Preconception health indicators among adult US men: Race/ethnicity variations and temporal trends.

BACKGROUND: Preconception health is important for men as it is for women. However, optimizing preconception health is understudied among men. OBJECTIVES: To examine the time trends and temporal shifts in preconception health risk indicators among 20-44-year-old adult US men in need of preconception care and their racial/ethnic variations. MATERIALS AND METHODS: Data from the 2011-2019 National Survey of Family Growth male file was used to estimate the prevalence of nine preconception health indicators among men (20-44 years) intending to have a future pregnancy (n = 6813), stratifying by race/ethnicity, and assessing temporal changes across the study period. Binary logit and linear regression models estimated temporal trends from 2011-2013 to 2017-2019. Absolute and relative changes were estimated to detect temporal shifts in men's preconception health comparing 2011-2013 to 2017-2019. RESULTS: Men in all groups exhibited substantial preconception health needs, with unique trends across race/ethnicity groups. Between 2011 and 2019, the prevalence of marijuana use (28.6%-39.4%, p = 0.001), overweight/obese status (60.7%-65.1%, p ≤ 0.001), and the mean number of preconception health indicators (M = 2.69-2.84, p = 0.018) increased. Among non-Hispanic White men, the prevalence of marijuana use (30.1%-41.4%, p = 0.028), overweight/obese status (60.6%-63.7%, p = 0.002), and mean number of preconception health risk indicators (M = 2.74-2.90, p = 0.033) increased. Among Hispanic men, the prevalence of inconsistent/no condom use (68.9%-81.4%, p = 0.022), marijuana use (18.9%-40.4%, p = 0.001), and the mean number preconception health risk indicators (M = 2.50-2.96, p = 0.014) increased. Among non-Hispanic Black men, sexually transmitted infections declined (5.4%-3.6%, p = 0.002). Significant temporal shifts, which varied by race/ethnicity, were also observed. DISCUSSION AND CONCLUSION: Our study, which provides initial insight into men's preconception health development in the last decade, highlights a tremendous need for preconception health care among men. Their increasing preconception health needs, and their racial/ethnic variations, suggest additional contributors to racial/ethnic differences in men's reproductive outcomes and their long-term health.

Expectant fathers' health behaviors, infant care intentions, and social-emotional wellbeing in the perinatal period: A latent class analysis and comparison to mothers.

While parental behaviors during the 'first thousand days' are critical for child health, little is known about fathers during this time. We examined prenatal patterns of health behaviors, social-emotional wellbeing, and infant care intentions among expectant fathers, both overall and compared to expectant mothers. Among 227 mother-father dyads enrolling in a randomized controlled trial of a perinatal obesity prevention program in Boston, Massachusetts (July 2020-July 2022), participants independently completed baseline surveys addressing (1) health behaviors, (2) social emotional wellbeing, and (3) infant care intentions. We compared paternal and maternal responses to survey items within each of these domains. Further, we conducted a latent class analysis of paternal responses and examined their associations with sociodemographic characteristics. Compared to expectant mothers, fathers were more likely to report increased body mass index, less fruit intake, decreased sleep, increased physical activity, and no recent primary care visit. Latent class analysis revealed four distinct groups of paternal health behaviors and infant care intentions: (1) more health behaviors with less infant care; (2) less health behaviors with less infant care; (3) less health behaviors with more infant care; and (4) more health behaviors with more infant care. Fathers with increased health behaviors were more likely to have higher education and income. Fathers with decreased health behaviors were more likely to endorse food insecurity, housing insecurity, and social isolation. Our findings identify potential areas for targeting expectant fathers in health promotion initiatives and suggest that social needs may impact the capacity to adopt healthy lifestyle behaviors.

Activating Life Course Theory through a Whole System Prevention Framework to Address the Wicked Problem of Maternal and Infant Morbidity and Mortality.

BACKGROUND: Racial/ethnic disparities in maternal and infant morbidity and mortality (MIM&M) is a wicked problem that is reinforced and perpetuated by our system[s] of care. Life Course Theory (LCT) helps to explain drivers of health disparities, but its application is challenged. An upstream approach that promotes systemic change requires the implementation of an expanded prevention framework that includes primordial and quaternary prevention. RESEARCH DESIGN: We developed an innovative expanded Whole System Prevention Framework (WSPF) that incorporates LCT, prevention (including primordial and quaternary prevention) and systems thinking. STUDY SAMPLE: We implemented this new conceptual Framework with two Healthy Start community partnerships through training, service mapping, and strategic planning to address upstream drivers of MIM&M. DATA COLLECTION AND ANALYSIS: Service mapping revealed few Healthy Start upstream activities/services with the predominance being delivered downstream at the program (microsystem) level. RESULTS: Service mapping provided a snapshot of the current service distribution of services across the systems. The preponderance were primary, secondary and tertiary prevention activities (75.5% and 65.6%) delivered at the program level (58.2% and 68%), revealing opportunities for upstream strategies to promote equity. The implementation process provided a new way to frame strategic planning and develop upstream strategies to promote health equity and reduce MIM&M. CONCLUSION: The Whole System Prevention Framework and its implementation methodology could be applied to address other wicked problems.

Household food insecurity is associated with obesogenic health behaviours among a low-income cohort of pregnant women in Boston, MA.

OBJECTIVE: To examine associations of household food insecurity with health and obesogenic behaviours among pregnant women enrolled in an obesity prevention programme in the greater Boston area. DESIGN: Cross-sectional evaluation. Data were collected from structured questionnaires that included a validated two-item screener to assess household food insecurity. We used separate multivariable linear and logistic regression models to quantify the association between household food insecurity and maternal health behaviours (daily consumption of fruits and vegetables, sugar-sweetened beverages and fast food, physical activity, screen time, and sleep), mental health outcomes (depression and stress), hyperglycaemia status and gestational weight gain. SETTING: Three community health centres that primarily serve low-income and racial/ethnic minority patients in Revere, Chelsea and Dorchester, Massachusetts. PARTICIPANTS: Totally, 858 pregnant women participating in the First 1,000 Days program, a quasi-experimental trial. RESULTS: Approximately 21 % of women reported household food insecurity. In adjusted analysis, household food insecurity was associated with low fruit and vegetable intake (ß = -0·31 daily servings; 95 % CI -0·52, -0·10), more screen time (ß = 0·32 daily hours; 95 % CI 0·04, 0·61), less sleep (ß = -0·32 daily hours; 95 % CI -0·63, -0·01), and greater odds of current (adjusted odds ratio (AOR) 4·42; 95 % CI 2·33, 8·35) or past depression (AOR 3·01; 95 % CI 2·08, 4·35), and high stress (AOR 2·91; 95 % CI 1·98, 4·28). CONCLUSIONS: In our sample of mostly low-income, racial/ethnic minority pregnant women, household food insecurity was associated with mental health and behaviours known to increase the likelihood of obesity.

Expectant Fathers' Social Determinants of Health in Early Pregnancy.

This cross-sectional, descriptive study examined unmet social and economic needs and health information requests of low-income, expecting fathers who participated in the First 1000 Days program. The First 1000 Days is a systems-level intervention aiming to prevent obesity among low-income mothers and infants across 3 community health centers in Greater Boston, MA, USA. Fathers who attended their partner's first prenatal care visit were invited to complete a program survey during early pregnancy. Among 131 fathers surveyed, 45% were white, 21% were Hispanic/Latino, 55% were foreign-born, and 69% reported an annual income under $50 000. Fathers reported elevated levels of food insecurity (18%) and 33% were unaware of someone that could provide a $50 loan; however, over 85% of fathers knew someone that could provide non-financial social support. Fathers requested information about pregnancy, birth preparation, and fatherhood. Findings support addressing fathers' unmet needs during pregnancy and providing father-specific perinatal information.

Regional variation in Black infant mortality: The contribution of contextual factors.

BACKGROUND: Compared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement. METHODS AND FINDINGS: Black infant mortality data are from the Linked Birth/Infant Death files for 2009-2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70-0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92-0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81-0.90). Modeled variables accounted for 35% of the regional variation in Black IMR. CONCLUSIONS: These findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional variation, further research is needed to more fully understand regional variation in Black IMR disparities.

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies.

OBJECTIVE: Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days. METHODS: The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement. RESULTS: Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics. CONCLUSIONS: Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.

Strengthening integration of clinical and public health systems to prevent maternal-child obesity in the First 1,000Days: A Collective Impact approach.

INTRODUCTION: Obesity interventions may be most effective if they begin in the earliest stages of life, support changes across family, clinical, and public health systems, and address socio-contextual factors. METHODS: The First 1000Days is a systematic program starting in early pregnancy lasting through the first 24months of infancy to prevent obesity among low-income mother-infant pairs in three community health centers in Massachusetts. The program uses a Collective Impact approach to create the infrastructure for sustained, system-wide changes for obesity prevention across early life clinical and public health services, including Obstetrics, Pediatrics, Adult Medicine, Behavioral Health, Nutrition, Community Health, the Women, Infants and Children (WIC) program, and the Maternal, Infant and Childhood Home Visiting program. Program components include 1) staff and provider training; 2) enhanced gestational weight gain and infant overweight tracking; 3) universal screening of adverse health behaviors and socio-contextual factors; 4) universal patient navigation to support individual behavior change and social needs, while strengthening integration of clinical and public health services; 5) individualized health coaching for mother-infant pairs at high risk of obesity; and 6) educational materials to support behavior change. RESULTS: A quasi-experimental evaluation design will examine changes, between 2015 and 2019, in gestational weight gain and prevalence of infant overweight from 0 to 24months of age. CONCLUSIONS: The First 1000Days program will examine the effectiveness of an early life obesity prevention program for mother-infant pairs. If successful, the program could provide a model for chronic disease prevention and health promotion among vulnerable families starting in early life.

Father's Role in Preconception Health.

As part of the federal multi-agency conference on Paternal Involvement in Pregnancy Outcomes, the existing Fatherhood paradigm was expanded to include a new focus on Men's Preconception Health. This concept grew out of the women's preconception health movement and the maternal and child health (MCH) life course perspective, as well as pioneering research from the child development, public health data and family planning fields. It encourages a new examination of how men's preconception health impacts both reproductive outcomes and men's own subsequent health and development. This essay introduces the concept of men's preconception health and health care; examines its historical development; notes the challenges of its inclusion into fatherhood and reproductive health programs; and situates it within a longer men's reproductive health life course. We then briefly explore six ways men's preconception health and health care can have positive direct and indirect impacts-planned and wanted pregnancies (family planning); enhanced paternal biologic and genetic contributions; improved reproductive health biology for women; improved reproductive health practices and outcomes for women; improved capacity for parenthood and fatherhood (psychological development); and enhanced male health through access to primary health care. Research on men's preconception health and health care is very limited and siloed. We propose a research agenda to advance this topic in three broad domains: increasing the basic epidemiology and risk factor knowledge base; implementing and evaluating men's preconception health/fatherhood interventions (addressing clinical health care, psychological resiliency/maturation, and social determinants of health); and fostering more fatherhood health policy and advocacy research.

Women's Use of Health Care in the First 2 Years Postpartum: Occurrence and Correlates.

Objectives We sought to determine rates and correlates of accessing health care in the 2 years following delivery among women at an urban academic medical center. Methods We used electronic medical records, discharge, and billing data to determine the occurrence of primary care, other non-primary outpatient care, emergency department visits, and inpatient admissions among women delivering at a single medical center who had a known primary care affiliation to that medical center over a 5 year period. We explored sociodemographic, clinical, and health care-related factors as correlates of care, using bivariate and multivariable modeling. Results Of 6216 women studied, most (91 %) had had at least one health care visit in the window between 2 months and 2 years postpartum (the "late postpartum period"). The majority (81 %) had had a primary care visit. Factors associated with use of health care in this period included a chronic medical condition diagnosed prior to pregnancy (adjusted odds ratio (AOR) 1.42, 95 % CI [1.19, 1.71]), prenatal care received in an urban community health center (AOR 1.35 [1.06, 1.73]), having received obstetric (AOR 1.90 [1.51, 2.37]), primary (AOR 2.30 [1.68, 3.23]), or other non-primary outpatient care (AOR 2.35 [1.72, 3.39]) in the first 2 months postpartum, and living closer to the hospital [AOR for residence >17.8 miles from the medical center (AOR 0.74 [0.61, 0.90])]. Having had an obstetrical complication did not increase the likelihood of receipt of care during this window. Conclusions for Practice Among women already enrolled in a primary care practice at our medical center, health care utilization in the late postpartum period is high, but not universal. Understanding the characteristics of women who return for health care during this window, and where they are seen, can improve transitions of care across the life course and can provide opportunities for important and consistent interconception and well-woman messaging.

Growing a Best Babies Zone: Lessons Learned from the Pilot Phase of a Multi-Sector, Place-Based Initiative to Reduce Infant Mortality.

PURPOSE: Infant mortality reduction in the U.S. has been addressed predominantly through clinical approaches. While these efforts have reduced the infant mortality rate overall, they have not reduced disparities between different racial/socioeconomic groups. To address the interrelated social, economic and environmental factors contributing to infant mortality, a place-based approach is needed to complement existing initiatives and clinical practices. DESCRIPTION: Best Babies Zone (BBZ) is an early attempt to put life course theory into practice, taking a place-based approach to reducing infant mortality by aligning resources, building community leadership, and transforming educational opportunities, economic development, and community systems in concentrated neighborhoods. BBZ is currently in three neighborhoods: Price Hill (Cincinnati, OH), Hollygrove (New Orleans, LA), and Castlemont (Oakland, CA). Assessment In its first 4 years, each BBZ crafted resident-driven strategies for decreasing the root causes of toxic stress and poor birth outcomes. To address resident priorities, BBZ sites experimented with tools from other fields (like design thinking and health impact assessment), and emphasized existing MCH strategies like leadership development. Early challenges, including shifting from traditional MCH interventions and addressing health equity, point to areas of growth in implementing this approach in the maternal and child health field. CONCLUSION: BBZ aims to elevate local voice and mobilize multiple sectors in order to address the social determinants of infant mortality, and other initiatives working to improve MCH outcomes can learn from the successes and challenges of the first 4 years of BBZ in order to bring life course theory into practice.

Catalyzing a Reproductive Health and Social Justice Movement.

OBJECTIVES: The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women's reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. METHODS: This paper synthesizes three current, interrelated approaches to addressing MCH challenges-life course theory, preconception health, and social justice/reproductive equity. CONCLUSION: Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.

The impact of the State Children's Health Insurance Program's unborn child ruling expansions on foreign-born Latina prenatal care and birth outcomes, 2000-2007.

The 2002 "unborn child ruling" resulted in State Children's Health Insurance Program (SCHIP) expansion for states to cover prenatal care for low-income women without health insurance. Foreign-born Latinas who do not qualify for Medicaid coverage theoretically should have benefited most from the policy ruling given their documented low rates of prenatal care utilization. This study compares prenatal care utilization and subsequent birth outcomes among foreign-born Latinas in six states that used the unborn child ruling to expand coverage to those in ten states that did not implement the expansion. This policy analysis examines cross-sectional pooled US natality data from the pre-enactment years (2000-2003) versus post-enactment years (2004-2007) to estimate the effect of the UCR on prenatal care utilization and birth outcome measures for foreign-born Latinas. Then using a difference-in-difference estimator, we assessed these differences across time for states that did or did not enact the unborn child ruling. Analyses were then replicated on a high-risk subset of the population (single foreign-born Latinas with lower levels of education). The SCHIP unborn child ruling policy expansion increased PNCU over time in the six enacting states. Foreign-born Latinas in expansion enacting states experienced increases in prenatal care utilization though only the high-risk subset were statistically significant. Birth outcomes did not change. The SCHIP unborn child ruling policy was associated with enhanced PNC for a subset of high-risk foreign-born Latinas.

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: a population-based approach.

INTRODUCTION: Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, 'acute only' (detoxification/stabilization), or 'ongoing' services. METHODS: We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002-2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. RESULTS: Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15-49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained 'ongoing' treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive 'ongoing' treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received 'acute only' services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving 'ongoing' treatment. CONCLUSIONS: Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. 'Ongoing' services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.

Racial/ethnic differences in hospital use and cost among a statewide population of children with Down syndrome.

Children with Down syndrome (DS) use hospital services more often than children without DS, but data on racial/ethnic variations are limited. This study generated population-based estimates of hospital use and cost to 3 years of age by race/ethnicity among children with DS in Massachusetts using birth certificates linked to birth defects registry and hospital discharge data from 1999 to 2004. Hospital use (≥ 1 post-birth hospitalization and median days hospitalized birth and post-birth) and reasons for hospitalization were compared across maternal race/ethnicity using relative risk (RR) and Wilcoxon rank sums tests, as appropriate. Costs were calculated in 2011 United States dollars. Greater hospital use was observed among children with DS with Hispanic vs. Non-Hispanic White (NHW) mothers (post-birth hospitalization: RR 1.4; median days hospitalized: 20.0 vs. 11.0, respectively). Children with DS and congenital heart defects of Non-Hispanic Black (NHB) mothers had significantly greater median days hospitalized than their NHW counterparts (24.0 vs. 16.0, respectively). Respiratory diagnoses were listed more often among children with Hispanic vs. NHW mothers (50.0% vs. 29.1%, respectively), and NHBs had more cardiac diagnoses (34.1% vs. 21.5%, respectively). The mean total hospital cost was nine times higher among children with DS ($40,075) than among children without DS ($4053), and total costs attributable to DS were almost $18 million. Median costs were $22,781 for Hispanics, $18,495 for NHBs, and $13,947 for NHWs. Public health interventions should address the higher rates of hospital use and hospitalizations for respiratory and cardiac diseases among racial/ethnic minority children with DS in Massachusetts.

Potential savings from redetermining disability among children receiving supplemental security income benefits.

OBJECTIVE: To compare the costs of redetermining disability to potential savings in Supplemental Security Income payments associated with different strategies for implementing Continuing Disability Reviews (CDRs) among children potentially enrolled in SSI from 2012 to 2021. METHODS: We reviewed publicly available reports from the Social Security Administration and Government Accountability Office to estimate costs and savings. We considered CDRs for children ages 1-17 years, excluding mandated low-birth weight and age 18 redeterminations that SSA routinely has performed. RESULTS: If in 2012 the Social Security Administration performs the same number of CDRs for children as in 2010 (16,677, 1% of eligibles) at a cessation rate of 15%, the agency would experience net savings of approximately $145 million in benefit payments. If CDR numbers increased to the greatest level ever (183,211, 22% of eligibles, in 1999) at the same cessation rate, the agency would save approximately $1.6 billion in benefit payments. DISCUSSION: Increasing the numbers of CDRs for children represents a considerable opportunity for savings. Recognizing the dynamic nature of disability, the agency could reassess the persistence of disability systematically; doing so could free up resources from children who are no longer eligible and help the agency better direct its benefits to recipients with ongoing disability and whose families need support to meet the extra costs associated with raising a child with a major disability.

Innovative strategies to reduce disparities in the quality of prenatal care in underresourced settings.

This study examined what innovative strategies, including the use of health information technology (health IT), have been or can be used to reduce disparities in prenatal care quality in underresourced settings. Based on literature review and key informant interviews, the authors identified 17 strategies that have been or can be used to (a) increase access to timely prenatal care, (b) improve the content of prenatal care, and (c) enhance the organization and delivery of prenatal care. Health IT can be used to (a) increase consumer awareness about the importance of preconception and early prenatal care, facilitate spatial mapping of access gaps, and improve continuity of patient records; (b) support collaborative quality improvement, facilitate performance measurement, enhance health promotion, assist with care coordination, reduce clinical errors, improve delivery of preventive health services, provide decision support, and encourage completeness of documentation; and (c) support data integration and engineer collaborative innovation.

Hospital use and associated costs of children aged zero-to-two years with craniofacial malformations in Massachusetts.

BACKGROUND: Craniofacial malformations (CFMs) are among the most common and correctable birth defects in the United States, often requiring multiple medical and surgical treatments. However, population-based data on hospital utilization and costs are sparse. METHODS: This retrospective cohort study used linked data from the Massachusetts Pregnancy to Early Life Longitudinal Data System. Cases were children born during 1998-2002 in Massachusetts hospitals to Massachusetts residents, alive at age two years, and ascertained by the Massachusetts Birth Defects Monitoring Program as having a CFM (orofacial cleft, craniosynostosis, microtia/anotia). Mean and median number of inpatient days and hospital facility costs (excluding professional fees) during birth and postbirth hospitalizations to age two years are presented by defect type and pattern for cases and compared to Massachusetts children without CFMs. RESULTS: Children with CFMs (N = 649) mostly had orofacial clefts (73%), and 73% had no other major birth defect. Both mean (12.0) and median (6) number of inpatient days from birth to age two years among children with CFMs were three times higher than among all other children. Mean incremental hospital cost of children who survived to age two years with CFMs compared to those with no CFM was $4,901 more during the birth hospitalization and $12,858 more for postbirth hospitalizations, or $17,760 overall. CONCLUSION: In the first two years of life, children with CFMs incur increased hospital costs compared to other children without such conditions, with substantial heterogeneity by defect and pattern type.