Parental age difference and adverse perinatal outcomes in the United States

This study was undertaken to examine the relationship between paternal and maternal age differences and adverse perinatal outcomes in the United States. Data were obtained on singleton pregnancies delivering at >or=20 weeks gestation in the United States in 1995-97 from the National Center for Health Statistics data sets. Adverse perinatal outcomes that were evaluated included fetal death rate (>or=20 weeks), preterm delivery <37 weeks and small-for-gestational-age (SGA) births (birthweight <10th centile for gestational age and corrected for sex). Age difference was defined as paternal minus maternal age. The analysis included 8995274 pregnancies (11.3% blacks, 88.7% whites). An increase in fetal death rate, preterm delivery and SGA births was noted among white women who were older than their male partners. For black mothers older than their partners, there was an increase in fetal death rate when the women were <20 years old, but a decrease in fetal death rate when >35 years old. Neither rates of preterm delivery nor SGA births were increased much for black women with varying parental age differences. This demonstrates that race and maternal age both contribute to the effects of parental age difference on adverse perinatal outcomes.     

Ascertainment of maternal deaths in New York City.

Maternal deaths in New York City are defined as deaths from any cause in a woman while pregnant or within six months of pregnancy termination. Pilot studies seeking to improve maternal death ascertainment found that selected medical examiner reports contributed an additional 10.5 percent of the total maternal deaths, vital statistics review contributed 6.3 percent, linkage of death tapes of women of reproductive age to live birth and fetal death tapes contributed 1.0 percent. Medical examiner cases should be incorporated into surveillance data for accurate ascertainment of pregnancy associated deaths.     

Pregnancy-related deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women--United States, 1991-1997

In the United States in 1997, the Hispanic, Asian/Pacific Islander, and American Indian/ Alaska Native population represented 16% of all reproductive-age women (aged 15-49 years) but accounted for 23.5% of all live births (1,2). Although statistics by race/ethnicity are available for maternal deaths (3), pregnancy-related mortality ratios (PRMRs) have been reported regularly only for black and white women. Pregnancy-related deaths in Hispanic women have been studied (4); however, combining pregnancy-related mortality risk among Asians/Pacific Islanders and American Indians/Alaska Natives into an "other" category masks differences in their health status. This report presents PRMRs among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women in the United States during 1991-1997. The findings indicate that these groups have higher PRMRs than non-Hispanic white (white) women and lower ratios than non-Hispanic black (black) women and underscore the need for targeted interventions that address the maternal health needs of racial/ethnic minority women.     

Disparities in gestational age–specific fetal mortality rates in the United States, 2009–2013

PurposeAlthough studies have examined overall temporal changes in gestational age–specific fetal mortality rates, there is little information on the current status of racial/ethnic differences. We hypothesize that differences exist between racial/ethnic groups across gestational age and that these differences are not equally distributed.MethodsUsing the 2009–2013 data from US fetal death and live birth files for non-Hispanic white (NHW); non-Hispanic black (NHB); Hispanic; and American Indian/Alaska Native (AIAN) women, we conducted analyses to examine fetal mortality rates and estimate adjusted prevalence rate ratios and 95% confidence intervals (CIs).ResultsThere were lower risks of fetal mortality among NHB women (aPRR = 0.76; 95% CI = 0.71–0.81) and Hispanic women (aPRR = 0.89; 95% CI = 0.83–0.96) compared with NHWs at 22–23 weeks’ gestation. For NHB women, the risk was higher starting at 32–33 weeks (aPRR = 1.11; 95% CI = 1.04–1.18) and continued to increase as gestational age increased. Hispanic and AIAN women had lower risks of fetal mortality compared with NHW women until 38–39 weeks.ConclusionsFurther examination is needed to identify causes of fetal death within the later pregnancy period and how those causes and their antecedents might differ by race and ethnicity.     

Changes in rates of spontaneous fetal deaths reported in Upstate New York vital records by gestational age, 1968-78

Between 1968 and 1978, the rates for spontaneous deaths, recorded on Upstate New York fetal death certificates, that occurred after 28 or more weeks of gestation dropped 37 percent, and the rates for deaths that occurred at 20 to 27 completed weeks of gestation dropped 12 percent. However, the rates of reported spontaneous fetal deaths after 16 to 19 weeks gestation dropped only 4 percent. The rates for such deaths at 12-15 weeks of gestation increased by 21 percent and by 55 percent at less than 12 weeks of gestation. The decline in the late fetal death rate is probably attributable, at least in part, to medical and social advances during this period. The reported rise in early fetal deaths may be due, among other factors, to changes in reporting practices or to earlier deaths of conceptuses that formerly would have been lost after 20 weeks of gestation.     

Ethnic differences in perinatal mortality--a challenge.

The perinatal mortality rates of mothers who delivered at St. Thomas's Hospital from 1969 to 1976 have been examined. The rate in the West Indian population was significant higher than in the United Kingdom white population. The increased West Indian mortality was confined to infants with a birth weight of more than 2.0 kg and a gestational age of more than 37 weeks. The relative risk of perinatal death for West Indian mothers compared with UK white mothers was 1.4 at birth weights of 2.5 kg to 2.9 kg, rising to 4.3 at 4.0 + kg. West Indian perinatal mortality in term babies of normal birth weight was higher in all maternal age and parity groups except parity 3, but the difference was greatest in women aged 30 or over. The African perinatal mortality rate was not significantly greater than the UK white rate although it followed the West Indian trends. Pre-eclampsia and forceps delivery were associated with a greatly increased perinatal mortality in West Indian babies. The excess West Indian mortality could not be explained completely by differences in the proportions of stillbirths and early neonatal deaths nor by the distribution of births by parity, maternal age, or social class. Possible explanations for the differences in mortality are discussed.     

Excessive maternal weight gain patterns in adolescents

The objective of this study was to examine the correlates of excessive maternal weight gain among adolescent mothers in the United States. Data from the Centers for Disease Control & Prevention 2000 natality file were analyzed to examine weight gain among adolescents (≤19 years) compared with their older counterparts (≥20 years). Using the Institute of Medicine guidelines, we defined excessive weight gain as more than 40 pounds. Our study population was restricted to singleton births, delivered after 36 weeks of gestation, who did not live in California. Maternal weight gain distributions were tabulated by maternal age and other maternal characteristics. Demographic characteristics potentially associated with maternal weight gain were compared for adolescents and older mothers. We further evaluated the role of parity and maternal race on the relationship between excessive weight gain and maternal age. Odds ratios and 95% confidence intervals were estimated using logistic regression. Over 27% of adolescent mothers gained excessive weight during pregnancy, although approximately 18% of their older counterparts gained more than 40 pounds. The association between young maternal age and weight gain was stronger for primiparous women than multiparous women and stronger among non-Hispanic white and non-Hispanic black mothers than Hispanic mothers. Adolescents were more likely to gain excessive weight than their older counterparts in nearly all demographic categories, regardless of parity or race. Adolescents are at high risk of gaining an excessive amount of weight during pregnancy and should be monitored during pregnancy by dietetics professionals.     

Maternal mortality in New York City: Excess mortality of black women

To assess maternal mortality in New York City, birth certificates and mortality records for New York City from 1988 through 1994 were linked and examined. During these 7 years, maternal mortality in New York City (defined by the International Classification of Diseases, 9th edition [ICD-9], as 630–676) per 100,000 live births signicantly exceeded that of the country as a whole (20.2 vs. 8.2, respectively). Within New York City, an even greater variation of maternal mortality by race/ethnicity was noted, with the mortality ratio of whites, blacks, and Hispanics being 7.1, 39.5, and 14.4 per 100,000 live births, respectively. Socioeconomic characteristics such as educational attainment, marital status, and income influenced maternal mortality more in non-blacks than blacks. Analyses of cause-specific mortality revealed that, overall, ectopic pregnancy, embolism, and hypertension were the leading causes of death. However, the major factors explaining the excess maternal mortality among blacks were hypertension (mortality ratio of blacks to whites 5.57,95% confidence interval 2.30–13.39), ectopic pregnancy (4.78,95% confidence interval 2.40–9.51), and abortion (4.58, 95% confidence interval 1.72–12.22). These findings confirm a persisting gap in maternal death between black and white women. Indeed, if all New Yorkers who became pregnant enjoyed the survival of the city's non-Hispanic white residents, the difference in maternal mortality between the city and the nation would be eliminated.     

Trends in preterm-related infant mortality by race and ethnicity, United States, 1999-2004.

Trends in preterm-related causes of death were examined by maternal race and ethnicity. A grouping of preterm-related causes of infant death was created by identifying causes that were a direct cause or consequence of preterm birth. Cause-of-death categories were considered to be preterm-related when 75 percent or more of total infant deaths attributed to that cause were deaths of infants born preterm, and the cause was considered to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. In 2004, 36.5 percent of all infant deaths in the United States were preterm-related, up from 35.4 percent in 1999. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers. The preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for non-Hispanic white, Mexican, and Asian or Pacific Islander mothers. The leveling off of the U.S. infant mortality decline since 2000 has been attributed in part to an increase in preterm and low-birthweight births. Continued tracking of preterm-related causes of infant death will improve our understanding of trends in infant mortality in the United States.     

Racial and Ethnic Variations in Temporal Changes in Fetal Deaths and First Day Infant Deaths

The purpose was to examine changes in overall and gestational age-specific proportions and rates of fetal death, first day death (<24 h), and combined fetal-first day death from 1990–1991 to 2001–2002. Changes were considered by race/ethnicity. Deliveries to U.S. white, black, and Hispanic mothers were selected from the NCHS linked live birth-infant death cohort and fetal deaths files (1990–1991 and 2001–2002). There was an overall improvement in mortality, but improvements were not uniform across all racial/ethnic groups or by gestational age. The fetal mortality rate among whites and Hispanics declined 4.32 and 12.82 percent, respectively. For blacks, the fetal mortality rate increased 4.06 percent between 1990–1991 and 2001–2002. Despite overall reductions in perinatal and <24 h mortality, black rates in all outcomes maintained a twofold disparity. The overall black: white fetal mortality rate ratio increased from 2.17 to 2.36 over time. The gestational age-specific black: white combined fetal-first day mortality rate ratios were greater than 1 at later gestational ages. In some cases, the ratio increased over time, indicating that despite reductions, fetal mortality did not decline uniformly among whites and blacks at term and post-term. Despite overall improvements in fetal, first day, and combined fetal-first day mortality, racial disparities persisted and in some cases widened. This study identifies lack of improvements in fetal death in the black population compared to the white or Hispanic population at later gestational ages.     

An assessment of the effects of maternal age and parity in different components of perinatal mortality

Perinatal mortality has several components which may have distinct epidemiologic features. In an investigation of the total singleton birth population of New York City in 1976-1978 (n = 320,726), the authors divided perinatal mortality into four components: late fetal deaths that occurred before labor (late antepartum fetal deaths), fetal deaths during labor (intrapartum fetal deaths), neonatal deaths, and perinatal deaths attributed to congenital anomalies, and they assessed the relation of each of these to maternal age and parity, controlling for relevant confounding factors. In analyses which controlled for prior fetal loss, type of service (public vs. private), race, marital status, and mother's educational attainment in a multiple logistic regression model, the authors found that: 1) increasing maternal age was strongly associated with antepartum fetal deaths but not with intrapartum fetal deaths, while older maternal age was also associated with perinatal deaths attributed to congenital anomalies; 2) high parity bore a strong relationship to intrapartum fetal deaths, but none to antepartum fetal deaths, neonatal deaths, or congenital anomaly deaths; and 3) for neonatal death, there was a statistically significant (p less than 0.001) interaction between parity and age such that mothers over 34 years old having their first birth were at especially high risk.     

The urban American Indian oversample in the 1988 National Maternal and Infant Health Survey.

Although more than two-thirds of American Indians and Alaska Natives (AI) live outside reservations and Tribal lands, few data sets describe social and maternal-child health risk factors among urban AI. The Indian Health Service sponsored a special effort to survey mothers of AI infants as part of the 1988 National Maternal and Infant Health Survey (NMIHS), a comprehensive national study conducted by the National Center for Health Statistics, Centers for Disease Control. The authors analyzed questionnaires completed by mothers residing in selected locations served by urban Indian health programs and compared the data with those for women of other races residing in metropolitan areas. After adjusting the sample for nonparticipating States, the response rate in the Urban Indian Oversample was 60.8 percent (763 of 1,254). More than 45 percent of AI and black respondents, compared with 15 percent of white respondents, reported an annual household income of less than $10,000. About half of AI and black women, compared with nearly three-quarters of white women, reported having insurance or health maintenance organization coverage during pregnancy. Despite having a similarly low rate of health insurance coverage and low household income, AI respondents were far less likely than black respondents to have Medicaid coverage. A higher proportion of AI women than of black or white women reported difficulties in obtaining prenatal care, and AI women were less likely to obtain prenatal care. AI women were also less likely than white women to obtain prenatal care in the first trimester.(ABSTRACT TRUNCATED AT 250 WORDS)