Rate of Second and Third Trimester Weight Gain and Preterm Delivery Among Underweight and Normal Weight Women.

Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m(2). However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m(2) who delivered a live-birth ≥28 weeks gestation (n = 12,526).

Investigating Implausible Gestational Age and High Birthweight Combinations.

Background: Birth certificate data overestimate national preterm births because a high percentage of last menstrual period (LMP) dates have errors. Study goals were to determine: (i) To what extent errors in transfer of birthweight and LMP date from medical records to birth certificates contribute to implausibly high birthweight-for-gestational-age births; (ii) What percentage of implausible births would be resolved if the clinical estimate (CE) from birth certificates were used instead of LMP-based gestational age, and with what degree of certainty; and (iii) Of those not resolved, what percentage had a medical explanation.

Methods: Medical records and birth certificates for all singleton infants with implausibly high birthweight-for-gestational-age based on LMP delivered in the Kaiser Permanente Northwest system in Oregon during 1998-2007 were examined.

Abortion-Related Mortality in the United States: 1998-2010.

Objective: To examine characteristics and causes of legal induced abortion-related deaths in the United States between 1998 and 2010.

Methods: Abortion-related deaths were identified through the national Pregnancy Mortality Surveillance System with enhanced case-finding. We calculated the abortion mortality rate by race, maternal age, and gestational age and the distribution of causes of death by gestational age and procedure.

Associations of Gestational Weight Gain with Preterm Birth among Underweight and Normal Weight Women.

Studies report increased risk of preterm birth (PTB) among underweight and normal weight women with low gestational weight gain (GWG). However, most studies examined GWG over gestational periods that differ by term and preterm which may have biased associations because GWG rate changes over the course of pregnancy. Furthermore, few studies have specifically examined the amount and pattern of GWG early in pregnancy as a predictor of PTB.

Pregnancy-related mortality in the United States, 2006-2010.

Objective: To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2006-2010.

Methods: We used data from the Pregnancy Mortality Surveillance System and calculated pregnancy-related mortality ratios by year and age group for four race-ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic, and other. We examined causes of pregnancy-related deaths by pregnancy outcome during 2006-2010 and compared causes of pregnancy-related deaths since 1987.

Maternal mortality and morbidity in the United States: where are we now?

This article provides a brief overview of the work conducted by the Division of Reproductive Health at the Centers for Disease Control and Prevention on severe maternal morbidity and mortality in the United States. The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division, and includes future directions of work in all these areas.

Health care utilisation in the first year of life among infants of mothers with perinatal depression or anxiety.

Background: Limited information is available on associations between maternal depression and anxiety and infant health care utilisation.

Methods: We analysed data from 24 263 infants born between 1998 and 2007 who themselves and their mothers were continuously enrolled for the infant's first year in Kaiser Permanente Northwest. We used maternal depression and anxiety diagnoses during pregnancy and postpartum to categorise infants into two depression and anxiety groups and examined effect modification by timing of diagnosis (pregnancy only, postpartum only, pregnancy and postpartum).

Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality.

Objective: To estimate the birth prevalence and 7-year case-fatality rate of peripartum cardiomyopathy for a statewide population by applying the National Institutes of Health Workshop on Peripartum Cardiomyopathy definition, including echocardiographic criteria for left ventricular dysfunction.

Methods: This was an epidemiologic study of residents of North Carolina experiencing an obstetric delivery or a pregnancy-related death before delivery in 2002 through 2003 including 235,599 live births. Potential cases were identified from International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM), pregnancy and cardiovascular codes followed by medical record review, and from the state pregnancy-related mortality file.

Extent of maternal morbidity in a managed care population in georgia.

Background: Although maternal deaths are among the most tragic events related to pregnancy, they are uncommon in the US and, therefore, inadequate indicators of a woman's pregnancy-related health. Maternal morbidity has become a more useful measure for surveillance and research. Traditional attempts to monitor maternal morbidity have used hospital discharge data, which include data only on complications that resulted in hospitalisation, underestimating the frequency and scope of complications.

Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993-2006.

Objective: To compare trends in and causes of pregnancy-related mortality by race, ethnicity, and nativity from 1993 to 2006.

Methods: We used data from the Pregnancy Mortality Surveillance System. For each race, ethnicity, and nativity group, we calculated pregnancy-related mortality ratios and assessed causes of pregnancy-related death and the time between the end of pregnancy and death.

From identification and review to action--maternal mortality review in the United States.

The maternal mortality review process is an ongoing quality improvement cycle with 5 steps: identification of maternal deaths, collection of medical and other data on the events surrounding the death, review and synthesis of the data to identify potentially alterable factors, the development and implementation of interventions to decrease the risk of future deaths, and evaluation of the results. The most important step is utilization of the data to identify and implement evidence-based actions; without this step, the rest of the work will not have an impact. The review committee ideally is based in the health department of a state (or large city) as a core public health function.

Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China.

This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003.

Changes in pregnancy mortality ascertainment: United States, 1999-2005.

Objective: To estimate mortality ratios for all reported pregnancy deaths in the United States, 1999-2005, and to estimate the effect of the 1999 implementation of International Classification of Diseases, Tenth Revision (ICD-10) and adoption of the U.S. Standard Certificate of Death, 2003 Revision, on the ascertainment of deaths resulting from pregnancy.

Trends in ectopic pregnancy mortality in the United States: 1980-2007.

Objective: To estimate trends in ectopic pregnancy mortality and examine characteristics of recently hospitalized women who died as a result of ectopic pregnancy in the United States.

Methods: We used 1980-2007 national birth and death certificate data to calculate ectopic pregnancy mortality ratios (deaths per 100,000 live births) overall and stratified by maternal age and race. We performed nonparametric tests for trend to assess changes in ectopic pregnancy mortality over time and calculated projected mortality ratios for 2013-2017.

Pregnancy-related mortality in the United States, 1998 to 2005.

Objective: To estimate the risk of women dying from pregnancy complications in the United States and to examine the risk factors for and changes in the medical causes of these deaths.

Methods: De-identified copies of death certificates for women who died during or within 1 year of pregnancy and matching birth or fetal death certificates for 1998 through 2005 were received by the Pregnancy Mortality Surveillance System from the 50 states, New York City, and Washington, DC. Causes of death and factors associated with them were identified, and pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were calculated.

Trends in postpartum hemorrhage: United States, 1994-2006.

Objective: The purpose of this study was to estimate the incidence of postpartum hemorrhage (PPH) in the United States and to assess trends.

Study Design: Population-based data from the 1994-2006 National Inpatient Sample were used to identify women who were hospitalized with postpartum hemorrhage. Data for each year were plotted, and trends were assessed.

Overview of maternal morbidity during hospitalization for labor and delivery in the United States: 1993-1997 and 2001-2005.

Objective: To assess progress toward meeting the U.S. Healthy People 2010 objective of reducing the rate of maternal morbidity at delivery hospitalization by comparing National Hospital Discharge Survey data from two time periods.

Cesarean delivery among women with low-risk pregnancies: a comparison of birth certificates and hospital discharge data.

Objective: To examine the effect of data source (birth certificate compared with hospital discharge records) and the definition of risk on the prevalence of cesarean deliveries thought to have "no indicated risk"; eg, the fetus is full-term, singleton, and in the vertex position, and the mother has no reported medical risk factors or complications of labor and/or delivery identified on the birth certificate.

Methods: The study is based on data from 565,767 women who delivered singleton, vertex neonates with gestational ages of 37-41 weeks in Georgia hospitals between 1999 and 2004 and for whom data from birth certificates and hospital discharge records could be linked. The percentages of women with primary cesarean deliveries who did not have risk indicated on the birth certificate and on the hospital discharge record were compared.

Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy.

Objective: To estimate trends in postpartum glucose testing in a cohort of women with gestational diabetes mellitus (GDM).

Methods: A validated computerized algorithm using Kaiser Permanente Northwest automated data systems identified 36,251 live births or stillbirths from 1999 through 2006. The annual percentage of pregnancies complicated by gestational diabetes with clinician orders for and completion of a fasting plasma glucose (FPG) test within 3 months of delivery was calculated.

Maternal morbidity rates in a managed care population.

Objective: To identify and estimate prevalence rates of maternal morbidities by pregnancy outcome and selected covariates during the antepartum, intrapartum, and postpartum periods in a defined population of pregnant women.

Methods: We used electronic data systems of a large, vertically integrated, group-model health maintenance organization (HMO) to develop an algorithm that searched International Classification of Diseases, 9th Revision, Clinical Modification, codes for 38 predetermined groups of pregnancy-related complications among women enrollees of this HMO between January 1, 1998, and December 31, 2001.

Results: We identified 24,481 pregnancies among 21,011 women.

Association between obesity during pregnancy and increased use of health care.

Background: In the United States, obesity during pregnancy is common and increases obstetrical risks. An estimate of the increase in use of health care services associated with obesity during pregnancy is needed.

Methods: We used electronic data systems of a large U.

Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003.

Objective: This investigation aimed to identify pregnancy complications and risk factors for women who experienced severe maternal morbidity during the delivery hospitalization and to estimate severe maternal morbidity rates.

Study Design: We used the National Hospital Discharge Survey for 1991-2003 to identify delivery hospitalizations with maternal diagnoses and procedures that indicated a potentially life-threatening diagnosis or life-saving procedure.

Results: For 1991-2003, the severe maternal morbidity rate in the United States was 5.

Variation between last-menstrual-period and clinical estimates of gestational age in vital records.

An accurate assessment of gestational age is vital to population-based research and surveillance in maternal and infant health. However, the quality of gestational age measurements derived from birth certificates has been in question. Using the 2002 US public-use natality file, the authors examined the agreement between estimates of gestational age based on the last menstrual period (LMP) and clinical estimates in vital records across durations of gestation and US states and explored reasons for disagreement.

Development of an algorithm to identify pregnancy episodes in an integrated health care delivery system.

Objective: To develop and validate a software algorithm to detect pregnancy episodes and maternal morbidities using automated data.

Data Sources/study Setting: Automated records from a large integrated health care delivery system (IHDS), 1998-2001.

Study Design: Through complex linkages of multiple automated information sources, the algorithm estimated pregnancy histories.