Births: Final Data for 2022.

Objectives- This report presents 2022 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods-Descriptive tabulations based on birth certificates of the 3.67 million births registered in 2022 are shown by maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2022 are presented for selected items, and by race and Hispanic origin for 2016-2022. Results-A total of 3,667,758 births occurred in the United States in 2022, essentially unchanged from 2021. The general fertility rate declined 1% from 2021 to 56.0 births per 1,000 females ages 15-44 in 2022. The birth rate for females ages 15-19 declined 2% from 2021 to 2022; birth rates fell 7% for women ages 20-24, rose 1% to 5% for women ages 25-29 and 35-44, and rose 12% for women ages 45-49 (the first increase since 2016). The total fertility rate declined less than 1% to 1,656.5 births per 1,000 women in 2022. Birth rates declined for unmarried women but increased for married women from 2021 to 2022. Prenatal care beginning in the first trimester declined to 77.0% in 2022; the percentage of women who smoked during pregnancy declined to 3.7%. The cesarean delivery rate was unchanged in 2022 (32.1%); Medicaid was the source of payment for 41.3% of births. The preterm birth rate declined 1% to 10.38%; the low birthweight rate rose 1% to 8.60%. The twin birth rate was unchanged in 2022 (31.2 per 1,000 births); the 2% decrease in the triplet and higher-order multiple birth rate.

Shifts in the Distribution of Births by Gestational Age: United States, 2014-2022.

Objectives-This report presents changes in the distribution of singleton births by gestational age in the United States for 2014-2022, by maternal age and race and Hispanic origin. Methods-Data are based on all birth certificates for singleton births registered in the United States from 2014 to 2022. Gestational age is measured in completed weeks using the obstetric estimate and categorized as early preterm (less than 34 weeks), late preterm (34-36 weeks), total preterm (less than 37 weeks), early term (37-38 weeks), full term (39-40 weeks), and late- and post-term (41 and later weeks). Data are shown by maternal age and race and Hispanic origin. Single weeks of gestation at term (37-41 weeks) are also examined. Results-Despite some fluctuation in most gestational age categories during the pandemic years of 2020-2022, trends from 2014 to 2022 demonstrate a shift towards shorter gestational ages. Preterm and early-term birth rates rose from 2014 to 2022 (by 12% and 20%, respectively), while full-term and lateand post-term births declined (by 6% and 28%, respectively). Similar shifts for each gestational age category were seen across maternal age and race and Hispanic-origin groups. By single week of gestation at term, the largest change was for births at 37 weeks (an increase of 42%).

Trends in Cesarean Delivery in Puerto Rico, 2018-2022.

Cesarean delivery is major surgery associated with higher costs and adverse outcomes, such as surgical complications, compared with vaginal delivery (1-3). The cesarean delivery rate in Puerto Rico rose from just over 30% in the early to mid-1990s to over 40% by the early 2000s (4,5). During this time, cesarean delivery rates in Puerto Rico were 40%-70% higher than rates in the U.S. mainland and up to 78% higher than rates for Hispanic women in the U.S. mainland (4,5). This report describes trends in Puerto Rico's cesarean delivery rate from 2010 to 2022 and explores changes by maternal age, gestational age, and municipality from 2018 to 2022.

Births in the United States, 2022.

This report presents selected highlights from 2022 final birth data on key demographic, healthcare utilization, and infant health indicators. The number of births, general fertility rates (GFRs) (births per 1,000 females aged 15-44), age-specific birth rates (births per 1,000 women in specified age group), and cesarean delivery and preterm (less than 37 weeks of gestation) birth rates are presented. Results for 2020, 2021, and 2022 are shown for all births to describe changes in birth patterns during the COVID-19 pandemic years (1,2). Cesarean and preterm birth rates are shown for select race and Hispanic-origin groups.

Changes in Prenatal Care Utilization:United States, 2019-2021.

Objectives-This report describes changes in prenatal care use (utilization) in the United States before and during the COVID-19 pandemic by month of birth and the mother's race and Hispanic origin.

Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021.

Access to health care coverage during pregnancy and delivery allows women to receive the care needed to maximize the likelihood of a healthy pregnancy and baby (1). National birth certificate data on the principal source of payment for the delivery became available in 2016, when all states implemented the 2003 U.S. Standard Certificate of Live Birth. This certificate provides information on payment through private insurance; Medicaid; CHAMPUS, TRICARE, and other types of government insurance; and self-pay, which has been shown to reflect the uninsured status of the mother at the time of delivery (2). This report describes the principal source of payment for the delivery in 2021 overall and by maternal race and Hispanic origin, age, and education.

Births: Final Data for 2021.

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.

Declines in Cigarette Smoking During Pregnancy in the United States, 2016-2021.

Smoking during pregnancy is an established risk factor for adverse pregnancy outcomes and health issues for newborns later in life (1-3). National birth certificate data on cigarette smoking and the number of cigarettes smoked before and during pregnancy first became available in 2016. These data allow for the analysis of maternal cigarette use during pregnancy by numerous maternal and infant characteristics. This report describes changes in the number and percentage of mothers who smoked cigarettes at any time during pregnancy in the United States from 2016 to 2021 and changes between 2016 and 2021 in the percentage of mothers who smoked during pregnancy by maternal age, race and Hispanic origin, and state of residence.

Changes in Home Births by Race and Hispanic Origin and State of Residence of Mother: United States, 2018-2019 and 2019-2020.

Objectives-This report describes changes between 2019 and 2020 in the percentage of U.S. home births by month, race and Hispanic origin, and state of residence of the mother and makes comparisons with changes occurring between 2018 and 2019.

Births: Final Data for 2019.

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. 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 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.

Births in the United States, 2019.

This report presents selected highlights from 2019 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44), prenatal care timing (the percentage of mothers with first trimester care), source of payment for the delivery (the percentage of births covered by Medicaid), and preterm birth rates are presented. All indicators are compared between 2018 and 2019 and are presented for all births and for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic.

Recent Trends in Vaginal Birth After Cesarean Delivery: United States, 2016-2018.

For the first time since 2004 (1), national data on vaginal birth after cesarean delivery (VBAC) became available in 2016 after all reporting areas implemented the 2003 revision of the U.S. Standard Certificate of Live Birth. Women who deliver vaginally after a previous cesarean are less likely to experience birth-related morbidity such as blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the Intensive Care Unit than women who have repeat cesareans (2). This report describes recent trends in the VBAC rates by maternal age, race and Hispanic origin, mother's state of residence, and gestational age of the newborn from 2016 to 2018.

Is Twin Childbearing on the Decline? Twin Births in the United States, 2014-2018.

Following years of relative stability, twin births began to climb in the United States in the early 1980s, rising 79% from 1980 to 2014 (1,2). In 1980, one in every 53 births was a twin, compared with one in every 29 births in 2014 (1,2). The increase in twinning over the more than three decades was widespread, occurring across age and race and Hispanic-origin groups, and in all U.S. states (1,2). It is important to track twin birth rates as twins are at greater risk than singletons for poor outcomes, including preterm birth and neonatal morbidity and mortality (1,3,4). This report presents trends in twin childbearing overall for 1980-2018, and by maternal age, race and Hispanic origin, and state of residence for 2014-2018.

Births in the United States, 2018.

This report presents selected highlights from 2018 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44) and teen birth rates are presented. Also shown are the distribution of births with a previous cesarean delivery (vaginal births after previous cesarean [VBAC] and repeat cesarean delivery) and the distribution of births by gestational age. All indicators are compared between 2017 and 2018 and are presented for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic.

Assessing the Quality of Medical and Health Data From the 2003 Birth Certificate Revision: Results From New York City.

Objectives-A primary goal of the 2003 revision of the U.S. Standard Certificate of Live Birth was to improve data quality.This report evaluates the quality of selected 2003 revision-based medical and health data by comparing birth certificate data for New York City with information abstracted from hospital medical records.Methods-A random sample of records for 900 births occurring in New York City in 2013 was reviewed. Birth certificate and hospital medical records data were compared for these categories: pregnancy history, prenatal care, gestational age, birthweight, pregnancy risk factors, source of payment, characteristics of labor and delivery, fetal presentation, method of delivery, abnormal conditions of the newborn, infant living, and infant breastfed. Levels of missing data, exact agreement, kappa scores, sensitivity, and false discovery rates are presented where applicable. Results-Exact agreement or sensitivity between birth certificate and medical record data was high (90.0% or greater) for a number of items (e.g., number of previous cesarean deliveries, cephalic presentation, cesarean delivery, vaginal/spontaneous delivery, obstetric estimate of gestation [within 2 weeks], Medicaid as source of payment for the delivery, birthweight [within 500 grams]), but extremely low (less than 40.0%) for several items (e.g., gestational hypertension, previous preterm birth, augmentation of labor, assisted ventilation, maternal transfusion). Levels of agreement or sensitivity for several items (e.g., obstetric estimate of gestation at delivery [exact number of weeks], previous cesarean delivery, private insurance as the source of payment for delivery, and total number of prenatal care visits [within two visits]), were substantial (between 75.0% and 89.9%) or moderate (between 60.0% and 74.9%). Data quality often varied by hospital.

Births: Final Data for 2018.

Objectives-This report presents 2018 data on U.S. births according to a wide variety of characteristics. 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 3.79 million births that occurred in 2018 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 through 2018 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2018. Results-3,791,712 births were registered in the United States in 2018, down 2% from 2017. Compared with rates in 2017, the general fertility rate declined to 59.1 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2018. Birth rates declined for women aged 20-34 and increased for women aged 35-44. The total fertility rate declined to 1,729.5 births per 1,000 women in 2018. Birth rates for both married and unmarried women declined from 2017 to 2018. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.5% in 2018; the percentage of all women who smoked during pregnancy declined to 6.5%. The cesarean delivery rate decreased to 31.9% in 2018 following an increase in 2017. Medicaid was the source of payment for 42.3% of all 2018 births, down 2% from 2017. The preterm birth rate rose for the fourth straight year to 10.02% in 2018; the rate of low birthweight was unchanged at 8.28%. Twin and triplet and higher-order multiple birth rates declined in 2018 (Figure 1).

Births in the United States, 2017.

This report presents selected highlights from 2017 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 females aged 15-44 years) and teen birth rates are presented by race and Hispanic origin. The use of Medicaid as the source of payment for the delivery and preterm birth rates are presented by the age of the mother. Data for 2017 are compared with 2016 for each indicator.

Describing the Increase in Preterm Births in the United States, 2014-2016.

Infants born before 37 weeks of gestation, commonly referred to as preterm, are at greater risk of early death than those born later in pregnancy and can suffer numerous health and developmental problems, especially at earlier gestational ages (1-3). The incidence of preterm birth in the United States rose from the early 1980s through 2006 but declined from 2007 through 2014 (4-6). Recent data for 2014-2016, however, indicate that the preterm rate is on the rise again (6). This report describes trends in total, early (less than 34 weeks), and late (34-36 weeks) preterm births by plurality, race and Hispanic origin of the mother, and state of residence during 2014-2016.

Timing and Adequacy of Prenatal Care in the United States, 2016.

This report describes prenatal care utilization in the United States for 2016, based on the trimester of pregnancy in which prenatal care began and the Adequacy of Prenatal Care Utilization (APNCU) Index, by selected maternal characteristics. Data are from the 2016 national birth file and are based on 100% of births registered to residents of the 50 states and the District of Columbia. All data are based on the 2003 revision of the U.S. Standard Certificate of Live Birth. The APNCU is based on the month prenatal care began and the number of visits adjusted for gestational age; categories are inadequate, intermediate, adequate, and adequate plus. Overall, 77.1% of women who gave birth in 2016 initiated prenatal care in the first trimester of pregnancy; 4.6% began prenatal care in the third trimester, and 1.6% of women received no care at all. According to the APNCU, more than 75% of women received at least adequate prenatal care, and 15.0% of women received inadequate prenatal care. Younger women, women with less education, women having a fourth or higher-order birth, and non-Hispanic Native Hawaiian or Other Pacific Islander women were the least likely to begin care in the first trimester of pregnancy and to have at least adequate prenatal care. The percentages of prenatal care beginning in the first trimester and adequate prenatal care varied by state.

Births: Final Data for 2016.

This report presents 2016 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2016 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010-2016 are presented for selected items. A total of 3,945,875 births were registered in the United States in 2016, down 1% from 2015. Compared with rates in 2015, the general fertility rate declined to 62.0 per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 9% in 2016. Birth rates declined for women in their 20s but increased for women intheir 30s and early 40s. The total fertility rate declined to 1,820.5 births per 1,000 women in 2016. The birth rate for unmarried women declined, while the rate for married women increased. More than three-quarters of women began prenatal care in the firsttrimester of pregnancy (77.1%) in 2016, while 7.2% of all women smoked during pregnancy. The cesarean delivery rate declined for the fourth year in a row. Medicaid was the source of payment for 42.6% of all 2016 births. The preterm birth rate rose for the second straight year, and the rate of low birthweight increased 1%. Twin and triplet and higher-order multiple birth rates declined, although the changes were not statistically significant.