. 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 3.98 million births that occurred in 2015 are presented. Results-In 2015, 3,978,497 births were registered in the United States, down less than 1% from 2014. The general fertility rate was 62.5 per 1,000 women aged 15-44, a decline of 1% from 2014. The birth rate for teenagers aged 15-19 fell 8% in 2015, to 22.3 per 1,000 females. Birth rates declined for women in their 20s but increased for women in their 30s and early 40s. The total fertility rate (estimated number of births over a woman's lifetime) declined to 1,843.5 births per 1,000 women in 2015. The birth rate for unmarried women declined for the seventh straight year to 43.5 per 1,000. The cesarean delivery rate declined for the third year in a row to 32.0%. The preterm birth rate increased slightly from 2014, to 9.63% in 2015, as did the rate of low birthweight (8.07% in 2015). The twin birth rate declined to 33.5 per 1,000; the triplet and higher-order multiple birth rate was down 9% to 103.6 per 100,000.

Continued Declines in Teen Births in the United States, 2015.

KEY FINDINGS: •The teen birth rate declined to another historic low for the United States in 2015, down 8% from 2014 to 22.3 births per 1,000 females aged 15-19. •The birth rates for teenagers aged 15-17 and 18-19 declined in 2015 to 9.9 and 40.7, respectively, which are record lows for both groups. •In 2015, birth rates declined to 6.9 for Asian or Pacific Islander, 16.0 for non-Hispanic white, 25.7 for American Indian or Alaska Native, 31.8 for non-Hispanic black, and 34.9 for Hispanic female teenagers aged 15-19. •Birth rates fell to record lows for nearly all race and Hispanic-origin groups of females aged 15-19, 15-17, and 18-19 in 2015. The birth rate for teenagers aged 15-19 has fallen almost continuously since 1991, reaching historic lows for the nation every year since 2009 (1-4). Despite declines in all racial and ethnic groups, teen birth rates continue to vary considerably by race and ethnicity. Moreover, the U.S. teen birth rate remains higher than in other industrialized countries (5). Childbearing by teenagers continues to be a matter of public concern. This report presents the recent and long-term trends and disparity in teen childbearing by race and Hispanic origin.

Mean Age of Mothers is on the Rise: United States, 2000-2014.

KEY FINDINGS: Data from the National Vital Statistics System. The mean age of mothers has increased from 2000 to 2014 for all birth orders, with age at first birth having the largest increase, up from 24.9 years in 2000 to 26.3 years in 2014. Increases in the average age for all birth orders were most pronounced from 2009 to 2014. In 2014, Asian or Pacific Islander mothers had the oldest average age at first birth (29.5 years), while American Indian or Alaska Native mothers had the youngest (23.1 years). Mean age at first birth increased in all states and the District of Columbia (D.C.) from 2000 to 2014, but D.C. (3.4 years) and Oregon had the largest increases (2.1 years).

When are babies born: morning, noon, or night? Birth certificate data for 2013.

KEY FINDINGS: The highest percentages of births occurred during the morning and midday hours. Births on Saturday and Sunday were more likely to occur in the late evening and early morning hours than births Monday through Friday. Compared with induced vaginal deliveries and noninduced vaginal deliveries, cesarean deliveries were the least likely to occur during the evening and early morning. Noninduced vaginal births were more likely than cesarean and induced vaginal births to occur in the early morning. Cesarean deliveries with no trial of labor were much more concentrated during the day than were cesarean deliveries with a trial of labor. Births delivered in hospitals and all births show similar time-of-day patterns.

Pregnancy and childbirth among females aged 10-19 years - United States, 2007-2010.

Pregnancy and childbirth among females aged <20 years have been the subject of long-standing concern among the public, the public health community, and policy makers. Teenagers who give birth are much more likely than older women to deliver a low birthweight or preterm infant, and their babies are at higher risk for dying in infancy. The annual public costs associated with births among teenage girls are an estimated $10.9 billion. According to the 2006-2010 National Survey of Family Growth (NSFG), an estimated 77% of births to teenagers aged 15-19 years were unintended.

Infant deaths - United States, 2005-2008.

Infant mortality rates are associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices, which makes infant mortality an increasingly important public health concern. After large declines throughout the twentieth century, the U.S. infant mortality rate did not decline significantly during 2000-2005. Analysis of 2000-2004 infant mortality in the United States indicated considerable disparities by race and Hispanic origin. Race and ethnic disparities in U.S. infant mortality have been apparent since vital statistics data began to be collected more than 100 years ago. These disparities have persisted over time, and research indicates that not all groups have benefited equally from social and medical advances.

Recent declines in infant mortality in the United States, 2005-2011.

After a plateau from 2000 through 2005, the U.S. infant mortality rate declined by 12% to a rate of 6.05 in 2011. Provisional infant mortality counts for the first half of 2012 suggest a continued downward trend. Infant mortality declined from 2005 through 2011 for all major racial and ethnic groups, with the most rapid decline among non-Hispanic black women. Among leading causes of death, infant mortality declined for four of the five leading causes. Infant mortality rates declined most rapidly from 2005 through 2010 for selected Southern states; still, rates in 2010 remained higher in the South and Midwest than in other regions. In 2008, the United States ranked 27th in infant mortality rate among Organization for Economic Cooperation and Development countries, and a previous report linked the United States' relatively unfavorable infant mortality ranking to its higher percentage of preterm births. Despite the recent infant mortality decline, comparing the 2011 U.S. infant mortality rate with the 2008 international rankings would still have the United States ranked 27th.

Declines in state teen birth rates by race and Hispanic origin.

Teen birth rates fell steeply in the United States from 2007 through 2011, resuming a decline that began in 1991 but was briefly interrupted in 2006 and 2007. The overall rate declined 25% from 41.5 per 1,000 teenagers aged 15-19 in 2007 to 31.3 in 2011--a record low. The number of births to teenagers aged 15-19 also fell from 2007 to 2011, by 26% to 329,797 in 2011. Births to teenagers are at elevated risk of low birthweight, preterm birth, and of dying in infancy compared with infants born to women aged 20 and over, and they are associated with significant public costs, estimated at $10.9 billion annually. Recent trends by state and race and Hispanic origin are illustrated using the most current available data from the National Vital Statistics System.

Births: final data for 2011.

OBJECTIVES: This report presents 2011 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics, including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (e.g., period of gestation, birthweight, and plurality). Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. 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 3.95 million births that occurred in 2011 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2010 census. Birth and fertility rates for 2001-2009 are based on revised intercensal population estimates. Denominators for 2011 and 2010 rates for the specific Hispanic groups are derived from the American Community Survey; denominators for earlier years are derived from the Current Population Survey. RESULTS: The number of births declined 1% in 2011 to 3,953,590. The general fertility rate also declined 1%, to 63.2 per 1,000 women aged 15-44. The teen birth rate fell 8%, to 31.3 per 1,000 women. Birth rates declined for women in their 20s, were unchanged for women aged 30-34, and rose for women aged 35-44. The total fertility rate (estimated number of births over a woman's lifetime) declined 2% to 1,894 per 1,000 women. The number and rate of births to unmarried women declined; the percentage of births to unmarried women was essentially stable at 40.7%. The cesarean delivery rate was unchanged from 2010 at 32.8%. The preterm birth rate declined for the fifth straight year to 11.73%; the low birthweight rate declined slightly to 8.10%. The twin birth rate was not significantly changed at 33.2 per 1,000 births; the rate of triplet and higher-order multiple births also was essentially stable at 137.0 per 100,000.

Infant mortality statistics from the 2009 period linked birth/infant death data set.

OBJECTIVES: This report presents 2009 period infant mortality statistics from the linked birth/infant death data set (linked file) by maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. METHODS: Descriptive tabulations of data are presented and interpreted. RESULTS: The infant mortality rate in the United States in 2009 was 6.39 infant deaths per 1,000 live births, 3% lower than the rate of 6.61 in 2008. The number of infant deaths was 28,075 in 2008 and 26,408 in 2009, a decline of 1,667 infant deaths. Infant mortality rates ranged from 4.40 per 1,000 live births for Asian or Pacific Islander mothers to 12.40 for non-Hispanic black mothers. Infant mortality was higher for male infants and infants born preterm or at low birthweight. Infant mortality rates were also higher for those infants who were born in multiple deliveries, to mothers who were unmarried, and for those whose mothers were born in the 50 states or the District of Columbia. From 2008 to 2009, the neonatal mortality rate (under age 28 days) declined 3% to 4.18 neonatal deaths per 1,000 live births, while the postneonatal mortality rate (aged 28 days to under 1 year) declined 5% to 2.21. Preterm and low birthweight infants had the highest infant mortality rates and contributed greatly to overall U.S. infant mortality. The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--accounted for 46% of all infant deaths. In 2009, 35.4% of infant deaths were "preterm-related."

Recent Trends in Out-of-Hospital Births in the United States.

INTRODUCTION: Although out-of-hospital births are still relatively rare in the United States, it is important to monitor trends in these births, as they can affect patterns of facility usage, clinician training, and resource allocation, as well as health care costs. Trends and characteristics of home and birth center births are analyzed to more completely profile contemporary out-of-hospital births in the United States. METHODS: National birth certificate data were used to examine a recent increase in out-of-hospital births. RESULTS: After a gradual decline from 1990 to 2004, the number of out-of-hospital births increased from 35,578 in 2004 to 47,028 in 2010. In 2010, 1 in 85 US infants (1.18%) was born outside a hospital; about two-thirds of these were born at home, and most of the rest were born in birth centers. The proportion of home births increased by 41%, from 0.56% in 2004 to 0.79% in 2010, with 10% of that increase occurring in the last year. The proportion of birth center births increased by 43%, from 0.23% in 2004 to 0.33% in 2010, with 14% of the increase in the last year. About 90% of the total increase in out-of hospital births from 2004 to 2010 was a result of increases among non-Hispanic white women, and 1 in 57 births to non-Hispanic white women (1.75%) in 2010 was an out-of-hospital birth. Most home and birth center births were attended by midwives. DISCUSSION: Home and birth center births in the United States are increasing, and the rate of out-of-hospital births is now at the highest level since 1978. There has been a decline in the risk profile of out-of-hospital births, with a smaller proportion of out-of-hospital births in 2010 than in 2004 occurring to adolescents and unmarried women and fewer preterm, low-birth-weight, and multiple births.

Home births in the United States, 1990-2009.

After 14 years of decline, the percentage of home births rose by 29% from 2004 to 2009, to the point where it is at the highest level since data on this item began to be collected in 1989. The overall increase in home births was driven mostly by a 36% increase for non-Hispanic white women. About 1 out of every 90 births to non-Hispanic white women are now home births. The percentage of home births for non-Hispanic white women was three to five times higher than for any other racial or ethnic group. Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk profile of home compared with hospital births suggests that home birth attendants are selecting low-risk women as candidates for home birth. The increase in the percentage of home births from 2004 to 2009 was widespread and involved selected states from every region of the country. The large variations in the percentage of home births by state may be influenced by differences among states in laws pertaining to births are more prevalent among non-Hispanic white women (7). midwifery practice or out-of-hospital birth (8,9), as well as by differences in the racial and ethnic composition of state populations, as home Studies have suggested that most home births are intentional or planned home births, whereas others are unintentional or unplanned, because of an emergency situation (i.e., precipitous labor, labor complications, or unable to get to the hospital in time) (3,6). Although not representative of all U.S. births (see "Data source and methods"), 87% of home births in a 26-state reporting area (comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of home births were planned (10). Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends, and cultural or religious concerns (9,11). Lack of transportation in rural areas and cost factors may also play a role, as home births cost about one-third as much as hospital births (9,11,12).

Trends and characteristics of home vaginal birth after cesarean delivery in the United States and selected States.

OBJECTIVE: To examine trends and characteristics of home vaginal birth after cesarean delivery (VBAC) in the United States and selected states from 1990-2008. METHODS: Birth certificate data were used to track trends in home and hospital VBACs from 1990-2008. Data on planned home VBAC were analyzed by sociodemographic and medical characteristics for the 25 states reporting this information in 2008 and compared with hospital VBAC data. RESULTS: In 2008, there were approximately 42,000 hospital VBACs and approximately 1,000 home VBACs in the United States, up from 664 in 2003 and 656 in 1990. The percentage of home births that were VBACs increased from less than 1% in 1996 to 4% in 2008, whereas the percentage of hospital births that were VBACs decreased from 3% in 1996 to 1% in 2008. Planned home VBACs had a lower risk profile than hospital VBACs with fewer births to teenagers, unmarried women, or smokers; fewer preterm or low-birth-weight deliveries; and higher maternal education levels. CONCLUSION: Recent increases in the proportion of U.S. women with a prior cesarean delivery mean that an increasing number of women are faced with the choice and associated risks of either VBAC or repeat cesarean delivery. Recent restrictions in hospital VBAC availability have coincided with increases in home VBACs; however, home VBAC remains rare, with approximately 1,000 occurrences in 2008. LEVEL OF EVIDENCE: II.

Infant mortality statistics from the 2008 period linked birth/infant death data set.

OBJECTIVES: This report presents 2008 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. METHODS: Descriptive tabulations of data are presented and interpreted. RESULTS: The U.S. infant mortality rate was 6.61 infant deaths per 1,000 live births in 2008, 2 percent lower than the rate of 6.75 in 2007. Infant mortality rates ranged from 4.51 per 1,000 live births for Asian or Pacific Islander mothers to 12.67 for non-Hispanic black mothers. The rate for non-Hispanic black women declined 5 percent from 2007 to 2008. Infant mortality was higher for male infants and infants born preterm or at low birthweight. Infant mortality rates were also higher for those infants who were born in multiple deliveries, to mothers who were unmarried, and for those whose mothers were born in the 50 states or the District of Columbia. From 2007 to 2008, the neonatal mortality rate (under age 28 days) declined by 3 percent to 4.29 neonatal deaths per 1,000 live births, while the postneonatal mortality rate (aged 28 days to under 1 year) remained essentially unchanged (2.32). Preterm and low birthweight infants had the highest infant mortality rates and contributed greatly to the overall U.S. infant mortality. The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--accounted for 46 percent of all infant deaths. In 2008, 35.4 percent of infant deaths were "preterm-related."

Births: final data for 2010.

OBJECTIVES: This report presents 2010 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and plurality). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as birth rates by age and race 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 4.0 million births that occurred in 2010 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2010 census. RESULTS: The number of births declined to 3,999,386 in 2010, 3 percent less than in 2009. The general fertility rate also declined 3 percent, to 64.1 per 1,000 women aged 15-44. The teen birth rate fell 10 percent to 34.2 per 1,000. Birth rates for women in each 5-year age group from 20 through 39 years declined, but the rate for women aged 40-44 continued to rise. The total fertility rate (estimated number of births over a woman's lifetime) was down 4 percent to 1,931 per 1,000 women. The number, rate, and percentage of births to unmarried women declined. The cesarean deliver rate was down for the first year since 1996 to 32.8 percent. The preterm birth rate declines for the fourth year in a row to 11.99 percent; the low birthweight rate was stable at 8.15 percent. The twin birth rate declined slightly to 33.1 per 1,000 births; the triplet and higer-order multipe birth rate dropped 10 percent to 137.6 per 100,000.

Infant mortality statistics from the 2007 period linked birth/infant death data set.

OBJECTIVES: This report presents 2007 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. METHODS: Descriptive tabulations of data are presented and interpreted. RESULTS: The U.S. infant mortality rate was 6.75 infant deaths per 1,000 live births in 2007, not significantly different than the rate of 6.68 in 2006. Infant mortality rates ranged from 4.57 per 1,000 live births for mothers of Central and South American origin to 13.31 for non-Hispanic black mothers. Infant mortality rates were higher for those infants who were born in multiple deliveries; for those whose mothers were born in the 50 states or the District of Columbia; and for mothers who were unmarried. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate was essentially unchanged from 2006 (4.46) to 2007 (4.42). The postneonatal mortality rate increased 5 percent from 2.22 in 2006 to 2.33 in 2007, similar to the rate in 2005 (2.32). Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. For example, more than one-half of all infant deaths in the United States in 2007 (54 percent) occurred to the 2 percent of infants born very preterm (less than 32 weeks of gestation). Still, infant mortality rates for late preterm infants (34-36 weeks of gestation) were 3.6 times, and those for early term (37-38 weeks) infants were 1.5 times, those for infants born at 39-41 weeks of gestation, the gestational age with the lowest infant mortality rate. The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--accounted for 45 percent of all infant deaths. The percentage of infant deaths that were "preterm-related" was 36.0 percent in 2007. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.4 times higher, and the rate for Puerto Rican mothers was 71 percent higher than for non-Hispanic white mothers.

United States home births increase 20 percent from 2004 to 2008.

BACKGROUND: After a gradual decline from 1990 to 2004, the percentage of births occurring at home increased from 2004 to 2008 in the United States. The objective of this report was to examine the recent increase in home births and the factors associated with this increase from 2004 to 2008. METHODS: United States birth certificate data on home births were analyzed by maternal demographic and medical characteristics. RESULTS: In 2008, there were 28,357 home births in the United States. From 2004 to 2008, the percentage of births occurring at home increased by 20 percent from 0.56 percent to 0.67 percent of United States births. This rise was largely driven by a 28 percent increase in the percentage of home births for non-Hispanic white women, for whom more than 1 percent of births occur at home. At the same time, the risk profile for home births has been lowered, with substantial drops in the percentage of home births of infants who are born preterm or at low birthweight, and declines in the percentage of home births that occur to teen and unmarried mothers. Twenty-seven states had statistically significant increases in the percentage of home births from 2004 to 2008; only four states had declines. CONCLUSION: The 20 percent increase in United States home births from 2004 to 2008 is a notable development that will be of interest to practitioners and policymakers. (BIRTH 38:3 September 2011).