US Birth Research Articles

Parity Moderates the Socioeconomic Predictors of Birth Setting Choice.

The increase in the number of people choosing community birth has raised interest in understanding the factors that influence birth setting choices. This study investigates how parity influences the association between maternal socioeconomic factors and choice of community versus hospital birth. We used 2009-2021 US birth certificate data to identify community births (planned home or birth center births), parity, and maternal characteristics, including Women, Infants, and Children (WIC) program participation, race, ethnicity, educational attainment, marital status, body mass index (BMI), and age. Parity was interacted with each covariate in a multivariable logistic regression model of birth setting. Among 26,526,010 eligible births, 58% were to multiparous mothers, with 1.9% occurring in a birth center or at home. For most maternal characteristics, associations with community birth were stronger in the multiparous group compared to the nulliparous group. For example, being married was associated with greater odds of community birth in both groups, but the strength of this association was greater within the multiparous group (odds ratio 4.00 vs. 1.94, interaction p < 0.001). The same pattern (stronger association with community birth in the multiparous group than in the primiparous group) was observed for race/ethnicity, educational attainment, and WIC participation, all of which were associated with lower odds of community birth. This study shows that parity significantly moderates associations between maternal socioeconomic characteristics and birth setting, implying studies of decision-making in this context should purposively stratify samples and analyses by parity.

The maternal and infant health consequences of restricted access to abortion in the United States

Since the recent US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the history of abortion access in the United States to inform predictions for this new future. I study the effects of targeted regulations on abortion providers (TRAP laws) on a variety of maternal and infant health outcomes, using variation in the timing of policy adoption across states and a direct measure of the distance to an abortion provider. I implement difference-in-differences techniques across outcomes from restricted-use microdata on the universe of US births. I find that TRAP laws lead to 11–16 % increased rates of hypertensive disorders of pregnancy. Additionally, I find evidence that TRAP laws widen existing disparities in adverse infant health outcomes across parental race. These results demonstrate the potentially wide-ranging health effects of restricting access to abortion.

Reexamining the causes of age patterns in Black-White birth weight disparities: Evidence from U.S. cohorts

Black-White disparities in low birth weight (LBW) rise with maternal age. Why? The “weathering hypothesis” holds that the increasing disparity is due to the accumulation of adverse exposures leading to accelerated aging among Black compared to White mothers. Using US birth certificate data covering millions of births to successive cohorts of US women, this paper finds two sets of results that complicate this theory. Descriptively, I find that Black-White LBW disparities increase with age for some cohorts but not others. More causally, analyses exploiting a plausibly exogenous policy shock show that the effects of reducing adverse exposures were larger for older compared to younger mothers. This evidence points toward an alternative or complementary hypothesis: that LBW risks are more responsive to adverse exposures at older maternal ages than at younger ages. Emphasizing this pathway -- what I call “responsiveness” -- as opposed to accumulation has important implications for both research and policy.

Sociodemographic Trends and Perinatal Outcomes in Fathers 50 Years and Older

The age of fathers at childbirth is rising, with an increasing number of births attributed to older fathers. While the impact of advanced paternal age has been documented, sociodemographic data about fathers aged 50 years and older remain scarce. To explore sociodemographic and temporal trends among the oldest US fathers (age ≥50 years) and their associations with perinatal outcomes. This retrospective cross-sectional study included data from all US births from 2011 to 2022 using the National Vital Statistics System. Data were analyzed from August 2023 and May 2024. Reported paternal age at childbirth. Outcomes of interest were sociodemographic factors, temporal trends in older fatherhood, and perinatal outcomes, including preterm birth, low birth weight, gestational diabetes, gestational hypertension, assisted reproductive technology (ART), rates of maternal primiparity, and the infant sex ratio. From 2011 to 2022, the US recorded 46 195 453 births, with an overall mean (SD) paternal age of 31.5 (6.8) years and 484 507 (1.1%) involving fathers aged 50 years or older, 47 785 (0.1%) aged 60 years or older, and 3777 (0.008%) aged 70 years or older. Births to fathers aged 50 years or older increased from 1.1% in 2011 to 1.3% in 2022 (P for trend < .001). Fathers aged 50 years or older were more diverse, with variations in educational achievement and race and ethnicity. Marital status and maternal racial and ethnic and educational backgrounds also varied by paternal age and race. Despite controlling for maternal age and other sociodemographic and perinatal factors, every 10-year increase in paternal age was consistently associated with greater use of ART (eg, age 50-59 years: adjusted odds ratio [aOR], 2.23; 95% CI, 2.19-2.27), higher likelihood of first maternal birth (eg, age 50-59 years: aOR, 1.16; 95% CI, 1.15-1.17), and increased risks of preterm birth (eg, age 50-59 years: aOR, 1.16; 95% CI, 1.15-1.18) and low birth weight (eg, age 50-59 years: aOR, 1.14; 95% CI, 1.13-1.15) compared with fathers aged 30 to 39 years. No significant changes in the infant sex ratio were observed, except among fathers aged 70 years or older (aOR, 0.92; 95% CI, 0.86-0.99) and 75 years or older (aOR, 0.84; 95% CI, 0.73-0.97), who showed a decreased likelihood of having male offspring. In this cross-sectional study of all US births from 2011 to 2022, the percentage attributed to older fathers, while small, increased. Notable variations in paternal and maternal race and education were identified. Older fatherhood was associated with increased ART use, first-time maternal births, adverse perinatal outcomes, and altered sex ratio. Further research of this population is crucial for improving patient counseling and family planning.

Childhood Maltreatment and Longitudinal Epigenetic Aging

Child physical and emotional abuse and neglect may affect epigenetic signatures of accelerated aging several years after the exposure. To examine the longitudinal outcomes of early-childhood and midchildhood exposures to maltreatment on later childhood and adolescent profiles of epigenetic accelerated aging. This cohort study used data from the Future of Families and Child Wellbeing Study (enrolled 1998-2000), a US birth cohort study with available DNA methylation (DNAm) data at ages 9 and 15 years (assayed between 2017 and 2020) and phenotypic data at birth (wave 1), and ages 3 (wave 3), 5 (wave 4), 9 (wave 5), and 15 (wave 6) years. Data were analyzed between June 18 and December 10, 2023. Emotional aggression, physical assault, emotional neglect, and physical neglect via the Parent-Child Conflict Tactics Scale at ages 3 and 5 years. Epigenetic accelerated aging (DNAmAA) was measured using 3 machine learning-derived surrogates of aging (GrimAge, PhenoAge, and DunedinPACE) and 2 machine learning-derived surrogates of age (Horvath and PedBE), residualized for age in months. A total of 1971 children (992 [50.3%] male) representative of births in large US cities between 1998 and 2000 were included. Physical assault at age 3 years was positively associated with DNAmAA for PhenoAge (β = 0.073; 95% CI, 0.019-0.127), and emotional aggression at age 3 years was negatively associated with PhenoAge DNAmAA (β = -0.107; 95% CI, -0.162 to -0.052). Emotional neglect at age 5 years was positively associated with PhenoAge DNAmAA (β = 0.051; 95% CI, 0.006-0.097). Cumulative exposure to physical assault between ages 3 and 5 years was positively associated with PhenoAge DNAmAA (β = 0.063; 95% CI, 0.003-0.123); emotional aggression was negatively associated with PhenoAge DNAmAA (β = -0.104; 95% CI, -0.165 to -0.043). The association of these measures with age 15 years PhenoAge DNAmAA was almost fully mediated by age 9 years PhenoAge DNAm age acceleration. Similar patterns were found for GrimAge, DunedinPACE, and PhenoAge, but only those for PhenoAge remained after adjustments for multiple comparisons. In this cohort study, altered patterns of DNAmAA were sensitive to the type and timing of child maltreatment exposure and appeared to be associated with more proximate biological embedding of stress.

Preterm and Early-Term Delivery After Heat Waves in 50 US Metropolitan Areas

Heat waves are increasing in frequency, intensity, and duration and may be acutely associated with pregnancy outcomes. To examine changes in daily rates of preterm and early-term birth after heat waves in a 25-year nationwide study. This cohort study of singleton births used birth records from 1993 to 2017 from the 50 most populous US metropolitan statistical areas (MSAs). The study included 53 million births, covering 52.8% of US births over the period. Data were analyzed between October 2022 and March 2023 at the National Center for Health Statistics. Daily temperature data from Daymet at 1-km2 resolution were averaged over each MSA using population weighting. Heat waves were defined in the 4 days (lag, 0-3 days) or 7 days (lag, 0-6 days) preceding birth. Daily counts of preterm birth (28 to <37 weeks), early-term birth (37 to <39 weeks), and ongoing pregnancies in each gestational week on each day were enumerated in each MSA. Rate ratios for heat wave metrics were obtained from time-series models restricted to the warm season (May to September) adjusting for MSA, year, day of season, and day of week, and offset by pregnancies at risk. There were 53 154 816 eligible births in the 50 MSAs from 1993 to 2017; 2 153 609 preterm births and 5 795 313 early-term births occurring in the warm season were analyzed. A total of 30.0% of mothers were younger than 25 years, 53.8% were 25 to 34 years, and 16.3% were 35 years or older. Heat waves were positively associated with daily rates of preterm and early-term births, showing a dose-response association with heat wave duration and temperatures and stronger associations in the more acute 4-day window. After 4 consecutive days of mean temperatures exceeding the local 97.5th percentile, the rate ratio for preterm birth was 1.02 (95% CI, 1.00-1.03), and the rate ratio for early-term birth was 1.01 (95% CI, 1.01-1.02). For the same exposure, among those who were 29 years of age or younger, had a high school education or less, and belonged to a racial or ethnic minority group, the rate ratios were 1.04 (95% CI, 1.02-1.06) for preterm birth and 1.03 (95% CI, 1.02-1.05) for early-term birth. Results were robust to alternative heat wave definitions, excluding medically induced deliveries, and alternative statistical model specifications. In this cohort study, preterm and early-term birth rates increased after heat waves, particularly among socioeconomically disadvantaged subgroups. Extreme heat events have implications for perinatal health.

Prepandemic Factors Associated With Pandemic Impact and Psychosocial Distress Among Mothers of Young Children

ObjectiveTo describe the Coronovirus 19 (COVID-19) pandemic impact among mothers of young children (0–8 years) and assess prepandemic factors associated with greater pandemic impact and psychosocial distress. MethodsMothers from 3 US birth cohorts (n = 301, mean child age 2.4 years) reported on demographics and psychosocial distress (anxiety, perceived stress, financial stress) before the pandemic (February 2015–February 2020). During the pandemic (July 2020–June 2021), they completed a supplemental survey about the impact of the pandemic on their families (Coronavirus Impact Scale) and psychosocial distress. Multivariable linear and ordinal logistic regression were used to evaluate prepandemic factors associated with pandemic impact overall and by domain. ResultsCompared to prepandemic reports, maternal anxiety symptoms increased by 9.4%, perceived stress increased by 13.3%, and financial stress increased by 41.7%, of which all were statistically significant changes. Participants reported the most severe pandemic impact in family routines (72.4%), experiences of stress (40.2%), and social support (38.6%). Mothers with some college or a 4-year degree experienced higher overall pandemic impact compared to mothers with the least and highest education. Prepandemic distress was not associated with pandemic impact; however, midpandemic, all 3 distress measures were significantly positively associated with overall Coronavirus Impact Scale, with the largest effect size noted for perceived stress (B = 1.36, 95% CI: 0.90,1.82). ConclusionsWhile, on average, mothers of young children experienced worsening psychosocial stress during the COVID-19 pandemic, prepandemic psychosocial stress alone was not prospectively associated with greater pandemic impact, suggesting that the COVID-19 pandemic may have both elaborated existing systemic social inequalities and created new burdens.

School racial/ethnic composition, effect modification by caring teacher/staff presence, and mid-/late-life depressive symptoms: findings from the Study of Healthy Aging in African Americans.

For Black students in the United States, attending schools with a higher proportion of White students is associated with worse mental and physical health outcomes in adolescence/early adulthood. To our knowledge, no prior studies have evaluated the association between school racial/ethnic composition from kindergarten through grade 12 and later-life mental health. In a cohort of Black adults aged ≥50 years in Northern California who retrospectively reported (2017-2020) school racial/ethnic composition for grades 1, 6, 9, and 12, we assessed the association between attending a school with mostly Black students versus not and mid-/late-life depressive symptoms (8-item Patient-Reported Outcomes Measurement Information System (PROMIS) depression score, standardized to the 2000 US adult population) using age-, sex/gender-, southern US birth-, and parental education-adjusted generalized estimating equations, and assessed effect modification by the presence of a caring teacher/staff member. Levels of later-life depressive symptoms were lower among those who attended schools with mostly Black students in grades 1 and 6 (β = -0.12 [95% CI, -0.23 to 0.00] and β = -0.11 [95% CI, -0.22 to 0.00], respectively). In grade 6, this difference was larger for students without an adult at school who cared about them (β = -0.29 [95% CI, -0.51 to -0.07] vs β = -0.04 [95% CI, -0.17 to 0.09]). Among Black Americans, experiencing early schooling with mostly Black students may have later-life mental health benefits; this protective association appears more important for students without the presence of caring teachers/staff. This article is part of a Special Collection on Mental Health.

ACNM's Commentary on the Midwifery Workforce in the US.

The American College of Nurse-Midwives (ACNM) represents certified nurse-midwives (CNMs) and certified midwives (CMs) who are graduate-prepared advanced practice providers. They attend educational programs accredited by the American Commission for Midwifery Education (ACME) and are certified by the American Midwifery Certification Board (AMCB). Their scope of practice as defined by ACNM includes primary care, reproductive services beginning with menarche through menopause, gender-affirming services, contraception, abortion, prenatal, birth, postpartum, and care of the newborn. CNMs/CMs attend 10.9% of US births, but other high-income countries have the reverse proportion of midwives to obstetricians. The CNM/CM workforce is growing, but retirements and attrition slow the growth. Research demonstrates good outcomes from care provided by midwives, and ACNM's primary goal is to expand the midwifery workforce and increase consumer access to midwifery care to mitigate the persistent rise in maternal mortality and morbidity. Barriers to workforce expansion include restricted practice at the state level, inability to expand the number of seats in education programs due to lack of clinical preceptors, and a lack of diversity in the workforce. Strategies to address these barriers may allow the workforce to grow, increasing access to high-quality, equitable sexual and reproductive care for people in the United States.

Association of Food Desert Residency and Preterm Birth in the United States.

Food deserts are a major public health concern. Inadequate access to healthy food has been associated with poor nutrition and the development of dietary related chronic conditions. To determine the association between geographic access to nutritious food and preterm birth and whether gestational hypertension mediates this relationship. Food access data was retrieved from the U.S. Department of Agriculture Food Access Research Atlas (2019) and used to quantify the percentage of Census tracts within each county that were food deserts: low-income tracts with limited access to grocery stores, supermarkets, or other sources of healthy, nutritious foods. These data were merged with US birth records from 2018 to 2019 by using the maternal county of residence (n = 7,533,319). We fit crude and adjusted logistic regression models with generalized estimating equations to determine the association between living in a food desert and the odds of preterm birth. We conducted a secondary within-group analysis by stratifying the fully adjusted model by race for non-Hispanic White and non-Hispanic Black birthing people. In the fully adjusted model, we found a dose-response relationship. As the prevalence of tract-level food deserts within counties increased, so did the likelihood of preterm birth (mid-range: odds ratio (OR) = 1.04, 95% confidence interval (C.I.) 1.01-1.07; high: OR = 1.07, 95% C.I. 1.03-1.11). Similar results were seen in the White-Black stratified models. However, a disparity remained as Black birthing people had the highest odds for preterm birth. Lastly, gestational hypertension appears to mediate the relationship between nutritious food access and preterm birth (natural indirect effect (NIE) = 1.01, 95% CI = 1.00, 1.01). It is salient, particularly for Black birthing people who experience high rates of adverse birth outcomes, that the role of food desert residency be explored within maternal and child health disparities.

The importance of community resources for breastfeeding

BackgroundBreastfeeding has long-lasting effects on children’s cognition, behavioral, mental and physical health. Previous research shows parental characteristics (e.g., education, race/ethnicity, income level) are associated with breastfeeding initiation and duration. Further, research shows significant variation in access to community resources by race/ethnicity. It is unclear how community resources may impact breastfeeding practices and how this might intersect with maternal race/ethnicity.MethodsThis study combined nationally-representative data from the Study of Attitudes and Factors Effecting Infant Care (SAFE), which surveyed US mothers immediately after the infant’s birth and at two to six months of infant age, with the Child Opportunity Index (COI) 2.0, a census tract measure of community resources associated with child development, to explore the association between community resources and breastfeeding initiation and whether this varies based on maternal race/ethnicity and country of birth. The SAFE Study used a stratified, two-stage, clustered design to obtain a nationally representative sample of mothers of infants, while oversampling Hispanic and non-Hispanic (NH) Black mothers. The SAFE study enrolled mothers who spoke English or Spanish across 32 US birth hospitals between January 2011 and March 2014.ResultsAfter accounting for individual characteristics, mothers residing in the highest-resourced communities (compared to the lowest) had significantly greater likelihood of breastfeeding. Representation in higher-resourced communities differed by race/ethnicity. Race/ethnicity did not significantly moderate the association between community resources and breastfeeding. In examining within race/ethnic groups, however, community resources were not associated with non-US born Black and Hispanic mothers’ rates of breastfeeding, while they were with US born Black and Hispanic mothers.ConclusionsFindings suggest that even health behaviors like breastfeeding, which we often associate with individual choice, are connected to the community resources within which they are made. Study implications point to the importance of considering the impact of the contextual factors that shape health and as a potential contributor to understanding the observed race/ethnicity gap.

Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women.

American Indian/Alaska Native (AI/AN) women experience distinct political and health care environments and possess unique health risks and resources. We tested whether state Medicaid expansions under the Affordable Care Act were associated with health insurance, prenatal care, health conditions, and birth outcomes among AI/AN women. Using data from the 2010-19 American Community Survey and 2010-19 US birth certificates, we used a difference-in-differences study design to compare outcomes among AI/AN women before and after Medicaid expansions. Medicaid expansions increased the proportion of AI/AN women reporting health care coverage from both Medicaid and the Indian Health Service (IHS), with larger effects among women living in areas with relatively high percentages of reservation land. Consistent with prior research on the broader population of women, Medicaid expansions had no effects on first-trimester prenatal care usage or birthweight among AI/AN women. We found mixed evidence of increased rates of prepregnancy chronic conditions after the expansions. Our findings demonstrate the importance of Medicaid, the IHS, and tribal health systems as sources of health care coverage for AI/AN women of childbearing age.

Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens Collected Longitudinally in Healthy Children in a US Birth Cohort.

Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort. Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression. From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not. Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding.

Maternal Smoking and Risk of Hypertensive Disorders of Pregnancy: Effect Modification by Body Mass Index and Gestational Weight Gain.

Although smoking cigarettes has been shown to have a protective effect on preeclampsia, quitting smoking also results in weight gain. Weight gain leading to an obese body mass index is a risk factor for hypertensive disorders of pregnancy (HDP). The objective of this study was to explore the relationship between smoking status, body mass index, and gestational weight gain on the risk of HDP. A cross-sectional analysis was performed utilizing US birth certificate data. We examined HDP risks in relation to maternal smoking, body mass index, and gestational weight gain. Associations were expressed as rate ratios with 95% CIs and adjusted for potential confounders. Clinically important outcomes of smoking throughout pregnancy were also evaluated. Of the 22 191 568 women studied, HDP rates among nonsmokers, those who quit smoking, and persistent smokers were 6.8%, 8.6%, and 7.0%, respectively. The rate ratio of HDP was higher for women who quit smoking, especially evident among those with excessive gestational weight gain. Corrections for exposure misclassification and unmeasured confounding strengthened the associations among women who quit smoking. There was an almost 6-fold increase in the rate of stillbirth for persistent smokers (2.3%) compared with those who quit smoking (0.4%) and nonsmokers (0.4%). Women who quit smoking during pregnancy were more likely to gain excessive weight and develop HDP. Although quitting smoking during pregnancy may be associated with an increase in the risk of HDP, it is also associated with a reduced risk of stillbirth. Pregnant women counseled to quit smoking should also receive counseling on nutrition and exercise to prevent excessive gestational weight gain.

Factors Associated with Fetal Growth in Pregnancies Complicated by Type 2 Diabetes Mellitus

Background and Hypothesis:The prevalence of type 2 diabetes (T2DM) is increasing, and it is associated with an increased risk for adverse perinatal outcomes. Fetal overgrowth is associated with an increased risk for obesity and diabetes in offspring of individuals with type 2 diabetes, and we sought to identify factors associated with excess fetal growth in pregnant individuals with T2DM.&#x0D; Experimental Design or Project Methods:This was a retrospective cohort study of 350 pregnant individuals with T2DM who delivered at IU Health Hospitals or Eskenazi Hospital from January 1, 2019-December 31,2021. We excluded pregnancies complicated by twin gestation or stillbirth. Maternal demographic data and perinatal outcomes were abstracted from the electronic medical record. Birth weights were classified as small for gestational age (SGA; &lt;10th percentile), appropriate for gestational age (AGA; 10-90th percentile), and large for gestational age (LGA; &gt;90th percentile) using a US birth weight standard. Maternal characteristics and pregnancy outcomes were compared across the 3 categories using ANOVA and chi squared statistic. Multinomial logistic regression was used to identify factors associated with birth weight category.&#x0D; Results:LGA birth weight occurred in 95 (27%) and SGA birth occurred in 32 (9%) of pregnancies. After adjusting for covariates, HbA1c after 20 weeks’ gestation was significantly associated with risk for SGA birth weight (aOR 0.4, 95% CI 0.19-0.94) and LGA birth weight (aOR 1.47, 95% CI 1.10-1.96). Individuals requiring treatment with both insulin and oral agents at the first prenatal visit were at increased risk for LGA birth weight (aOR 4.49, 95% CI 1.43-14.10).&#x0D; Conclusion and Potential Impact:Our findings highlight the important relationship between glycemic control in the second half of pregnancy and fetal growth. Additional research is needed to optimize glycemic control in pregnant individuals with T2DM.

Cleft lip and/or palate mortality trends in the USA: a retrospective population-based study

BackgroundCleft lip and/or palate (CL/P) is one of the most common congenital anomalies worldwide. Although CL/P management may require a series of interventions, mortality resulting from CL/P alone is rare....

909 Optimally timed antenatal corticosteroids over a 5-year period in a large US birth cohort

909 Optimally timed antenatal corticosteroids over a 5-year period in a large US birth cohort

Declining birth rates, increasing maternal age and neonatal intensive care unit admissions.

To describe the number of US births, maternal age at birth and NICU admissions by maternal age cohorts. Our study aims to measure NICU utilization by maternal age over time. We queried the CDC WONDER Natality database for births, NICU admissions, and maternal age at delivery from 2016 to 2021. Births and NICU admissions were analyzed by maternal age. Between 2016 and 2021, US births decreased by 7% (3,945,875 to 3,664,292/year). NICU admissions increased from 344,454 to 351,775 (+2%) and admit rate from 8.7% to 9.6%. The proportion of births by maternal age declined each year for ≤29 y but increased for ≥30 y. NICU admission rates were lowest at maternal age 20-29 y and increased with age ≥30 y. US NICUs have demonstrated a 2% increase in admissions despite a 7% decrease in births. Higher rates of NICU admissions among infants born at maternal age ≥30 y warrants investigation.

Informing the ‘Broad Masses’: Early‐Twentieth‐Century Birth Control Debates and Activism in the Polish‐American Community

AbstractDuring 1925–26 and 1928, debates about birth control took place in the readers' column of North Star (Gwiazda Polarna), a US Polish language weekly. These discussions provide a rare insight into how ideas spread by the US birth control movement were received by an immigrant and ethnic working‐class Catholic community. The readers’ letters showed the prevalence of socialist rationales for birth control, expectation from men to play an active role in family limitation, the lack of references to women's sexual pleasure and an ambivalence towards the teachings of the Catholic Church. In the wake of the discussion, one North Star editor established a birth control association to inform the ‘broad masses’. This role was also played by the North Star letters, which spread family planning information and dispelled the misconceptions regarding birth control possessed by many Polish‐Americans at that time.

Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program.

We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.