Standard Birth Certificate Research Articles

Geocoding precision of birth records from 2008 to 2017 in Kentucky, USA.

Maternal address information captured on birth records is increasingly used to estimate residential environmental exposures during pregnancy. However, there has been limited assessment of the geocoding precision of birth records, particularly since the adoption of the 2003 standard birth certificate in 2015. To address this gap, this study evaluated the geocoding precision of live and stillbirth records of Kentucky residents over ten years, from 2008 through 2017. This study summarized the demographic characteristics of imprecisely geocoded records and, using a bivariate logistic regression, identified covariates associated with poor geocoding precision among three population density designations-metro, non-metro, and rural. We found that in metro areas, after adjusting for area deprivation, education, and the race, age and education of both parents, records for Black mothers had 48% lower odds of imprecise geocoding (aOR=0.52, 95% CI: 0.48, 0.56), while Black women in rural areas had 96% higher odds of imprecise geocoding (aOr=1.96, 95% CI: 1.68, 2.28). This study also found that over the study period, rural and non-metro areas began with a high proportion of imprecisely geocoded records (38% in rural areas, 19% in non-metro), but both experienced an 8% decline in imprecisely geocoded records over the study period (aOr=0.92, 95% CI: 0.92, 0.94). This study shows that, while geocoding precision has improved in Kentucky, further work is needed to improve geocoding in rural areas and address racial and ethnic disparities.

Does it matter when I quit? Could I just cut down some? Links between trimester‐specific smoking amount, preterm birth, and low birth weight

Substantial evidence demonstrates the harms of pregnancy smoking. Due to the need for very large data sets, less data exist to inform decisions about when quitting should occur, or whether a certain amount of reduction is beneficial. Our goal was to examine the effect of timing and amount of pregnancy smoking on low birth weight (LBW) and preterm birth (PTB). Data for 3 years of registered births in Tennessee were available and included standard birth certificate information. Of 241,616 women, 15.7% smoked at conception, and those who quit as early as the first trimester had significantly increased adjusted odds of LBW (27%) and PTB (14%) compared to nonsmokers, with this effect largely driven by smoking 10+ cigarettes per day. Smoking into the second trimester but quitting prior to the third also predicted increases in LBW and PTB compared to both not smoking at all and smoking only in the first trimester. Smoking to delivery predicted a 2.8-fold increased likelihood of LBW, and a 2.1-fold increased rate of PTB. Any level of smoking after the first trimester substantially increased the odds of poor outcomes compared to both nonsmoking and smoking only in the first trimester. Findings suggest that to avoid LBW or PTB, pregnant smokers should be advised that quitting completely by the end of the first trimester is important, and that continuing to smoke even <5 cigarettes per day after that point substantially increases the potential for of adverse outcomes.

Low birthweight in term singletons mediates the association between maternal smoking intensity exposure status and immediate neonatal intensive care unit admission: the E-value assessment

BackgroundResearch investigating the wellbeing of term neonates in the United States is scarce. The objectives of this study were to estimate the prevalence of low birthweight (LBW) and neonatal intensive care unit (NICU) admission among term singletons in association with maternal smoking intensity exposure status, to explore LBW as a mediator linking smoking to immediate newborn NICU transfer/admission, and to assess the potential impact of unmeasured confounding in effect estimates.MethodsThe Natality File of live births registered in the United States in 2016, the first year that all 50 states implemented the revised 2003 standard birth certificate, was restricted to singleton term births (37–41 completed weeks gestation). The prevalence of LBW (< 2500 g) and NICU transfer/admission was estimated across maternal demographic characteristics and smoking intensity status in early and in late pregnancy. Mediation analyses, based on the counterfactual approach, were conducted to examine the total effect (TE), controlled direct effect (CDE), natural direct (NDE) and indirect effects (NIE), and the percentage mediated through LBW. The E-values based on effect size estimates and on lower-bounds of 95% confidence intervals (CIs) assessed the potential impact of unmeasured confounding.ResultsNearly 6.8% of women smoked in early and in late pregnancy, most (36.4%) smoked at high intensity (≥ 10 cigarettes /day) and had the highest prevalence of LBW (6.7%) and NICU transfer/admission (7.0%). For the largest smoking intensity exposure category, the estimate of the TE was 1.68 (95% CI: 1.63, 1.73), of the NDE was 1.56 (95% CI: 1.51, 1.61), of the NIE was 1.08 (95% CI:1.07, 1.09), and the percentage mediated by LBW was 17.6%. The E-values for association estimates and for the lower-bounds of 95% CIs demonstrated the minimum strength of the potential unmeasured confounding necessary to explain away observed associations.ConclusionsThese findings fill a gap on the prevalence of LBW and NICU transfer/admission in term neonates of mothers who smoke and on the role of LBW linking to NICU placement, which could be used to update practitioners, to implement smoking cessation interventions, monitor trends, and to inform planning and allocation of healthcare resources.

208: By when do I have to quit? Could I just cut down some? Evidence to help inform difficult questions in pregnancy smoking interventions

Women who participate in pregnancy smoking interventions often do not quit smoking right away or completely. Due to the need for very large data sets, little evidence exists to inform advice about when quitting should occur, or whether a certain amount of reduction is beneficial. The goal of the current study was to examine the effect of timing of quitting and/or amount of smoking later in pregnancy on newborn birth weight, the birth outcome most often affected by smoking and highly predictive of other adverse events. Data for all births in Tennessee, a state with a high rate and amount of pregnancy smoking, were available for a three-year period and included standard birth certificate variables. Of the 241,616 women, 15.7% (n=37,975) self-reported entering pregnancy as smokers, with 20.4% (n=7,728) quitting by delivery, and another 31.7% (n=12,033) reporting smoking reduction. Compared to those who did not smoke at all, those who quit by the end of the first trimester had only a slightly increased risk of a low birth weight (LBW) delivery (OR=1.16). Overall, smoking into the second trimester but quitting prior to the third led to substantial increase in the likelihood of LBW (OR=1.70), and smoking to delivery nearly doubled the risk of LBW (OR=1.95). Several timing of quitting and amount of reduction patterns across the three trimesters were examined, with any smoking beyond the first trimester substantially increasing the risk of LBW over even smoking more than 10 cig/day in the first trimester then quitting (OR=1.30). Even smoking 5 or fewer cigarettes per day after the end of the first trimester only slightly decreased the risk of LBW compared with higher levels of smoking through to delivery (OR=.95). The self-report nature of the data poses some limitations, and other important outcomes besides LBW may reveal different results. However, these findings suggest that if the goal is to avoid a LBW delivery, pregnant smokers should be advised that quitting completely by the end of the first trimester is important, and that continuing to smoke even 5 cigarettes or fewer per day after that point substantially increases the risk that their newborn will be LBW.

Association Between Infant Mortality Attributable to Birth Defects and Payment Source for Delivery - United States, 2011-2013.

Birth defects are a leading cause of infant mortality in the United States (1), accounting for approximately 20% of infant deaths. The rate of infant mortality attributable to birth defects (IMBD) in the United States in 2014 was 11.9 per 10,000 live births (1). Rates of IMBD differ by race/ethnicity (2), age group at death (2), and gestational age at birth (3). Insurance type is associated with survival among infants with congenital heart defects (CHD) (4). In 2003, a checkbox indicating principal payment source for delivery was added to the U.S. standard birth certificate (5). To assess IMBD by payment source for delivery, CDC analyzed linked U.S. birth/infant death data for 2011-2013 from states that adopted the 2003 revision of the birth certificate. The results indicated that IMBD rates for preterm (<37 weeks of gestation) and term (≥37 weeks) infants whose deliveries were covered by Medicaid were higher during the neonatal (<28 days) and postneonatal (≥28 days to <1 year) periods compared with infants whose deliveries were covered by private insurance. Similar differences in postneonatal mortality were observed for the three most common categories of birth defects listed as a cause of death: central nervous system (CNS) defects, CHD, and chromosomal abnormalities. Strategies to ensure quality of care and access to care might reduce the difference between deliveries covered by Medicaid and those covered by private insurance.

Reliability of Reported Maternal Smoking: Comparing the Birth Certificate to Maternal Worksheets and Prenatal and Hospital Medical Records, New York City and Vermont, 2009.

Maternal smoking is captured on the 2003 US Standard Birth Certificate based on self-reported tobacco use before and during pregnancy collected on post-delivery maternal worksheets. Study objectives were to compare smoking reported on the birth certificate to maternal worksheets and prenatal and hospital medical records. The authors analyzed a sample of New York City (NYC) and Vermont women (n = 1,037) with a live birth from January to August 2009 whose responses to the Pregnancy Risk Assessment Monitoring System survey were linked with birth certificates and abstracted medical records and maternal worksheets. We calculated smoking prevalence and agreement (kappa) between sources overall and by maternal and hospital characteristics. Smoking before and during pregnancy was 13.7 and 10.4% using birth certificates, 15.2 and 10.7% using maternal worksheets, 18.1 and 14.1% using medical records, and 20.5 and 15.0% using either maternal worksheets or medical records. Birth certificates had "almost perfect" agreement with maternal worksheets for smoking before and during pregnancy (κ = 0.92 and 0.89) and "substantial" agreement with medical records (κ = 0.70 and 0.74), with variation by education, insurance, and parity. Smoking information on NYC and Vermont birth certificates closely agreed with maternal worksheets but was underestimated compared with medical records, with variation by select maternal characteristics. Opportunities exist to improve birth certificate smoking data, such as reducing the stigma of smoking, and improving the collection, transcription, and source of information.

The influence of misclassification bias on the reported rates of congenital anomalies on the birth certificates for West Virginia—A consequence of an open‐ended query

Passive surveillance for congenital anomalies using birth certificates are generally considered to have biased reporting, though the sources of those biases are not well-known nor controlled for. We have analyzed the congenital anomaly reporting data for 418,385 live births in West Virginia (1990-2009) from the 1989 US standard birth certificate and have newly identified a particular source of bias. Congenital anomaly prevalence rates per 100 live births have been determined for both specified birth defects and for other congenital anomalies by county, by hospital, and by year. Extreme outliers were identified by z score. Text strings for "other congenital anomaly" reports recorded for 1998-2009 were assessed for information on congenital anomalies. While rates for specified birth defects reported in checked-box format showed little variation, rates for "other congenital anomaly" collected in open-ended format showed much variation. Nearly half of the "other congenital anomaly" reports were for neonatal conditions rather than for major structural congenital anomalies. This misclassification alone had elevated the state-wide congenital anomaly reporting rate from 1.1 to 1.8% of live births. Geographic clustering and a temporal bulge in congenital anomaly reports disappeared after misclassified data were removed. Data collected in checked-box format on specified birth defects showed consistent patterns over time and space, while data collected in open-ended format on "other congenital anomalies" showed an epidemiological pattern reflecting neonatal conditions rather than birth defects. The 2003 US standard birth certificate wisely limits data collection to specified birth defects using the checked-box format.

History of the birth certificate: from inception to the future of electronic data

Enumerations of people were carried out long before the birth of Jesus. Data related to births were recorded in church registers in England as early as the 1500s. However, not until the 1902 Act of Congress was the Bureau of Census established as a permanent agency to develop birth registration areas and a standard registration system. Although all states had birth records by 1919, the use of the standardized version was not uniformly adopted until the 1930's. In the 1989 US Standard Birth Certificate revision, the format was finally uniformly adopted to include checkboxes to improve data quality and completeness. The evolution of the 12 federal birth certificate revisions is reflected in the growth of the number of items from 33 in 1900 to more than 60 items in the 2003 birth certificate. As birth registration has moved from paper to electronic, the birth certificate's potential utility has broadened, yet issues with updating the electronic format and maintaining quality data continue to evolve. Understanding the birth certificate within its historical context allows for better insight as to how it has been and will continue to be used as an important public-health document shaping medical and public policies.

Differences in Birth Weight for Gestational Age Distributions According to the Measures Used to Assign Gestational Age

Population-based standards for infant size for gestational age depend on accurate assessments of birth weight and gestational age; the accuracy of the latter measure has been questioned. The authors sought to explore how different methods of assigning gestational age in vital records data affect distributions of birth weight for gestational age. The 2005 US natality file was used to create 4 measures of gestational age for singleton births consisting of measures found on the 1989 (last menstrual period (LMP) and clinical estimate) and 2003 (LMP and obstetric estimate) revisions of the US standard birth certificate: clinical or obstetric estimate and LMP-based estimate agree within 7 days ("gold standard"); clinical estimate only; obstetric estimate only; and LMP-based estimate only. Birth weight for gestational age distributions differed according to the measurement of gestational age. Regardless of birth certificate revision, the median, 10th, and 90th percentile distributions were virtually identical for the gold standard, clinical estimate, and obstetric estimate. Birth weights for the LMP estimate were higher for preterm births and lower for postterm births for both birth certificate revisions. Agreement between the gold standard estimate and clinical and obstetric estimates of gestational age suggests that using the LMP-based estimate for establishing norms should be revisited.

Accuracy of assisted reproductive technology information on the Massachusetts birth certificate, 1997–2000

To evaluate the accuracy of assisted reproductive technology (ART) reporting on the Massachusetts birth certificate and to explore the individual and hospital-level characteristics associated with ART reporting. Validity analysis of population-based data. Live-birth deliveries by Massachusetts-resident mothers during 1997-2000. Live births and delivery mothers. The ART data maintained by the Centers for Disease Control and Prevention were linked with the live birth-infant death records in Massachusetts. Successfully linked records were used as the gold standard for ART-related deliveries in evaluating the validity of the ART information reported on the Massachusetts birth certificate. Sensitivity and specificity. The sensitivity of ART reporting on the birth certificate was 27% and the specificity >99%. Sensitivity of ART reporting was higher among women with multiple deliveries (twins: 32%; triplets+: 43%) and preterm deliveries (36%). During the period evaluated, reporting of ART information on the birth certificate was incomplete, and ART births identified through the birth certificate were a biased sample of the population of ART births. Using delivery hospital data as the sole source of ART information for the standard birth certificate may yield inaccurate information.

A Delay in Publication of the “Annual Summary of Vital Statistics” and the Need for New Vital Registration and Statistics Systems for the United States

Since 1950, an “Annual Summary of Vital Statistics” article has appeared in every December issue of Pediatrics . For 44 years, the article was written by Myron Wegman,1 a pediatrician and public health leader, who died earlier this year at the age of 95.2 Since 1995, the article has been authored by a group of colleagues from the National Center for Health Statistics (NCHS) and the Johns Hopkins Bloomberg School of Public Health.3 The goal of the article has been to keep pediatricians and public health officials up to date with the changing indicators of reproductive, perinatal, and children’s health in the United States. The delay in publishing this year’s “Annual Summary” requires an explanation to the many readers who have come to expect it. The specific reason for the delay is late receipt of data from some states. This lack of timeliness is attributed to state systems that were not easily modified to handle the new data standards for the 2003 … Address correspondence to Bernard Guyer, MD, MPH, Zanvyl Krieger Professor of Children’s Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E4146, Baltimore, MD 21205. E-mail: bguyer{at}jhsph.edu

Maternal smoking and birth defects: validity of birth certificate data for effect estimation.

The authors sought to assess the validity of birth certificate data for estimating the association between maternal smoking and birth defects. The US standard birth certificate includes check boxes for maternal smoking and for 21 congenital anomalies. The sensitivity and specificity of birth certificate data have been studied, but previous studies have not addressed the validity of these data for estimating the association between birth defects and maternal smoking or other risk factors. US public-use natality data (1997-1998) were used to calculate the prevalence ratio (adjusted for maternal age, race/ethnicity, and education) for the association between maternal smoking and 13 defects/defect categories. All analyses were restricted to 45 states, New York City, and the District of Columbia because they collect both maternal smoking and birth defect data. Maternal smoking was associated with an increased prevalence of hydrocephaly (adjusted prevalence ratio [PR] = 1.24; 95% confidence interval [CI] = 1.08, 1.43), microcephaly (PR 1.47; 95% CI 1.15, 1.88), omphalocele/gastroschisis (PR 1.37; 95% CI 1.22, 1.53), cleft lip/palate (PR 1.35; 95% CI 1.25, 1.45), clubfoot (PR 1.62; 95% CI 1.49, 1.75), and polydactyly/syndactyly/adactyly (PR 1.33; 95% CI 1.23, 1.43 ). Previous studies have indicated an association between maternal smoking and gastroschisis, oral clefts, and clubfoot with effect estimates of similar magnitude to this study. These findings suggest that birth certificate data may be useful for exploratory or corroborative studies estimating the association between birth defects and some risk factors recorded on birth certificates.

The surveillance of birth defects: the usefulness of the revised US standard birth certificate.

To assess the sensitivity and positive predictive value of birth defects reported on the 1989 revision of the US Standard Birth Certificate, a population of 76,862 Atlanta-area births during 1989 and 1990 was used as the basis for comparing 771 birth certificates that reported birth defects with 2428 live-born infant records in a birth defects registry that uses multiple sources of case ascertainment. Only 14% of birth defects in the registry records were reported on birth certificates. After the analysis was restricted to defects recognizable at birth, the sensitivity and positive predictive value of the birth certificates were 28% and 77%, respectively. Birth certificates underestimate birth defect rates and should be used cautiously for birth defect surveillance and epidemiological studies.

Birth registration: Nurse-midwifery roles and responsibilities

The birth certificate is not only an official, legal document, but also provides critical health planning and research data. This article provides an overview of birth registration in the United States, discusses the functions of the National Center for Health Statistics (NCHS), delineates the role of the CNM in birth certification, presents information regarding the 1989 Revised Standard Birth Certificate, and examines the quality and uses of birth certificate data. The implications of this information about vital statistics for nurse-midwifery practice, research and education are discussed and specific suggestions are made for improving the accuracy of birth registration data provided by CNMs.