Births In Michigan Research Articles

A predictive model for perinatal hypoxic ischemic encephalopathy using linked maternal and neonatal hospital data

PurposeTo build an evidence-based model to estimate case-specific risk of perinatal hypoxic ischemic encephalopathy. MethodsA retrospective, cross-sectional study of all births in Hawaii, Michigan, and New Jersey between 2010 and 2015, using linked maternal labor/delivery and neonatal birth records. Stepwise logistic regression and competitive Akaike information criterion were used to identify the most parsimonious model. Predictive ability of the model was measured with bootstrapped optimism-adjusted area under the ROC curve. ResultsAmong 836,216 births there were 376 (0.45 per 1000) cases of hypoxic ischemic encephalopathy. The final model included 28 variables, 24 associated with increased risk, and 4 that were protective. The optimism-adjusted area under the ROC curve was 0.84. Estimated risk in the study population ranged from 1 in ∼323,000 to 1 in 2.5. The final model confirmed known risk factors (e.g., sentinel events and shoulder dystocia) and identified novel risk factors, such as maternal race and insurance status. ConclusionOur study shows that risk of perinatal hypoxic ischemic encephalopathy injury can be estimated with high confidence. Our model fills a notable gap in the study of hypoxic ischemic encephalopathy prevention: the estimation of risk, particularly in the United States population which is unique with respect to racial and socioeconomic disparities.

Politically related stress and low-birth-weight infants among Arab, Asian, Hispanic, non-Hispanic Black, and non-Hispanic White women in Michigan.

Despite the high cost of low birth weight and the persistent challenge of racial inequities affecting the Arab American community, there has been limited research to identify and examine risk factors for these inequities with validated data on Arab American ethnicity and recent population stressors. This study examined whether the 2016 presidential election is associated with low birth weight among non-Hispanic White, Arab American, Hispanic, and non-Hispanic Black women. This population-based study of singleton births in Michigan (2008-2017) used an algorithm to identify mothers who were of Arab descent. We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between race/ethnicity and the odds of low birth weight. We examined whether these associations differed before and after the 2016 presidential election and according to maternal education. There were 1,019,738 births, including 66,272 (6.5%) classified as low birth weight. The odds of having a low-birth-weight infant were higher among all minority women compared to non-Hispanic White women. The association was similar before and after the 2016 presidential election and stronger among women with higher levels of education. This is the first study to estimate low birth weight among Arab American women in the context of political events. There are opportunities for future studies to discuss this issue in depth.

Vicarious structural racism and infant health disparities in Michigan: The Flint Water Crisis.

Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: −0.09, −0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: −0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.

P182 ASSOCIATION OF EARLY INFANCY DAYCARE EXPOSURE AND ALLERGY IN A SOUTHEAST MICHIGAN BIRTH COHORT

Several reports indicate that infant daycare attendance is associated with lower allergy risk. We assessed whether daycare by one month of age was associated with IgE levels, allergen sensitization, and allergic rhinitis among children in a southeast Michigan birth cohort.

Changes in residential greenness between pregnancies and birth outcomes: longitudinal evidence from Michigan births 1990--2012.

Residential exposure to greenness is associated with better birth outcomes, but it remains unknown whether this is explained by maternal characteristics associated with both place of residence and birth outcomes. We examined whether changes in residential greenness are associated with preterm birth (PTB) and birthweight. We examined cross-sectional associations between maternal exposure to residential greenness [normalized difference vegetation index (NDVI)] and PTB (<37 weeks of gestation) and birthweight in grams, using all births in Michigan (1990-2012) linked by mother (n = 1730424). We used maternal fixed effects analysis to estimate associations within mothers across multiple pregnancies and associations for mothers who did not move, but for whom greenness changed between pregnancies, to mimic an intervention. Each 0.1-unit change in NDVI was associated with 0.98 [95% confidence interval (CI): 0.97, 0.99] times lower odds of PTB and a 9.0 (95% CI: 8.1, 9.9)-gram increase in birthweight after adjusting for individual and neighbourhood covariates. When we controlled for time-invariant maternal unmeasured confounders; these associations were close to null [odds ratio (OR): 1.00 (95% CI: 0.98, 1.01); β: -0.3 (95% CI: -2.0, 3.6)]. We did not find a relationship between greenness and birth outcomes among women who did not move between pregnancies, but for whom greenness changed within their residential location (as in an intervention). Residential greenness does not predict birth outcomes, after controlling for time-invariant maternal characteristics, using longitudinal evidence. Future research should explore residential selection factors, spatial and individual heterogeneity and experimental study designs.

Incidence, demographic characteristics, and geographic distribution of sickle cell trait and sickle cell anemia births in Michigan, 1997-2014.

BackgroundThis study describes the incidence, demographic characteristics, and geographic distribution of sickle cell anemia (SCA) and sickle cell trait births in Michigan.MethodsMichigan newborn screening records and birth certificates (1997–2014) were used to identify sickle cell trait and SCA births, as well as demographic characteristics and mother's residential address. Incidence was calculated overall and by county.ResultsDuring the study period, there were 592 SCA births and 33,404 sickle cell trait births in Michigan. The majority of SCA (86.3%) and trait (80.2%) cases were among children who were black. Children with SCA were born in 23% of Michigan counties; children with trait were born in 93%.ConclusionCompared to SCA, sickle cell trait births occur at 50‐fold greater incidence and have a substantially expanded geographic distribution. Further research is necessary to understand the most appropriate and impactful use of resources to increase the proportion of families and adults that are aware of their sickle cell trait status.

Economic conditions during pregnancy and preterm birth: A maternal fixed-effects analysis.

Making causal inference regarding impacts of macrolevel economic conditions during pregnancy on pregnancy outcomes is hampered by the presence of unmeasured variables that may influence women's probability of giving birth under certain economic conditions (ie, exposure) as well as her pregnancy outcomes. Maternal fixed-effects (FE) analyses, in which the association between exposure and outcomes is estimated within mothers who had discordant outcomes, can control for such unmeasured variables when they are invariant across pregnancies. We utilised a maternally linked data set of all singleton births in Michigan from 1990 to 2012 (n=2657272 for full sample; n=269943 for FE analytic sample) to examine the relationship between state-level unemployment rates during pregnancy and preterm birth (PTB, <37weeks' gestation). Measured maternal characteristics that change across pregnancies, for example, age, marital status, education, parity, and infant sex, were included as covariates in the model. Using an FE approach, we found that each one percentage point increase in state unemployment in the first trimester of pregnancy was associated with a modest 3% increase in odds of PTB. Our results were consistent with previously published results in a national sample and held across random- versus fixed-effect models, analytic samples, and outcome measures. Our findings provide further evidence that economic downturn during early pregnancy may be associated with modest increases in PTB.

Geospatial Analysis of Birth Records to Target Programming for Mothers With Gestational Diabetes Mellitus in Michigan, 2013.

The incidence of gestational diabetes mellitus (GDM) in the United States has increased during the past several decades. The objective of this study was to use birth records and a combination of statistical and geographic information system (GIS) analyses to evaluate GDM rates among subgroups of pregnant women in Michigan. We obtained data on maternal demographic and health-related characteristics and regions of residence from 2013 Michigan birth records. We geocoded (ie, matched to maternal residence) the birth data, calculated proportions of births to women with GDM, and used logistic regression models to determine predictors of GDM. We calculated odds ratios (ORs) from the exponentiated beta statistic of the logistic regression test. We also used kernel density estimations and local indicators of spatial association (LISA) analyses to determine GDM rates in regions in the state and identify GDM hot spots (ie, areas with a high GDM rate surrounded by areas with a high GDM rate). We successfully geocoded 104 419 of 109 168 (95.6%) births in Michigan in 2013. Of the geocoded births, 5185 (5.0%) were to mothers diagnosed with GDM. LISA maps showed a hot spot of 8 adjacent counties with high GDM rates in southwest Michigan. Of 11 064 births in the Southwest region, 829 (7.5%) were to mothers diagnosed with GDM, the highest rate in the state and a result confirmed by geospatial analyses. Birth data and GIS analyses may be used to measure statewide pregnancy-associated disease risk and identify populations and geographic regions in need of targeted public health and maternal-child health interventions.

2392 - Multimodal Accessibility and Maternal-Infant Health across the Urban Rural Continuum in Southwest Michigan

Background Kalamazoo County, Michigan is an urban-rural county with high rates of gestational diabetes among expectant mothers and high disparities in the quality of birth outcomes among its population segments. Analysis of health outcomes in the county has primarily focused on densely populated areas of low socioeconomic status. However, the county has a clear urban to rural continuum. Because women without appropriate access to healthcare during particular stages of pregnancy have poorer outcomes than women with regular access to care, this paper examines the disparities in transportation network accessibility by public transit and private vehicle across the urban-rural continuum. Multimodal accessibility estimates were analyzed especially for individuals relying on Medicaid for perinatal health care from 2012–2014. Methods Reported, confirmed cases gestational diabetes, low birthweight infants and premature births for Kalamazoo County, were retrieved from 2012-14 Michigan birth records. For each case, the dataset includes mother's home address, Medicaid status, race, ethnicity, and an estimate of prenatal care. Batch geocoding was supplemented with extensive manual placement, resulting in an overall address match accuracy of over 90% of cases. Open Trip Planner and Google Maps JavaScript API were used to estimate travel time from census block centroids to pedicatric, obstetric, gynocological and emergency health services by both public vehicle and private transit. Results Individuals in the urban core had the highest multimodal accessibility, because of general proximity to the one central public transit hub. While hospitals are centrally accessible, and all pediatricians, 92 percent of OBGYNs, and 88 percent of family medical locations are transit accessible only 53 percent of pregnant women did not live within 400 m of the bus line. A travel time matrix for this data will be presented at the conference. Several specific areas of concern were identified, such as areas outside the urban core, along a rural continuum which is punctuated by low socioeconomic enclaves of high density, low-income housing (trailer parks). Analysis of Medicaid status and maternal health issues is ongoing. Conclusions Accessibility maps at the census block level have been distributed to community stakeholders. Further analysis of rural health in trailer park communities is imperative. This study has implications for Kalamazoo County health, but also the health of other urban-rural counties across the country with similar vulnerable populations.

Using multiple imputation to address the inconsistent distribution of a controlling variable when modeling an infrequent outcome.

Temporal changes in methods for collecting longitudinal data can generate inconsistent distributions of affected variables, but effects on parameter estimates have not been well described. We examined differences in Apgar scores of infants born in 2000-2006 to women with ovulatory dysfunction (risk) or tubal obstruction (reference) who underwent assisted reproductive technology (ART), using Florida, Massachusetts, and Michigan birth certificate data linked to the Centers for Disease Control and Prevention's National ART Surveillance System database. Florida had inconsistent information on induction of labor (a control variable) from a 2004 change in birth certificate format. Because we wanted to control for bias that may be introduced by the inconsistent distribution of labor induction in analysis, we used multiple imputation data in analysis. We used Cox-Iannacchione weighted sequential hot deck method to conduct multiple imputation for the labor induction values in Florida data collected before this change, and missing values in Florida data collected after the change and overall Massachusetts and Michigan data. The adjusted odds ratios for low Apgar score were 1.94 (95% confidence interval [CI] 1.32-2.85) using imputed induction of labor and 1.83 (95% CI 1.20-2.80) using not imputed induction of labor. Compared with the estimate from multiple imputation, the estimate obtained using not imputed induction of labor was biased towards the null with inflated standard errors, but the magnitude of differences was small.

Individual and County Level Correlates of Medicaid Births in Michigan

ABSTRACT Across Michigan the share of births covered by Medicaid varies widely, from a low of 15% in Menominee County to a high of 71% in Roscommon County in 2009 (Michigan League for Public Policy n.d.). This paper uses data on women who delivered a live infant in Michigan between 2009 and 2011 from Michigan's Pregnancy Risk Assessment Monitoring System (PRAMS) matched to county level socioeconomic information to identify factors associated with the likelihood Medicaid is used to cover the medical costs of giving birth. The results suggest that strategies to reduce Medicaid births without reducing health care available to low-income women include stimulating economic growth and expanding access to family planning resources. This analysis does not find evidence that pro-marriage policies would reduce Medicaid births.

Monitoring the impact of human papillomavirus vaccines on high-grade pre-invasive cervical lesions: Designing a framework of linked immunization information system and cancer registry data in Michigan

State immunization and cancer registries contain data that, if linked, could be used to monitor the impact of human papillomavirus (HPV) vaccine on cervical cancer and precancer. Michigan is uniquely positioned to examine these outcomes using two population-based resources: the state-wide cancer registry and immunization information system (IIS).We assessed the feasibility of identifying females in the IIS who had continuous Michigan residence and linking them to the cancer registry. We considered continuous residence necessary for future studies of vaccine impact to avoid misclassifying those who may have been immunized while residing out-of-state and whose immunization therefore may not have been reported in Michigan.We identified females with 1976–1996 birthdates in the IIS and used probabilistic linkage software to match them with Michigan birth records. A stratified random sample of IIS-birth matches was provided to a commercial locator service to identify females with continuous Michigan residence. Cervical carcinoma in situ cases diagnosed in 2006 among females aged 10 through 30 years were also matched with the birth records; cancer registry-birth matches were merged with the IIS-birth matches using the birth record identifier.Overall, 68% of the 1274,282 IIS and 61% of the 1358 cancer registry records could be matched with birth records. Among the sample of IIS-birth matches, most (86%) were continuous residents. Seventy percent or more of cancer registry-birth matches merged with IIS-birth matches for cases born after 1984.This is the first effort in the U.S. to show that linking records across IIS and cancer registries is practical and reasonably efficient. The increasing proportion of matches between the registries and live birth file with birth year, and the use of population-based data, strengthen the utility of this approach. Future steps include use of this method to examine incidence of cervical cancer precursors in HPV immunization-eligible females.

Life Course Variation in the Relation Between Maternal Marital Status and Preterm Birth

Maternal marriage is protective against preterm birth (PTB), whereas advanced maternal ageis associated with increased PTB risk. Because relations between social factors and health may vary during the life course, we assessed how the relation between marital status and PTB risk may change with maternal age. We assessed the interaction between marital status and maternal age as a determinant of PTB among all live singleton births in Michigan between 1995 and 2006. We also fit stratified models by race. We calculated absolute differences in predicted PTB as well as odds ratios of PTB by marital status for each age group. In adjusted models, there was a significant interaction (p(interaction)<.001) between marital status and maternal age. The predicted probability of PTB by marital status was marginally different among mothers ages 20-25 years (absolute difference of 1.5%); this difference was substantially greater (3.9% or greater) after 31 years of age. Odds of PTB followed a similar trajectory. Findings were similar among black and white mothers. The relationship between marriage and PTB may vary with maternal age suggesting that the influence of social factors on risk for adverse birth outcomes may differ through the maternal life trajectory. We discuss plausible explanations for these findings.

Changes in the Relationship between Marriage and Preterm Birth, 1989–2006

Maternal marriage has historically been protective against preterm birth (PTB); however, social norms and behaviors surrounding marriage have changed over time in the United States. We analyzed secular trends in the relationship between marriage and PTB. We collected data about all births in Michigan between 1989 and 2006 to assess (1) the relationship between marital status and PTB and moderately PTB risk by year, and (2) the relationship between married and unmarried status and PTB and moderately PTB by year relative to similar marital status in 1989. Among nearly 2.4 million births between 1989 and 2006, PTB risk among married mothers increased while risk among unmarried mothers decreased. In adjusted models, married status became less protective against PTB relative to unmarried status over time by year, and was associated with higher risk of PTB over time. Moderately PTB risk increased among both married and unmarried groups, but more so among married mothers. Our findings suggest that marriage is becoming less protective against PTB over time. The influence of social factors on risk for adverse birth outcomes is likely dynamic, suggesting that ongoing revisions to our understanding are in order.

Population-Based Analysis of Survival for Hypoplastic Left Heart Syndrome

To analyze survival patterns among infants with hypoplastic left heart syndrome (HLHS) in the State of Michigan. Cases of HLHS prevalent at live birth were identified and confirmed within the Michigan Birth Defects Registry from 1992 to 2005 (n=406). Characteristics of infants with HLHS were compared with a 10:1 random control sample. Compared with 4060 control subjects, the 406 cases of HLHS were more frequently male (62.6% vs 51.4%), born prematurely (<37 weeks gestation; 15.3% vs 8.7%), and born at low birth weight (LBW) (<2.5 kg; 16.0% vs 6.6%). HLHS 1-year survival rate improved over the study period (P=.041). Chromosomal abnormalities, LBW, premature birth, and living in a high poverty neighborhood were significantly associated with death. Controlling for neighborhood poverty, term infants versus preterm with HLHS or LBW were 3.2 times (95% CI: 1.9-5.3; P<.001) more likely to survive at least 1 year. Controlling for age and weight, infants from low-poverty versus high-poverty areas were 1.8 times (95% CI: 1.1-2.8; P=.015) more likely to survive at least 1 year. Among infants with HLHS in Michigan, those who were premature, LBW, had chromosomal abnormalities, or lived in a high-poverty area were at increased risk for early death.

Validation of an Arab name algorithm in the determination of Arab ancestry for use in health research

Objective. Data about Arab-Americans, a growing ethnic minority, are not routinely collected in vital statistics, registry, or administrative data in the USA. The difficulty in identifying Arab-Americans using publicly available data sources is a barrier to health research about this group. Here, we validate an empirically based probabilistic Arab name algorithm (ANA) for identifying Arab-Americans in health research. Design. We used data from all Michigan birth certificates between 2000 and 2005. Fathers' surnames and mothers' maiden names were coded as Arab or non-Arab according to the ANA. We calculated sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of Arab ethnicity inferred using the ANA as compared to self-reported Arab ancestry. Results. Statewide, the ANA had a specificity of 98.9%, a sensitivity of 50.3%, a PPV of 57.0%, and an NPV of 98.6%. Both the false-positive and false-negative rates were higher among men than among women. As the concentration of Arab-Americans in a study locality increased, the ANA false-positive rate increased and false-negative rate decreased. Conclusion. The ANA is highly specific but only moderately sensitive as a means of detecting Arab ancestry. Future research should compare health characteristics among Arab-American populations defined by Arab ancestry and those defined by the ANA.

The association between pregnancy weight gain and birthweight: a within-family comparison

Excessive weight gain during pregnancy seems to increase birthweight and the offspring's risk of obesity later in life. However, this association might be confounded by genetic and other shared effects. We aimed to examine the association between maternal weight gain and birthweight using state-based birth registry data that allowed us to compare several pregnancies in the same mother. In this population-based cohort study, we used vital statistics natality records to examine all known births in Michigan and New Jersey, USA, between Jan 1, 1989, and Dec 31, 2003. From an initial sample of women with more than one singleton birth in the database, we made the following exclusions: gestation less than 37 weeks or 41 weeks or more; maternal diabetes; birthweight less than 500 g or more than 7000 g; and missing data for pregnancy weight gain. We examined how differences in weight gain that occurred during two or more pregnancies for each woman predicted the birthweight of her offspring, using a within-subject design to reduce confounding to a minimum. Our analysis included 513 501 women and their 1 164 750 offspring. We noted a consistent association between pregnancy weight gain and birthweight (β 7·35, 95% CI 7·10-7·59, p<0·0001). Infants of women who gained more than 24 kg during pregnancy were 148·9 g (141·7-156·0) heavier at birth than were infants of women who gained 8-10 kg. The odds ratio of giving birth to an infant weighing more than 4000 g was 2·26 (2·09-2·44) for women who gained more than 24 kg during pregnancy compared with women who gained 8-10 kg. Maternal weight gain during pregnancy increases birthweight independently of genetic factors. In view of the apparent association between birthweight and adult weight, obesity prevention efforts targeted at women during pregnancy might be beneficial for offspring. US National Institutes of Health.

Community context, acculturation and low-birth-weight risk among Arab Americans: evidence from the Arab–American birth-outcomes study

BackgroundAn assessment was made as to whether maternal residence in areas with high Arab–American concentrations, hence with expected low acculturation for this ethnic group, was associated with low-birth-weight (<2500 g)...

Methodological Innovations in Data Gathering: Newborn Screening Linkage with Live Births Records, Michigan, 1/2007–3/2008

To match Michigan birth and newborn screening records to identify and follow-up potentially unscreened infants, assess data quality, and demonstrate the utility of Link Plus linkage software for matching MCH related administrative datasets. Birth and newborn screening records maintained by the Michigan Department of Community Health from January 2007 through March 2008 were used in this study. Link Plus, a freely-available probabilistic record linkage software program developed at the Centers for Disease Control and Prevention, was used to match records. Linkage performance was assessed by the linkage success rate (percentage of valid matches). Follow-up of un-matched records was conducted by the Michigan Newborn Screening Follow-up Program. Nearly all (99.2%) of the 142,178 birth records included in this study were successfully matched to newborn screening records. Following a transition to a web-based electronic birth certificate system and inclusion of a newborn screening card identification number on the birth record in 2008, the linkage success rate increased to 99.6% based on analysis of approximately 18,000 records. Of approximately 600 un-matched records, nearly half had received a newborn screen. Approximately 8% of un-matched records were due to parental refusal of newborn screening. Nine children received an initial screen as a result of this study; one was confirmed as having sickle cell trait. We have demonstrated that a freely available record linkage software, Link Plus, can be used to successfully match records of MCH databases thereby providing an opportunity for further research and quality assurance investigations.

Explaining the Low Risk of Preterm Birth Among Arab Americans in the United States: An Analysis of 617451 Births

Arab Americans have a lower risk for preterm birth than white Americans. We assessed factors that may contribute to the association between ethnicity and preterm birth risk in Michigan, the state with the largest concentration of Arab Americans in the United States. Factors assessed as potential contributors to the ethnicity/preterm birth risk association were maternal age, parity, education, marital status, tobacco use, and maternal birthplace. Data were collected about all births in Michigan between 2000 and 2005. Stratified analyses, trivariate analyses, and manual stepwise logistic regression model building were used to assess potential contributors to the ethnicity/preterm birth risk association. Arab ethnicity was associated with lower preterm birth risk compared with non-Arab white subjects in the unadjusted model. Maternal birthplace inside or outside the United States explained 0.17 of the difference in preterm birth risk between Arab ethnicity and non-Arab white mothers; ethnic differences in marital status and tobacco use explained less of the observed ethnic difference in preterm birth risk. In the final model adjusted for all explanatory variables, Arab ethnicity was no longer associated with preterm birth risk. Maternal birthplace, marital status, and tobacco use may contribute to the preterm birth risk difference between Arab ethnicity and non-Arab white mothers. Additional work is needed to consider the mechanisms relating factors such as maternal birthplace and marital status to ethnic differences in preterm birth risk.