The use of United States vital statistics in perinatal and obstetric research

doi:10.1016/j.ajog.2005.11.020

American Journal of Obstetrics and Gynecology

Volume 194, Issue 4, April 2006, Pages 911-915

https://doi.org/10.1016/j.ajog.2005.11.020 Get rights and content

Vital statistics data have been used to track maternal and child health in the United States since the early 1900s. The breadth of information collected on birth and death certificates coupled with advances in computer processing have made possible critical perinatal and obstetric research. These enhancements also facilitate potentially problematic uses of the same data. This commentary explores characteristics of the United States Vital Statistics System and presents some thoughts with regard to the appropriate use of these data. The advantages of vital statistics include representativeness and the ability to examine subpopulations. Limitations include possible underreporting of medical conditions and procedures, lack of ability to ascertain clinical intent, and the well-known issues with gestational age reporting. Analyses based on vital statistics are important in informing future clinical research projects. However, respecting the limitations of vital statistics data enhance their appropriate role in obstetric and perinatal research.

Section snippets

History of birth and death certificate reporting

The first national U.S. birth registration area, consisting of 10 states and the District of Columbia, was established in 1915; by 1933 all states were included, with Alaska and Hawaii joining the system once they were granted statehood.² National death certificate reporting began earlier, in 1900, and also was complete by 1933. Although there is no federal law requiring collection of vital statistics, the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS)

Conclusion

The U.S. Vital Statistics System is an important source of data for perinatal and obstetric epidemiologic research. The tracking of national trends in pregnancy outcomes and selected procedures with reasonably complete and accurate reporting, such as the method of delivery, is a fundamental use of those data. The data are also well suited to contribute to analysis of relationships between demographic factors and pregnancy outcomes such as preterm birth and infant mortality, including

References (17)

N.E. Reichman et al.
Validation of birth certificate data: a study of women in New Jersey's HealthStart program
Ann Epidemiol
(2001)
M.T. Lydon-Rochelle et al.
The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data
Am J Obstet Gynecol
(2005)
J. Zhang et al.
Birthweight for gestational age patterns by race, sex, and parity in the United States population
Obstet Gynecol
(1995)
G.R. Alexander et al.
A United States national reference for fetal growth
Obstet Gynecol
(1996)
R.W. Platt
The effect of gestational age errors and their correction in interpreting population trends in fetal growth and gestational age-specific mortality
Semin Perinatol
(2002)
A.P. MacKay et al.
An assessment of pregnancy-related mortality in the United States
Paediatr Perinat Epidemiol
(2005)
R.D. Grove et al.
Vital statistics rates in the United States: 1940-1960
(1968)
J.M. Piper et al.
Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records
Am J Epidemiol
(1993)

There are more references available in the full text version of this article.

Cited by (114)

Exposure to wildfires and health outcomes of vulnerable people: Evidence from US data
2023, Economics and Human Biology
This paper investigates the causal effect of wildfire exposure on birth outcomes and older people’s health outcomes in United States (US). The study focuses on three sub-questions for each health outcome: (1) the causal effect of each of the five largest wildfires on individual health, (2) the causal impact of multiple large wildfires on individual health outcomes, and (3) the causal influence of wildfires larger than different sizes within different distances of counties on health outcomes at the county level. The analysis exploits data from National Vital Statistics System, Behavioural Risk Factor Surveillance System and FIRESTAT. In terms of birth outcomes, the findings show that the largest wildfire slightly increased the risk of other circulatory or respiratory anomalies. Multiple large wildfires moderately raised the risk of prematurity and led to a small decline in the probability of getting omphalocele and cleft lip. The county-level analysis suggests an increased risk of macrosomia following maternal exposure to wildfires. As for the elderly aged 65 + , the results indicate that exposure to multiple massive wildfires led to frequent occurrence of asthma symptoms, while the largest wildfire led to sleeping difficulty caused by asthma symptoms. The number of days older people experienced psychological problems was increased following exposure to multiple large wildfires.
Impact of new labor management guidelines on Cesarean rates among low-risk births at New York City hospitals: A controlled interrupted time series analysis
2023, Annals of Epidemiology
To examine the impact of the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (ACOG-SMFM) 2014 recommendations for preventing unnecessary primary Cesareans.
In a population-based cohort of births in New York City from 2012 to 2016, we used controlled interrupted time series analyses to estimate changes in age-standardized Cesarean rates among nulliparous, term, singleton vertex (NTSV) deliveries.
Among 192,405 NTSV births across 40 hospitals, the age-standardized NTSV Cesarean rate decreased after the ACOG-SMFM recommendations from 25.8% to 24.0% (Risk ratio [RR]: 0.93; 95% CI 0.89, 0.97), with no change in the control series. Decreases were observed among non-Hispanic White women (RR: 0.89; 95% CI 0.82, 0.97), but not among non-Hispanic Black women (RR: 0.97; 95% CI 0.88, 1.07), Asian/Pacific Islanders (RR: 1.01; 95% CI 0.91, 1.12), or Hispanic women (RR: 0.94; 95% CI 0.86, 1.02). Similar patterns were observed at teaching hospitals, with no change at nonteaching hospitals.
While low-risk Cesarean rates may be modifiable through changes in labor management, additional research, and interventions to address Cesarean disparities, are needed.
Variation and racial/ethnic disparities in Cesarean delivery at New York City hospitals: the contribution of hospital-level factors
2022, Annals of Epidemiology
We aimed to quantify general and specific contextual effects associated with Cesarean delivery at New York City hospitals, overall and by maternal race/ethnicity.
Among 127,449 singleton, nulliparous births at New York City hospitals from 2015 to 2017, we used multilevel logistic regression to examine the association of hospital characteristics (public/private ownership, teaching status and delivery caseloads) with Cesarean delivery, overall, and by maternal race/ethnicity. We estimated the intra-class correlation to examine general contextual effects and 80% interval odds ratios (IOR) and percentage of opposed odds ratios (POOR) to examine specific contextual effects.
Overall, 27.8% of births were Cesareans. The general contextual (hospital) effect on Cesarean delivery was small (intra-class correlation: 1.8%). Hospital characteristics associated with Cesarean delivery differed by maternal race/ethnicity, with delivery in teaching hospitals reducing the odds of Cesarean delivery among White (IOR: 0.31, 0.86; POOR: 4.7%) and Asian women (IOR: 0.41, 0.95; POOR: 7.3%), but not among Black (IOR: 0.51, 1.34; POOR: 30.7%) or Hispanic women (IOR: 0.44, 1.24; POOR: 22.6%). Hospital ownership and caseloads were not associated with Cesarean delivery for any group.
There is little within-hospital clustering of Cesarean delivery, suggesting that Cesarean disparities may not be explained by hospital of delivery.
Variations in Maternal Factors and Preterm Birth Risk among Non-Hispanic Black, White, and Mixed-Race Black/White Women in the United States, 2017
2022, Women's Health Issues
This study aims to compare preterm birth (PTB) risk and maternal factors associated with PTB among non-Hispanic White, Black, and mixed-race Black/White women in the United States.
In this study, we used U.S. birth certificate data from the 2017 National Vital Statistics System. We included live singleton births to women who self-identified as non-Hispanic White, Black, or mixed-race Black/White. PTB was defined as less than 37 weeks of gestation. We used logistic regression models to estimate the PTB odds ratios for Black and Black/White relative to White women, adjusted for maternal factors. We used logistic regression to estimate associations between PTB and maternal factors in race-stratified models.
The sample included a total of 2,297,076 births in 2017 to White (n = 1,792,257), Black (n = 476,969), and Black/White (n = 27,850) women. The prevalence of PTB varied for Black (11.2%), Black/White (8.2%), and White (6.8%) women. The odds of PTB compared with White differed for Black (odds ratio, 1.51; 95% confidence interval, 1.49–1.53) and Black/White (odds ratio, 1.13; 95% confidence interval, 1.08–1.18) women after adjusting for maternal factors. The odds of PTB associated with maternal sociodemographic, prepregnancy, and gestational factors differed by maternal race.
Evaluation of PTB risk among White, Black, and Black/White women revealed distinct associations between PTB and maternal factors for Black/White women. This study highlights the need for research assessing the relationships between social risk factors such as colorism and racism and the outcome of PTB, and it provides evidence that may inform more targeted PTB prevention among Black/White and Black women.
Birth registration policies in the United States and their relevance to sexual and/or gender minority families: Identifying existing strengths and areas of improvement
2022, Social Science and Medicine
Birth certificates are some of the most critical identity documents available to current residents of the United States, yet sexual and gender minority (SGM) parents frequently face barriers in obtaining accurate documents for their children. It is essential for SGM parents to have accurate birth certificates for their children at the time of birth registration so that they do not experience undue burden in raising their children and establishing their status as legal parents. In this analysis, we focused on the birth registration process in the US as they apply to SGM family-building and the assignation of parentage on birth certificates at the time of a child's birth. We utilized keyword-based search criteria to identify, collect, and tabulate official state policies related to birth registration. Birth registration policies rely on gendered, heteronormative assumptions about the sex and gender of a child's parents in all but three states when identifying the birthing person and in all but eight states when identifying the non-birthing person. We found additional barriers for SGM parents who give birth outside of a marriage or legal union. These barriers leave SGM parents particularly vulnerable to inaccuracies on their children's identity documents and incomplete recognition of their parental roles and rights. Existing birth registration policies also do little to ensure the inclusion of diverse family structures in administrative data collection. There are many ways to modify existing birth registration policies and enhance the inclusion of SGM parents within governmental administrative structures. We conclude with suggestions to improve upon existing birth registration systems by de-linking parental sex and gender from birthing role, parental role, and contribution to the pregnancy.
The association of adverse outcomes with pregnancy conception methods among low-risk term pregnancies
2021, Fertility and Sterility
To compare composite neonatal and maternal adverse outcomes among low-risk singleton pregnancies at 37–41 weeks among conception methods: spontaneously-conceived (SC) pregnancy; infertility medications and/or intrauterine insemination (IFM/IUI); and assisted reproductive technology (ART).
Population-based retrospective cohort study.
US Vital Statistics datasets 2013–2017.
Low-risk pregnancies (without hypertensive disorders, pregestational or gestational diabetes, or history of preterm birth) of women ≥20 years with nonanomalous singletons, who labored, delivered at 37–41 weeks, and had data on pregnancy conception method.
None.
The primary outcome was the composite neonatal adverse outcome (CNAO). The secondary outcome was the composite maternal adverse outcome (CMAO).
Of the 19.7 million deliveries during the study period, 54.0% (N = 10,676,184) met the inclusion criteria, with 99.0% (N = 10,573,741) being conceived spontaneously, 0.4% (N = 47,227) by IFM/IUI, and 0.5% (N = 55,216) by ART. The overall rate of CNAO was 6.68 per 1,000 live births. Compared with SC, the risk of CNAO was significantly higher among IFM/IUI (adjusted relative risk [aRR], 1.29; 95% CI, 1.18–1.41) and ART (aRR, 1.29; 95% CI, 1.18–1.39). The overall rate of CMAO was 2.50 per 1,000 live births. Compared with SC, the risk of CMAO was significantly increased among IFM/IUI (aRR, 1.72; 95% CI, 1.50–1.97) and ART (aRR, 2.40; 95% CI, 2.17–2.65).
Among low-risk term singleton pregnancies, IFM/IUI and ART have modestly higher rates of adverse outcomes to maternal-neonatal dyad than SC.
Asociación de resultados adversos con los métodos de concepción de la gestación en embarazos a término de bajo riesgo.
Comparar los resultados adversos neonatales y maternos combinados a las 37-41 semanas en gestaciones con feto único según los métodos de concepción: gestación concebida espontáneamente (SC); medicamentos para la infertilidad y/o inseminación intrauterina (IFM/IUI); y tecnología de reproducción asistida (ART).
Estudio retrospectivo de cohorte basado en una población.
Bases de datos de US Vital Statistics 2013-2017.
Embarazos de bajo riesgo (sin trastornos hipertensivos, diabetes pregestacional o gestacional o antecedentes de nacimiento pretérmino) de mujeres ≥ 20 años con hijos únicos no anómalos, con trabajo de parto a las 37-41 semanas y de las que existían datos sobre el método de concepción del embarazo.
Ninguna.
La medida de resultado primaria fue el resultado adverso neonatal combinado (CNAO). La medida de resultado secundaria fue el resultado adverso materno combinado (CMAO).
De los 19,7 millones de partos durante el período de estudio, el 54,0% (N=10,676,184) cumplieron los criterios de inclusión, con el 99,0% (N=10,573,741) de concepción espontánea, 0,4% (N047,227) mediante IFM/IIU, y 0,5% (N=55,216) mediante ART. La tasa global de CNAO fue de 6,68 por 1,000 nacidos vivos. En comparación con SC, el riesgo de CNAO fue significativamente mayor entre IFM/IIU (riesgo relativo ajustado [aRR], 1,29; IC del 95%, 1.18-1.41) y ART (aRR, 1,29; IC del 95%, 1.18-1.39). La tasa general de CMAO fue de 2.50 por cada 1,000 nacidos vivos. En comparación con SC, el riesgo de CMAO aumentó significativamente entre IFM/IIU (aRR, 1,72; IC del 95%, 1.50–1.97) y ART (aRR, 2,40; IC del 95%, 2.17–2.65).
Entre los embarazos de feto único a término de bajo riesgo, IFM/IIU y ART tienen tasas moderadamente más altas de resultados adversos para la díada materno-neonatal que SC.

View all citing articles on Scopus

: Reprints not available from the authors.

View full text

Research Methods: State of the ScienceThe use of United States vital statistics in perinatal and obstetric research

Section snippets

History of birth and death certificate reporting

Conclusion

Ann Epidemiol

Am J Obstet Gynecol

Obstet Gynecol

Obstet Gynecol

Semin Perinatol

An assessment of pregnancy-related mortality in the United States

Paediatr Perinat Epidemiol

Vital statistics rates in the United States: 1940-1960

Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records

Am J Epidemiol

Research Methods: State of the Science
The use of United States vital statistics in perinatal and obstetric research