focus area 16: maternal, infant, and child health progress review october 22, 2003

Focus Area 16:Maternal, Infant, and Child

Health

Progress Review

October 22, 2003

Healthy People 2010 Focus Area 16

Maternal complications during labor and delivery

Maternal deaths

Cesarean births

Ectopic pregnancies*

Maternal Mortality and Morbidity Objectives

* Developmental objective

0

10

20

30

40

1998 1999 2000 2001

Maternal Complications During Labor and Delivery by Race: 1998 - 2001

Per 100 deliveries

Source: NHDS, NCHS, CDC.

Black

White

Total

Note: Data by race may be under reported.

2010 Target

Obj. 16-5a

A condition that adversely affects a woman’s physical health during childbirth beyond what would be expected in a normal delivery

Maternal ComplicationsDuring Labor and Delivery

Obstetric complications – 30.7% of live births

Preexisting medical conditions – 4.1% of live births

10

12

14

16

18

20

1989 1991 1993 1995 1997 1999 2001

0

5

10

15

20

25

White,Not Hispanic

Black,Not Hispanic

Hispanic*

Total

American Indian/Alaska Native

Percent2010 Target

Asian

Native Hawaiian/Other Pacific Islander

Obj. 16-9Source: NVSS, NCHS, CDC.

Cesarean Births by Race: 2001

Women giving birth for the first time

* Persons of Hispanic origin may be of any race.

0

20

40

60

80

100

1950 1960 1970 1980 1990 2000

0

5

10

15

20

25

30

1999 2000 2001

Maternal Deaths by Race and Ethnicity:

1999 - 2001

Black, Not Hispanic

White, Not Hispanic

Total

Hispanic*

Source: NVSS, NCHS, CDC.

Per 100,000 live births

Obj. 16-4* Persons of Hispanic origin may be of any race.

2010 Target

Healthy People 2010 Focus Area 16 Objectives

Fetal and infant deaths

Low and very low birth weight

Preterm births

Spina bifida and other neural tube defects

Healthy Pregnancies and Healthy Infants

0

5

10

15

1998 1999 2000 2001


Infant Death Rates (Within 1 Year)by Race and Ethnicity: 1998 - 2001

Per 1,000 live births

Black, Not Hispanic

White,Not Hispanic

Asian

Total

Hispanic*


Obj. 16-1cSource: NVSS, NCHS, CDC.

2010 Target


Per 1,000 live births N

(6)(9)

(15)(13)(8)

9.0 or more 8.0 - 8.97.0 – 7.96.0 – 6.9Less than 6.0

All Infant Deaths (Within 1 Year)by State: 1998-2000

D.C.


2010 Target = 4.5

Leading Causes of Infant Death(Within 1 Year): 2001

Source: NVSS, NCHS, CDC.

Cause of death

Infant deaths per 100,000 live births

Birth defects

Preterm & LBW

SIDS

Maternal complications

Total LBW VLBW

137.6 1011.8 2247.8

109.5 1361.8 7105.0

55.5 139.4 159.4

37.3 459.1 2353.6

All racesBlack, NotHispanic

White, NotHispanic


293.5 2159.3 8961.4 77.5 1081.6 6157.1

Total LBW VLBW

146.3 1271.5 2635.3

76.4 1130.5 6261.0

27.1 78.4 102.5

21.0 303.2 1655.5

Hispanic*

Total LBW VLBW

162.0 721.7 1291.4

113.5 230.3 262.3

85.3 630.1 2608.5

Total LBW VLBW

134.1 1071.8 2723.9

45.6 122.5 124.5

29.3 443.3 2438.8

Total LBW VLBW Total LBW VLBW

Very low birth weight

Low birth weight

0

5

10

15



LBW (<5 lbs 8 oz) and VLBW (<3 lbs 4 oz)

by Race and Ethnicity: 2001

* Persons of Hispanic origin may be of any race. Obj. 16-10Source: NVSS, NCHS, CDC.

LBW2010 Target

VLBW2010 Target

Black, NotHispanic

Percent of live births

Total Asian White, NotHispanic

Hispanic*

0

2

4

6

8

10

1981 86 91 96 2001

0

5

10

15



LBW (<5 lbs 8 oz) and VLBW (<3 lbs 4 oz)

by Race and Ethnicity: 2001

* Persons of Hispanic origin may be of any race. Obj. 16-10Source: NVSS, NCHS, CDC.

LBW2010 Target

VLBW2010 Target

Black, NotHispanic

Percent of live birthsVery low birth weight

Low birth weight

Total Asian White, NotHispanic

Hispanic*

0

2

4

6

8

10

1981 86 91 96 2001

Economic and Social ImpactHealth care: 24 – fold differential in first year

medical costs between VLBW infants and all infants born in the US.

Education: Children born LBW are almost 50% more likely to be enrolled in any type of special education than children who were normal weight at birth.

Social services:

Recent disaggregated costs are not available. Costs would include developmental services, day care programs, case management and counseling, respite care and residential care.

Family expenses:

Special care for LBW infants directly attributed to an infants illness account for 2 - 4% of a family's income.


Healthy Pregnancies and Healthy Infants

Prenatal care Very low birth weight infants born at level III hospitals

Prenatal substance exposure Breastfeeding

Optimum folic acid levels Infants put to sleep on their backs

60

70

80

90

1998 1999 2000 2001

Early Prenatal Care (First Trimester)by Race and Ethnicity: 1998 - 2001

Percent

Black, Not Hispanic


White,NotHispanic

Asian Total

Hispanic*


2010 Target

* Persons of Hispanic origin may be of any race.Source: NVSS, NCHS, CDC. Obj. 16-6a

75

80

85

90

95

100

1998 1999 2000 2001

Pregnant Women Abstaining from Smoking by Race and Ethnicity:

1998 - 2001


Asian

Total

Hispanic*

Native Hawaiian/Other PacificIslander

Percent

Black, Not Hispanic

0

White, Not Hispanic


2010 Target


0

20

40

60

80

100 2010 Target

Trimester

Second Third

Race/Ethnicity

Total

Percent in month preceding survey

Pregnant Women Abstaining from Alcohol by Race/Ethnicity and

Trimester: 2002

FirstBlack WhiteHispanic*

Obj. 16-17aI 95% Confidence interval.Source: NSDUH, OAS, SAMHSA. * Persons of Hispanic origin may be of any race.

0

Not Hispanic

0

20

40

60

80

100

Breastfeeding by Race: 2002

White,Not Hispanic

Asian,Not Hispanic

Hispanic* Black,Not Hispanic

Obj. 16-19Source: Abbott Laboratories.

Percent of mothers

In Hospital2010 Target

In Hospital

At 6 Months

At 12 Months

6 Months2010 Target

12 Months2010 Target


0

50

100

150

200

250

300Baseline data

0

2

4

6

8

Median RBC Folate Level

Most recent data

Nu

mb

er (

ng

/ml)

Spina bifida and other NTD

Per

10,

000

2010 Target

Red Blood Cell Folate Level andNeural Tube Defects

1991-94 1999-2000 1996 2000

Obj. 16-16b & 16.15Source: NHANES, NCHS, CDC; NBDPN, NCBDDD, CDC.

(in nonpregnant women 15 – 44 years) (in live births & fetal deaths >20 wks. gestation)

77 72 67 62 5679

35

53 56

6664

0

20

40

60

80

1996 1997 1998 1999 2000 2001

Sudden Infant Death Syndrome and Sleep Position: 1996 - 2001

SIDS deathsInfants put to sleep on their

backsPer 100,000 live births Percent

Sources: NVSS, NCHS, CDC; NISPS, NICHD, NIH. Obj. 16-1h & 16.13

SIDS deaths2010 Target

Sleep position2010 Target


* Developmental objective

Children with Special Health Care Needs

Developmental disabilities Medical homes for children with special health care needs*

Sepsis among children with special health care needs*

Service systems for children with special health care needs*

Newborn bloodspot screening*

0

5

10

15

20

Sex

Male FemaleTotal

Percent

Proportion of Children with Special Health Care Needs by Race/Ethnicity,

Age and Sex: 2001

12 to 17Bla

ck,

Not H

ispan

icW

hite

,

Not H

ispan

ic

Hispan

ic*0

Age in years

0 to 5 6 to 11

Amer

ican

Indi

an

/Alask

a Nat

ive

Asian

Source: CSHCN, MCHB, HRSA, and NCHS, CDC.

0

1

2

3

4

5

6

7

WhiteBlack

Total

Autism In Children (3 to 10 years)by Race and Sex: 1996

Male FemaleTotal

Per 1,000 in Atlanta, GA

Male FemaleTotal

Source: MADDSP, NCBDDD, CDC. Obj. 16-14c

Progress review data and slidescan be found on the web at:

http://www.cdc.gov/nchs/hphome.htmhttp://www.cdc.gov/nchs/hphome.htm

focus area 16: maternal, infant, and child health progress review october 22, 2003

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