Births and maternity
For more information on the Utah Pregnancy Risk Assessment Monitoring System (PRAMS) visit Utah PRAMS program website.
Improving the well-being of mothers, infants, and children is an important public health goal for
the United States. Their well-being determines the health of the next generation and can help
predict future public health challenges for families, communities, and the health care system. The
objectives of the Maternal, Infant, and Child Health topic area address a wide range of conditions,
health behaviors, and health systems indicators that affect the health, wellness, and quality of
life of women, children, and families.
The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and interconception (between pregnancies) care.2 Moreover, healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential.3,4,5
6,7,8 These differences are likely the result of many factors.
Social determinants of maternal health
These include pre-pregnancy health behaviors and health status,9 which are influenced by a variety of environmental and social factors such as access to health care and chronic stress.10
Physical determinants of maternal health
Common barriers to a healthy pregnancy and birth include lack of access to appropriate health care before and during pregnancy. In addition, environmental factors can shape a woman's overall health status before, during, and after pregnancy by:
Social determinants of infant and child health
The social determinants that influence maternal health also affect pregnancy outcomes and infant health. Racial and ethnic disparities in infant mortality exist, particularly for African American infants.11 Child health status varies by both race and ethnicity, as well as by family income12 and related factors, including educational attainment among household members and health insurance coverage.13
Physical determinants of infant and child health
The cognitive and physical development of infants and children is influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development.14,15 Furthermore, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other social adversities, are more likely to have better outcomes as adults.16,17
Emerging issues in maternal, infant, and child health
Recent efforts to address persistent disparities in maternal, infant, and child health have employed a "life course" perspective to health promotion and disease prevention. At the start of the decade, fewer than half of all pregnancies are planned. Unintended pregnancy is associated with a host of public health concerns. In response, preconception health initiatives have been aimed at improving the health of a woman before she becomes pregnant through a variety of evidence-based interventions.18
The life course perspective also supports the examination of quality of life, including the challenges of male and female fertility. An estimated 7.3 million American women ages 15 to 44 have received infertility services (including counseling and diagnosis) in their lifetime.19 Infertility is an area where health disparities are large, particularly among African American women,20 and may only continue to increase as childbearing practices change over time.
Why it's important
Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children. These health risks may include:- Hypertension and heart disease
- Gestational diabetes
- Depression
- Genetic conditions
- Sexually transmitted diseases (STDs)
- Tobacco use and alcohol abuse
- Inadequate nutrition
- Unhealthy weight
The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and interconception (between pregnancies) care.2 Moreover, healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential.3,4,5
Who is at risk
Infant and child health are similarly influenced by sociodemographic factors, such as family income, but are also linked to the physical and mental health of parents and caregivers. There are racial and ethnic disparities in mortality and morbidity for mothers and children, particularly for African Americans. Many factors can affect pregnancy and childbirth, including:- Preconception health status
- Age
- Access to appropriate preconception and interconception health care
- Poverty
6,7,8 These differences are likely the result of many factors.
Social determinants of maternal health
These include pre-pregnancy health behaviors and health status,9 which are influenced by a variety of environmental and social factors such as access to health care and chronic stress.10
Physical determinants of maternal health
Common barriers to a healthy pregnancy and birth include lack of access to appropriate health care before and during pregnancy. In addition, environmental factors can shape a woman's overall health status before, during, and after pregnancy by:
- Affecting her health directly
- Affecting her ability to engage in healthy behaviors
Social determinants of infant and child health
The social determinants that influence maternal health also affect pregnancy outcomes and infant health. Racial and ethnic disparities in infant mortality exist, particularly for African American infants.11 Child health status varies by both race and ethnicity, as well as by family income12 and related factors, including educational attainment among household members and health insurance coverage.13
Physical determinants of infant and child health
The cognitive and physical development of infants and children is influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development.14,15 Furthermore, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other social adversities, are more likely to have better outcomes as adults.16,17
Emerging issues in maternal, infant, and child health
Recent efforts to address persistent disparities in maternal, infant, and child health have employed a "life course" perspective to health promotion and disease prevention. At the start of the decade, fewer than half of all pregnancies are planned. Unintended pregnancy is associated with a host of public health concerns. In response, preconception health initiatives have been aimed at improving the health of a woman before she becomes pregnant through a variety of evidence-based interventions.18
The life course perspective also supports the examination of quality of life, including the challenges of male and female fertility. An estimated 7.3 million American women ages 15 to 44 have received infertility services (including counseling and diagnosis) in their lifetime.19 Infertility is an area where health disparities are large, particularly among African American women,20 and may only continue to increase as childbearing practices change over time.
How it's tracked
Maternal and child health is tracked at the national and state levels primarily through:- Pregnancy Risk Assessment and Monitoring System (PRAMS)
- Birth certificates
- Death certificates
1. Healthy People 2020 Topics and Objectives, Maternal, Infant, and Child Health, accessed on 8/11/2014 from .
2. Centers for Disease Control and Prevention (CDC), Agency for Toxic
Substances and Disease Registry (ATSDR). Recommendations to improve preconception health and
health care-United States: A report of the CDC/ATSDR Preconception Care Work Group and the
Select Panel on Preconception Care. Atlanta: CDC; 2006. 23 p. (MMWR Recomm Rep. 2006;55[RR-06])
3. Centers for Disease Control and Prevention (CDC). Newborn screening for cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn screening programs. Atlanta: CDC; 2004. 37 p. (MMWR Recommen Reps. 2004;53[RR-13]).
4. Centers for Disease Control and Prevention (CDC). Identifying infants with hearing loss-United States, 1999-2007. Atlanta: CDC; 2010. (MMWR. 2010;59[8]:220-3).
5. Watson MS, Mann MY, Lloyd-Puryear MA, et al.; American College of Medical Genetics, Newborn Screening Expert Group. Newborn screening: Toward a uniform screening panel and system [executive summary]. Pediatrics. 2006;117(5 Pt. 2):S296-307.
3. Centers for Disease Control and Prevention (CDC). Newborn screening for cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn screening programs. Atlanta: CDC; 2004. 37 p. (MMWR Recommen Reps. 2004;53[RR-13]).
4. Centers for Disease Control and Prevention (CDC). Identifying infants with hearing loss-United States, 1999-2007. Atlanta: CDC; 2010. (MMWR. 2010;59[8]:220-3).
5. Watson MS, Mann MY, Lloyd-Puryear MA, et al.; American College of Medical Genetics, Newborn Screening Expert Group. Newborn screening: Toward a uniform screening panel and system [executive summary]. Pediatrics. 2006;117(5 Pt. 2):S296-307.
6. Centers for Disease Control and Prevention (CDC). Newborn screening for
cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn
screening programs. Atlanta: CDC; 2004. 37 p. (MMWR Recommen Reps. 2004;53[RR-13]).
7. Tucker MJ, Berg CJ, Callaghan WM, et al. The black-white disparity in pregnancy-related mortality from 5 conditions: Differences in prevalence and case-fatality rates. Am J Public Health. 2007 February 1;97(2):247-51.
8. Williams DR, Collins C. US Socioeconomic and racial differences in health: Patterns and explanations. Ann Rev Soc. 1995;21:349-86.
9. Bryant AS, Worjoloh A, Caughey AB, et al. Racial/ethnic disparities in obstetric outcomes and care: Prevalence and determinants. Am J Obstet Gynecol. 2010 Apr;202(4):335-43.
10. Williams DR, Collins C. US Socioeconomic and racial differences in health: Patterns and explanations. Ann Rev Soc. 1995;21:349-86
11. Centers for Disease Control and Prevention, Division of Vital Statistics; Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2006. Hyattsville, MD: National Center for Health Statistics; 2009 January 7. Report No. 57(7).
12. Larson K, Halfon N. Family income gradients in the health and health care access of US children [Internet]. Matern Child Health J. 2010 Jun 5;14(3):332-42.
13. Larson K, Russ SA, Crall JJ, et al. Influence of multiple social risks on children's health. Pediatrics. 2008 Feb 1;121(2):337-44.
14. US Department of Health and Human Services (HHS), Office on Women's Health. HHS blueprint for action on breastfeeding. Washington: HHS; 2000.
15. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2007 Apr. (Report/Technology Assessment, No. 153. AHRQ Publication No. 07-E007).
16. National Research Council and Institute of Medicine; Board on Children, Youth, and Families,Commission on Behavioral and Social Sciences and Education. From neurons to neighborhoods: The science of early childhood development. Shonkoff J, Philips D, editors. Washington: National Academy Press; 2000. 612 p.
17. Anda RF, Felitti VJ, Walker J, et al. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174-86.
18. Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR). Recommendations to improve preconception health and health care-United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55(RR-6).
19. Centers for Disease Control and Prevention, National Center for Health Statistics; Chandra A, Martinez GM, Mosher WD, et al. Fertility, family planning, and reproductive health of US women: Data from the 2002 National Survey of Family Growth. Vital Health Stat. 2005;23(25):1-160.
20. Wellons MF, Lewis CE, Schwartz SM, et al. Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: The CARDIA Women's Study. Fertil Steril. 2008 Nov;90(5):1640-8.
7. Tucker MJ, Berg CJ, Callaghan WM, et al. The black-white disparity in pregnancy-related mortality from 5 conditions: Differences in prevalence and case-fatality rates. Am J Public Health. 2007 February 1;97(2):247-51.
8. Williams DR, Collins C. US Socioeconomic and racial differences in health: Patterns and explanations. Ann Rev Soc. 1995;21:349-86.
9. Bryant AS, Worjoloh A, Caughey AB, et al. Racial/ethnic disparities in obstetric outcomes and care: Prevalence and determinants. Am J Obstet Gynecol. 2010 Apr;202(4):335-43.
10. Williams DR, Collins C. US Socioeconomic and racial differences in health: Patterns and explanations. Ann Rev Soc. 1995;21:349-86
11. Centers for Disease Control and Prevention, Division of Vital Statistics; Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2006. Hyattsville, MD: National Center for Health Statistics; 2009 January 7. Report No. 57(7).
12. Larson K, Halfon N. Family income gradients in the health and health care access of US children [Internet]. Matern Child Health J. 2010 Jun 5;14(3):332-42.
13. Larson K, Russ SA, Crall JJ, et al. Influence of multiple social risks on children's health. Pediatrics. 2008 Feb 1;121(2):337-44.
14. US Department of Health and Human Services (HHS), Office on Women's Health. HHS blueprint for action on breastfeeding. Washington: HHS; 2000.
15. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2007 Apr. (Report/Technology Assessment, No. 153. AHRQ Publication No. 07-E007).
16. National Research Council and Institute of Medicine; Board on Children, Youth, and Families,Commission on Behavioral and Social Sciences and Education. From neurons to neighborhoods: The science of early childhood development. Shonkoff J, Philips D, editors. Washington: National Academy Press; 2000. 612 p.
17. Anda RF, Felitti VJ, Walker J, et al. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174-86.
18. Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR). Recommendations to improve preconception health and health care-United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55(RR-6).
19. Centers for Disease Control and Prevention, National Center for Health Statistics; Chandra A, Martinez GM, Mosher WD, et al. Fertility, family planning, and reproductive health of US women: Data from the 2002 National Survey of Family Growth. Vital Health Stat. 2005;23(25):1-160.
20. Wellons MF, Lewis CE, Schwartz SM, et al. Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: The CARDIA Women's Study. Fertil Steril. 2008 Nov;90(5):1640-8.
Birth defects
Breastfeeding
Mortality
Pregnancy/maternal measures
- Adolescent births
- Birth rates
- Births from unintended pregnancies
- Diabetes: gestational diabetes
- Domestic violence during pregnancy
- General fertility rate
- Obesity prior to pregnancy
- Postpartum depression
- Prenatal care
- Severe maternal morbidity among hospital deliveries
- Smoking in the third trimester of pregnancy
Birth outcomes
- Cesarean delivery among low risk women with no prior births
- Low birth weight
- Preterm birth
- Very Preterm Birth
Newborn screening
Births
Fertility rate (live births per 1,000 female population)
Adolescent births
Prenatal care
2009 and later (new birth certificate)
More
information on the Kotelchuck Index
2008 and before (old birth certificate)
More
information on the Kotelchuck Index
Infant birth weight
Pre-term births
Gestational age is the period of time a baby is carried in the uterus
or the duration of the pregnancy, measured from the first day of the last menstrual period.
Full-term gestation is between 37 and 42 weeks.
Fetal and infant mortality
Infant
mortality and fetal mortality causes
Fetal mortality (20 weeks or more gestation)
Infant mortality
- All infant mortality selections
- Infant mortality rate (age 364 days or less) - death data only
- Infant mortality rate by major causes (age 364 days or less) - death data only
Infant mortality (death data only): number of infant deaths
during the year per 1,000 live births during the same year.