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InghamCountyHealthSurveillanceBook2015

Pregnancy & Natality

Section

InghamCountyHealthSurveillanceBook2015Pregnancy&Natality-3

Datelastu

Pregnancy & Natality

Thehealthofwomenandchildreniscentraltothepublichealthofacommunity.Ahealthypregnancy

andchildbirthpavesthewaytoahealthierchildhoodandadultlife.Therefore,itisimportanttoun-

derstandfactorsaffectingpregnancyandnatalityandrelatedoutcomedataatthecounty,stateand

nationallevels.

Todothatforalocalcounty,itisimportanttoscreentherelevantdatafromvitalrecordsstatistics

collectedbystateornationaldatasources.Theprimarypurposeforcollectionofvitalrecordsisto

recordinformationonvitaleventsforlegalpurposes;vitalrecords�ilesalsoserveasanimportant

sourceforstatisticalinformation.

Thissectionofthereportisintendedtoassistpolicymakers,programmanagers,andotherinterest-

edpersonsunderstandhealthfactorsandtrendsaffectinghealthypregnanciesandnatality.Thisre-

port includesanumberofpregnancyandnatalityindicators forInghamCounty,Michigan.Mostof

thedatawasgleanedfromtheStateofMichigan“Natality,PregnancyandAbortionStatistics”forthe

years2005-2015intrendsor2015forlateststatistics.

Theindicatorsselectedfallunderoneofthefollowingbroadcategoriesofvitalevents,andincludea

comparisonofcountyandstatedata.

Fertility(includesgraphoftrendsandestimatedpregnancies)

Abortiongraphandtrends

Livebirthtrendsandrates

Maternalcharacteristics,includingdemographics,prenatalcare,educationandbehav-

ioralriskssuchassmoking

Infantcharacteristics,includingpregnancyterms,birthweight

Eachsectionincludes:

An‘IndicatorExplanation’sectionwhichdescribeswhythisindicatorwasrelevant

AdescriptionofcurrentstatusinInghamCountyandMichigan

TablesandgraphsbasedonStateofMichiganrecords

Speci�icdatasourceslinkswillbeplacedbeloweachofthetablesandgraphs.Alsocitationswithin

textswillbelistedattheendofthisdocumentsection.


Datelastupdated:April2017

Refreshcycle:annually

Fertility

Fertilityistheactualreproductiveperformanceofanindividual,acouple,agrouporapopulation(1).Agrowing

populationofbabiesandyouthsleadstoworkingadultsandtaxpayerstosupportanagingpopulation.Acommu-

nitycanseeitspopulationgrowthwithincreasedfertilityofmothers,orwithadults’jobmobilitybetweencities,

orinternationalmigrationsbringingyoungfamiliestosettleandeventuallyreproducingthere.Whenfertilityis

lowinacommunity,theneedtoattractmoreworkingadultsandfamiliesfromothercitiesandcountriesgrows.

This is whyunderstanding fertility trends and the factorscontributing tohigher or lower fertilityare ways to

helppredictthefutureregenerationofcommunitiesthroughpregnancyandnewbirths(2).

IndicatorExplanation

Fertility refers to the number of live births that occur toawomanduringchildbearingagerangeusually15-44

years.Fertilityrateisnumberoflivebirthsper1000childbearingagewomeninacertainyearandgeographic

location.Notallwomenhaveexactlythesamepotentialtogivebirthtokidsduringtheirchildbearingyears,and

it varies signi�icantly across a population or countries, which contributes to difference in overall population

growth.

KeyFindings

Between2005and2015, InghamCountyhasmaintained fertilityrates thatareslightly lower thantheoverall

StateofMichiganfertilityrates.TherehasbeenaslightdeclineinfertilityratesinbothInghamcountyandthe

StateofMichiganfrom2008to2013andthenasmallincreasein2014thatwasnotsustainedin2015;this

trendfollowsasimilartrendintheUnitedStates.The2008Economicrecession hasbeenassociatedwiththe

Source:table1MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancyRatesbyCounty,EstimatedPopulationforFemales,MichiganResidents,2015;Retrievedfromhttp://www.mdch.state.mi.us/pha/osr/abortion/pregbyco.asp

Figure1.FertilityRatebyGeography,2015 Figure2.PregnancyRatebyGeography,2015




Fertility

Figure4.FertilityRateTrendInghamCountyandMichigan,2005-2015

Source3:http://www.mdch.state.mi.us/osr/CHI/Births14/frame.html

Figure3.FertilityRateinInghamCountyandMichigan,2015

lowerfertilityrates(2).ThepeakfertilityrateforInghamintheyears2005-2015wasin2006,at49.9per1000

women15-44andthelowestwasin2015at45.6.




Abortion

Abortionisaninterventionperformedbyalicensedclinician(e.g.,aphysician,nurse-midwife,nursepractition-

er,orphysicianassistant)thatisintendedtoterminateanongoingpregnancy(3).Understandingabortionrates

helpspolicymakersandhealthproviderstopreservematernalhealthandlife;Compilingmaternalandlifedata

andmonitoringallabortionshelpstoensurethattheyaredoneonlyunderandinaccordancewiththeprovi-

sionsofthelawtominimizetherisksincurredtomothersfromunsafeabortion.


TheAbortionrateisthetotalnumberofabortionsper1,000womenaged15–44yearsinacertainyearandgeo-

graphiclocation.TheStateofMichigancompiledtheabortiontrends.Thisreportusestrendsfrom2005-2015

bycountyofresidence.

KeyFindings

InghamCountyabortionrateshavedeclinedintheyearsfrom2005to2015reachingalowof6per1000wom-

enin2013butstartedincreasingagainin2014and2015;ThetrendfortheStateofMichiganhasincreaseddur-

ingthesameperiodfrom11.9to13.8per1000women.

Figure5.AbortionRateTrendInghamCountyandMichigan,2005-2015

FigureSource:MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancyRatesbyCounty,EstimatedPopulationforFemales,MichiganResidents,2015;Retrievedfromhttp://www.mdch.state.mi.us/osr/Abortion/AbortionRates.asp


AccordingtotheWorldHealthOrganization(4),Livebirthisde�inedasthe“completeexpulsionorextractionof

aproductofconceptionfromitsmother,irrespectiveofthedurationofthepregnancy,which,aftersuchsepara-

tion,breathesorshowsanyotherevidenceoflife,suchasbeatingoftheheart,pulsationoftheumbilicalcord,or

de�initemovementofvoluntarymuscles,whetherornottheumbilicalcordhasbeencutortheplacentaisat-

tached.UnderstandingLiveBirthdataforwomenofacertainagegrouporpopulationgroupsallowscommuni-

ties to plan ahead for increasing supportof healthier pregnancies. Live Birth data forspecial subgroups help

communities understand how to deter stressful factors that might contribute to reduce healthy live births

amongsubgroups.


Crudebirthrateisde�inedintheStateofMichiganasthenumberofbirthsper1,000populationforacertain

geographicareainthiscasecountyorstate,orinaspeci�iedagecohortorraceorancestrysuchasHispanicor

AraborigingroupsinMichigan.

KeyFindings

InghamCountybirthrateshavebeengraduallydecliningbetween2005and2015andfollowtheexacttrendas

theStateofMichigan.From2003to2013theCrudeBirthrateinInghamCountyfollowedthegeneralpatternas

inthestateofMichigan;therewasageneraldeclinefrom13in2004to11.6in2011andthenitstabilizedatthis

ratefrom2011through2013.

Figure6.CrudeBirthRatesinInghamCountyandMichigan,2005-2015



Live Birth

Source:MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancyRatesby

County,CrudeBirthRates,Retrievedfromhttp://www.mdch.state.mi.us/osr/Natality/BirthRateTrends.asp




Live Birth

Table2.LiveBirthsandFertilityRateper1000

inInghamCountyandMichigan,2015

KeyFindings(cont’d)

Thehighestbirthratewasforwomen25-29yearsfollowedby30-34yearsrangeinbothInghamandMichi-

ganinthatsametimespan.TeenpregnancywasslightlyhigherinInghamCountythanMichiganin2015,

6.36%comparedto5.7%.(Table2).InrecentyearstheUnitedStateshasseenadropinbirthratesamong

theyoungerageasmoreyoungadultsdecidetopostponehavingchildren,andanincreaseintherateamong

womenintheir30sand40s.(5)WomeninInghamCountyarefollowingthattrend,therateforolderwomen

30-34is93.4almostthreetimesastherateforwomen20-24yrsold32.6.

Amongthevariousracialgroups,ArabandHispanicancestrywomenhadthehighestbirthratesinboth

InghamandMichigan,followedbyBlackthenAsian&Paci�icIslandersin2015(Figure5)andalsowhenwe

lookedattrendsfrom2005to2015.Thetrendoflivebirthsforwhitefemales15-44yearswasslightlyhigh-

eroverallthanthatofAsianPaci�icIslanders(Figure6).

Source:MichiganHealthStatistics,PregnanciesbyOutcome

andFertility,AbortionandPregnancyRatesbyCounty,

BirthRatesbyAgeofMother,retrievedfromhttp://

www.mdch.state.mi.us/pha/osr/Chi/births14/frame.html




Maternal Characteristics Prenatal Care (PNC)

Prenatalvisitsstartinginthe�irsttrimesterareimportantforthehealthofbothinfantandmothertoincrease

chancesofhealthydeliveryandbirthweight.Duringtheprenatalcarevisits,healthcareproviderseducatemoth-

ersonimportanthealth issuesrelatedtopregnancyandchildbirthandthe importanceofcarefollowingbirth.

Topicsincludedietandnutrition,exercise,immunizations,weightgain,andabstainingfromdrugsthatareharm-

fulforthepregnancyandalcohol.Expectantparentsalsolearnaboutnutritionfortheirnewborn,thebene�itsof

breastfeeding,injuryandillnessprevention,aswellasmonitorforhealth-compromisingconditions,andprepar-

ingforthenewemotionalchallengesofcaringforaninfant.(6)


PrenatalCareistheregularvisitsofapregnantwomantoseekhealthcareandsupportbeforebirth.Inthisre-

portweusethe“Koteichuckindex,as theAdequacyPrenatalCareIndex(APNCU). It isbasedonAdequacyof

InitiationofPrenatalCareandAdequacyofReceivedservices. (7)Adequacyofcare,hasbeencorrelatedwith

positivebirthoutcomesandmayalsoconferbene�itssuchasreducedlikelihoodofpost-partumdepressionand

infantinjuries.Theindicatorislinkedtosomemothercharacteristics.Higherincome,bettereducatedmothers

aremorelikelytouseprenatalcareservicesandsomeracialorethnicgroupshavetraditionallybeenlesslikely

toenrollinprenatalcare.Itisimportanttounderstandfactorsleadingtolowerparticipationinprenatalcarein

order to provide services to subgroups that encourage such participation. Maternal health behavior such as

whetherornotsheisasmokerorlivesinahouseholdwhereherexposureofsmokingcompromisesherpreg-

nancyandmaternaleducationsaresomeofthecharacteristicsincludedinthissection.

KeyFindings

Between2005and2015theproportionofpregnantwomenparticipating inPrenatalcareby the4thmonthof

pregnancyformorethan80%ofrequiredtotalappointmentshasbeensteadilyincreasinginbothMichiganand

Inghamcounty,atasimilarpacetill2009butsince2010InghamCountyhassurpassedMichiganbyat least5

digitpointsontheKotelchuckIndex.Thepercentofwomenjoiningprenatalcareinthe�irsttrimesterhasslight-

lydeclinedforMichiganandInghamCounty.In2015Whitewomenwereatleast10%morelikelytoparticipate

inprenatalcarethananyotherraces.BlackwomenhadthelowestpercentageofparticipantsinPNCduringthe

�irst trimester comparedto other races,. Black women rates were at 56.6% in Ingham and 62.2%in Michigan

comparedto75.5%WhitewomeninbotherInghamandMichigan.




Maternal Characteristics > PNC

Figure7.InadequatePNC(KotelchuckIndex),2015

Figure8.PercentWomenentryinPrenatalCareintheir1sttrimesterByRaceandEthnicAncestry,in

InghamCountyandMichigan,2015

Source:MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancy.Retrievedfrom:http://

www.mdch.state.mi.us/pha/osr/Chi/births14/frame.html

Source:MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancyRetrievedfrom:http://

www.mdch.state.mi.us/pha/osr/Chi/births14/frameBxChar.html




Maternal Characteristics > Tobacco Use

Tobaccouseandexposureisanotherfactorthatisincludedinthisreportunderprenatalcare.Accordingtothe

Centers for Disease Control and Prevention,smoking reduces a woman’s chances of getting pregnant, causes

unnecessarycomplicationsinpregnancyandisharmfultothebabybeforeandafterbirth(8)


Tounderstandpatternsofmotheruseorexposuretotobacco,thereportusedornotthepregnantmotherused

tobacco,andwhetherornotthehouseholdhadanyoneregularlysmoking.

KeyFindings

Thepercentof livebirthsborntomotherswhosmokehasbeentrendingupwardfrom2005to2015inboth

InghamCounty(from13.7to17.0%)anditdoubledinMichigan(9.1%to18.2%).Raceisnotasigni�icantfac-

torinInghamcountyasitrangesbetween19.3%forwhite,20.4%forHispanicancestry,and22.6%forblack.

Dataforothergroupswerenotavailable.

InMichiganthepercentforHispanicswasmuchlowerthaneitherWhiteorBlackraces.ArabsandPaci�icIs-

landershaveamuchsmallerpercent(2.6%and1.7%,respectively)comparedtowhite18.3,black16.3andHis-

panic11.6%. LivebirthsinhouseholdswithsmokersorsecondhandsmokingisthehighestamongHispanic

ancestry,followedbyBlackandWhiteinInghamCounty,withnearlyaquarteroflivebirthsatriskofsmoke

exposureintheirhouseholds.

Figure9.TrendofthePercentofLiveBirthstoMotherswhousedTobaccoinInghamCountyandMichi-gan,2005-2015

Figures9,10,11Source:MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancy,PercentofLiveBirthstoMotherswhousedTobacco.Retrievedat:http://www.mdch.state.mi.us/pha/osr/Chi/births14/frameBxChar.html


Figure11.PercentofLiveBirthswithHouseholdSmokinginInghamCountyandMichigan,2015



Maternal Characteristics > Tobacco Use

Figure10.PercentofLiveBirthstoMotherswhousedTobaccobyRaceGroupinInghamCounty

andMichigan,2015




Maternal Characteristics > Education

Maternaleducationisthenumberofyearsamotherhasattendedformaleducationpriortogivingbirth.Itisone

ofthesocio-economicfactorsthatcontributetoadheringtogoodprenatalcarethatleadstoahealthyweightfull

term pregnancy and to infant care following birth. Lower levels of maternal education were associated with

higher maternal mortality even amongst women able to access facilities providing intrapartum care

(9).Understandingthematernaleducationlevelsacrossvariousraceorethnicgroupscanhelppredicttherisks

andaddressthemaccordinglytoimprovethechancesoffulltermhealthymotherandbabyatbirth.


Motherswithlessthan12yearsofeducationistheindicatorusedbytheStateofMichigan,thatmeansthemoth-

erwasnotahighschoolgraduatewhenshegavebirth.

KeyFindings

Since2005thepercentageofbirthstomothersoflessthan12yearseducationisthehighestamongthe15-19

years old age bracket in Ingham (56%) and Michigan (47.8%). This �igure has continued to drop in Ingham

Countyfrom16.2%to13.2%in2015whilethistrendisgoingupwardsfortheStateofMichiganfrom13.7%in

2005toreachapeakof19.7%in2013.Whenbrokendownbyracialandethnicancestry,theHispanicancestry

had the highest percent of births to mothers with less than 12 years education, both in Ingham (24.2%) and

Michigan(30.7%)comparedtoalltheotherracialandethnicgroups.

Table3.PercentofLiveBirthstoMotherswithlessthan12yrsofeducationbyMaternalAgeGroupin

InghamandMichigan,2015

Age of Mother Ingham County

Michigan

total 13.2% 12.1%

<15 years no data no data

15-19 years 56% 47.8%

20-24 years 22% 17%

25-29 years 8.3% 8.7%

30-34 years 5%% 6.3%

35-39 years 6.8 7.8%

40+ years 9.8% 9.7%

Table3andFigures12,13Source:MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,PregnanciesbyOut-comeandFertility,AbortionandPregnancy,MaternalCharacteristics,Education,Retrievedat:http://www.mdch.state.mi.us/pha/osr/Chi/births14/frame.html


Figure13.PercentLiveBirthstoMotherswithlessthan12yearseducationinInghamCountyand

Michigan,2005-2015

Datelastupdated:April2017Refreshcycle:annually

Maternal Characteristics > Education

Figure12.PercentLivebirthstomotherswithlessthan12yearseducationByRacialandEthnic

groups,InghamCountyandMichigan,2015




Infant Characteristics > Low Birthweight

Aninfant’sbirthweightisrecordedshortlyafterbirthandregisteredonthebirthcerti�icate.Aggregatebirthcer-

ti�icatedataonbirthweightsarethenusedtostudycommunitytrends.Loworverybirthweightinfantsaremore

likelytobeprematureoraresultofmothersufferingfromhealthissuesthataffectedfetalgrowth.Theyareata

higher risk of death in the �irst year of life. Understanding the factors associated with low birth weights is im-

portant to help minimize physical and developmental risks and to address the socio-economic maternal health

riskspriorandduringpregnancy.


Infantsbornatlowbirthweightarethosewhoweighlessthan2,500gramsor5pounds8ounces,andverylow

birthweightarethosebornlessthan1,500gramsor3.25pounds.

KeyFindings

The2015dataforbirthweightisbasedon2013birthcerti�icates.TheNationalaverageLowBirthweightreported

in2015was8%.Nationallythetrendsince2005hasbeengoingupwhichmeansmoreinfantsarebornatLBW.In

Michiganthetrendfrom2005-2015hasbeenstablearound8per100livebirths.Inghamhasseenaslight�luctua-

tioninthetrendduringthattime,intherangeof7.3%and9.2%butmostly8%orless.TheBlackandAsianPaci�ic

IslanderracialgroupsinInghamCountyhadthehighestLBWinfantsper1000birthsin2015,135.5and106.6re-

spectively. These rates for Black infants are nearly double that of the white racial group rates 69.6of LBW per

1000orthatofHispanicethnicgroupat65.4.

Figure14.LowBirthWeightbyMaternalAgeGroupinIngham

CountyandMichigan,2015

Table4andFigures14,15Source:MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,Pregnan-ciesbyOutcomeandFertility,AbortionandPregnancy,RateofLowBirthweightper1000livebirths,Retrievedat::http://www.mdch.state.mi.us/pha/osr/Chi/births14/frameBxChar.html


Figure16.LowBirthWeightTrendinInghamCountyandMichigan,2005-2015



Infant Characteristics > Low Birthweight

Figure15.LowBirthweightByRacialandEthnicGroupsinInghamCountyandMichigan,2015




Infant Characteristics > Preterm Birth

IntheUnitedStates,1in10infantswerebornbeforethemothercompleted37weeksofpregnancy,orpreterm

birthin2015.Pretermbirthratesdecreasedfrom2007to2014,andCDCresearchshowsthatthisdeclineisdue,in

part,todeclinesinthenumberofbirthstoteensandyoungmothers(11).Understandingfactorsthatleadtopre-

termbirthisimportanttoaddressthemandpreventpotentialcomplicationsthatcanoccurasaresultofpreterm

birth;suchasrespiratorydistress,jaundice,anemia,andinfectionshortlyafterdelivery.Long-termcomplications

canincludelearningandbehavioralproblems,cerebralpalsy,lungproblems,andvisionandhearingloss.


Preterm babies are born before 37 completed weeks of gestation, and are at increased risk of immediate life-

threateninghealthproblems,aswellaslong-termcomplicationsanddevelopmentaldelays.

KeyFindings

Thepre-termratetrendshavebeengoingdownnationallysince2007andMichiganandInghamCountyfollowed

thistrendfrom2005to2013withaslightrisein2014and2015.Thelowernumberofteenpregnancieshasbeen

attributedtolowerpreterminfantbirths.Thetworacialgroupsathigherriskofpre-termbirthsinInghamCounty

were theBlackandAsian/Paci�ic Islandergroups,withratesofpre-termbirthper1000 livebirthsat135.5and

101.5respectivelyin2015.TheoverallrateinInghamCounty(96.6)wasslightlylowerthanthatinMichigan(98.4

pretermper1000livebirths).

Table4.PretermBirthByMaternalAgeGroupInghamCountyandMichigan,2015

Age of Mother Ingham County Michigan

All Ages 96.6 98.4

<15 years No data No data

15-19 years 18 95.9

20-24 years 95.5 98.5

25-29 years 76.2 90.1

30-34 years 98 96.2

35-39 years 43 117

40+ years 7 149.3

Table5andFigures16,17Source:MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,PregnanciesbyOut-comeandFertility,AbortionandPregnancy,RateofPretermBirthsper1000livebirths,Retrievedat:http://www.mdch.state.mi.us/pha/osr/Chi/births14/frame.html


Figure18.Pre-termBirthTrendsinInghamCountyandMichigan,2005-2015



Infant Characteristics > Preterm Birth

Figure17.PretermBirthbyRaceandEthnicgroupInghamCountyandMichigan,2015




References

GlossaryofDemographicTerms;PopulationReferenceBureau,GlossaryofDemographicTerms,retrievedfromhttp://www.prb.org/Publications/Lesson-Plans/Glossary.aspx

Mather,Mark;WSJLivesegment,"IstheU.S.'s'BabyRecession'Over?";PopulationReferenceBureauvideo,re-trievedfrom:http://www.prb.org/Publications/Articles/2015/mather-wsj-baby-recession.aspx

Mather,Mark;TheDeclineofUSfertility,PopulationReferenceBureau,2012WorldfactSheet,Retrievedfromhttp://www.prb.org/publications/datasheets/2012/world-population-data-sheet/fact-sheet-us-population.aspx

DivisionofReproductiveHealth,NationalCenterforChronicDiseasePreventionandHealthPromotion,Abor-tionSurveillanceSystemFAQs;Retrievedfrom:https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm

Worldhealthorganization,healthStatisticsandInformationSystem,MaternalMortalityissues.Retrievedat:http://www.who.int/healthinfo/statistics/indmaternalmortality/en/

Childtrends,databankIndicators,LateofNoPrenatalCare.December2015Retrievedat:https://www.childtrends.org/indicators/late-or-no-prenatal-care/

MichiganDepartmentofHealthandHumanServices,MichiganHealthStatistics,PregnanciesbyOutcomeandFertility,AbortionandPregnancy,http://www.mdch.state.mi.us/pha/osr/natality/tab1.8perc.asp

CenterforDiseasecontrolandPrevention,SmokingDuringPregnancy.Retrievedathttps://www.cdc.gov/to-bacco/basic_information/health_effects/pregnancy/

Therelationshipbetweenmaternaleducationandmortalityamongwomengivingbirthinhealthcareinstitu-tions:AnalysisofthecrosssectionalWHOGlobalSurveyonMaternalandPerinatalHealth;BMCPublicHealth,2011,Volume11,Number1,Page1SaffronKarlsen,LaleSay,Joao-PauloSouza,CarolJHogue,DinorahLCalles,AMetinGulmezoglu,RosalindRaine;retrievedfrom:http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-606

CenterforDiseasecontrolandPrevention,Pre-termBirth.Retrievedfrom:https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm

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