Michelle J K Osterman’s research while affiliated with Centers for Disease Control and Prevention and other places

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Publications (61)


Increases in Neonatal Intensive Care Admissions in the United States, 2016-2023
  • Article

March 2025

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4 Reads

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2 Citations

NCHS data brief

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Michelle J K Osterman

Declines in Triplet and Higher-order Multiple Births in the United States, 1998-2023

October 2024

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8 Reads

NCHS data brief

Objectives: This report explores changes in the overall rate of triplet and higher-order births from 1998 to 2023 by detailed plurality, maternal race and Hispanic origin, and age. Methods: Data are from the National Vital Statistics System birth files. Triplet and higher-order birth rates (number of triplet and higher-order births per 100,000 births) from 1998 to 2023 are presented. Also presented are the number of triplet, triplet and higher-order, and quadruplet and higher-order births, and triplet and higher-order multiple birth rates by maternal race and Hispanic origin and maternal age for 1998, 2009, and 2023. Results: From 1998 to 2023, the triplet and higher-order multiple birth rate declined 62%, from 193.5 per 100,000 total births to 73.8; the largest declines were from 2009 to 2023. The number of triplet and higher-order births declined from 7,625 to 2,653. Declines in triplet and higher-order birth rates were observed for White non-Hispanic (71%) and Hispanic (25%) mothers, while the rate for Black non-Hispanic mothers increased (25%). Triplet and higher-order birth rates declined for all age groups 20 and older from 1998 to 2023, and the largest declines were for mothers age 30 and older.


Births in the United States, 2023

August 2024

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12 Reads

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13 Citations

NCHS data brief

Objectives: This report presents 2023 data on U.S. births compared with 2022 and 2021 for several key demographic and maternal and infant characteristics. Methods: Descriptive tabulations of data reported on the birth certificates of the 3.60 million births that occurred in 2023 are presented. Data are presented for the number of births, the general fertility rate, teenage birth rates, the distribution of births by trimester prenatal care began and the distribution of births by selected gestational age categories. Data for 2023 are compared with data for 2022 and 2021. Results: A total of 3,596,017 births were registered in the United States in 2023, down 2% from 2022. The general fertility rate declined 3% in 2023 to 54.5 births per 1,000 females ages 15-44. Birth rates declined for females ages 15-19 (4%), 15-17 (2%), and 18-19 (5%), from 2022 to 2023. The percentage of mothers receiving prenatal care in the first trimester of pregnancy declined 1% to 76.1% in 2023 while the percentage of mothers with no prenatal care increased 5%. The preterm birth rate was essentially unchanged at 10.41% in 2023 but the rate of early term births rose 2%.


Births: Final Data for 2022

April 2024

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61 Reads

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93 Citations

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

Michelle J K Osterman

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Claudia P Valenzuela

Objectives- This report presents 2022 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods-Descriptive tabulations based on birth certificates of the 3.67 million births registered in 2022 are shown by maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2022 are presented for selected items, and by race and Hispanic origin for 2016-2022. Results-A total of 3,667,758 births occurred in the United States in 2022, essentially unchanged from 2021. The general fertility rate declined 1% from 2021 to 56.0 births per 1,000 females ages 15-44 in 2022. The birth rate for females ages 15-19 declined 2% from 2021 to 2022; birth rates fell 7% for women ages 20-24, rose 1% to 5% for women ages 25-29 and 35-44, and rose 12% for women ages 45-49 (the first increase since 2016). The total fertility rate declined less than 1% to 1,656.5 births per 1,000 women in 2022. Birth rates declined for unmarried women but increased for married women from 2021 to 2022. Prenatal care beginning in the first trimester declined to 77.0% in 2022; the percentage of women who smoked during pregnancy declined to 3.7%. The cesarean delivery rate was unchanged in 2022 (32.1%); Medicaid was the source of payment for 41.3% of births. The preterm birth rate declined 1% to 10.38%; the low birthweight rate rose 1% to 8.60%. The twin birth rate was unchanged in 2022 (31.2 per 1,000 births); the 2% decrease in the triplet and higher-order multiple birth rate.


Shifts in the Distribution of Births by Gestational Age: United States, 2014-2022

January 2024

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11 Reads

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34 Citations

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

Objectives-This report presents changes in the distribution of singleton births by gestational age in the United States for 2014-2022, by maternal age and race and Hispanic origin. Methods-Data are based on all birth certificates for singleton births registered in the United States from 2014 to 2022. Gestational age is measured in completed weeks using the obstetric estimate and categorized as early preterm (less than 34 weeks), late preterm (34-36 weeks), total preterm (less than 37 weeks), early term (37-38 weeks), full term (39-40 weeks), and late- and post-term (41 and later weeks). Data are shown by maternal age and race and Hispanic origin. Single weeks of gestation at term (37-41 weeks) are also examined. Results-Despite some fluctuation in most gestational age categories during the pandemic years of 2020-2022, trends from 2014 to 2022 demonstrate a shift towards shorter gestational ages. Preterm and early-term birth rates rose from 2014 to 2022 (by 12% and 20%, respectively), while full-term and lateand post-term births declined (by 6% and 28%, respectively). Similar shifts for each gestational age category were seen across maternal age and race and Hispanic-origin groups. By single week of gestation at term, the largest change was for births at 37 weeks (an increase of 42%).


Trends in Cesarean Delivery in Puerto Rico, 2018-2022

January 2024

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1 Read

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2 Citations

NCHS data brief

Cesarean delivery is major surgery associated with higher costs and adverse outcomes, such as surgical complications, compared with vaginal delivery (1-3). The cesarean delivery rate in Puerto Rico rose from just over 30% in the early to mid-1990s to over 40% by the early 2000s (4,5). During this time, cesarean delivery rates in Puerto Rico were 40%-70% higher than rates in the U.S. mainland and up to 78% higher than rates for Hispanic women in the U.S. mainland (4,5). This report describes trends in Puerto Rico's cesarean delivery rate from 2010 to 2022 and explores changes by maternal age, gestational age, and municipality from 2018 to 2022.


Births in the United States, 2022

August 2023

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25 Reads

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29 Citations

NCHS data brief

This report presents selected highlights from 2022 final birth data on key demographic, healthcare utilization, and infant health indicators. The number of births, general fertility rates (GFRs) (births per 1,000 females aged 15-44), age-specific birth rates (births per 1,000 women in specified age group), and cesarean delivery and preterm (less than 37 weeks of gestation) birth rates are presented. Results for 2020, 2021, and 2022 are shown for all births to describe changes in birth patterns during the COVID-19 pandemic years (1,2). Cesarean and preterm birth rates are shown for select race and Hispanic-origin groups.


Changes in Prenatal Care Utilization:United States, 2019-2021

May 2023

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5 Reads

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28 Citations

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

Objectives-This report describes changes in prenatal care use (utilization) in the United States before and during the COVID-19 pandemic by month of birth and the mother's race and Hispanic origin.


Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021

May 2023

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6 Reads

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16 Citations

NCHS data brief

Access to health care coverage during pregnancy and delivery allows women to receive the care needed to maximize the likelihood of a healthy pregnancy and baby (1). National birth certificate data on the principal source of payment for the delivery became available in 2016, when all states implemented the 2003 U.S. Standard Certificate of Live Birth. This certificate provides information on payment through private insurance; Medicaid; CHAMPUS, TRICARE, and other types of government insurance; and self-pay, which has been shown to reflect the uninsured status of the mother at the time of delivery (2). This report describes the principal source of payment for the delivery in 2021 overall and by maternal race and Hispanic origin, age, and education.


Declines in Cigarette Smoking During Pregnancy in the United States, 2016-2021

January 2023

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19 Reads

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23 Citations

NCHS data brief

Smoking during pregnancy is an established risk factor for adverse pregnancy outcomes and health issues for newborns later in life (1-3). National birth certificate data on cigarette smoking and the number of cigarettes smoked before and during pregnancy first became available in 2016. These data allow for the analysis of maternal cigarette use during pregnancy by numerous maternal and infant characteristics. This report describes changes in the number and percentage of mothers who smoked cigarettes at any time during pregnancy in the United States from 2016 to 2021 and changes between 2016 and 2021 in the percentage of mothers who smoked during pregnancy by maternal age, race and Hispanic origin, and state of residence.


Citations (60)


... In 2023, approximately 9.8% of infants born in the United States of America were admitted into the neonatal intensive care unit (NICU) for reasons such as prematurity, transient tachypnea of the newborn, respiratory distress syndrome, jaundice, sepsis, and necrotizing enterocolitis [1]. In addition to the concern for their medically vulnerable infants, parents of infants in the NICU face many uncomfortable stressors, including unfamiliar surroundings, highly technical atmosphere, and dependence on healthcare providers [2]. ...

Reference:

Maternal Stress Responses and Coping Following a NICU Experience
Increases in Neonatal Intensive Care Admissions in the United States, 2016-2023
  • Citing Article
  • March 2025

NCHS data brief

... Cesarean scar pregnancy (CSP) is an abnormal implantation in which the embryo implants within a previous cesarean scar, with an estimated incidence of 1 in 1,800 to 1 in 2,216 pregnancies [1,2]. The increasing rates of cesarean deliveries have contributed to a rise in CSP cases, as prior cesarean section is a significant risk factor [3][4][5]. ...

Births in the United States, 2023
  • Citing Article
  • August 2024

NCHS data brief

... Our findings position collagen remodeling as a hallmark of myometrial aging, and raise the possibility that circulating markers of extracellular matrix turnover -such as procollagen peptides and matrix metalloproteinases -could serve as non-invasive biomarkers of uterine tissue health, as already explored in cardiovascular 75 and liver diseases 76 . These markers may also aid in early risk assessment for pelvic organ prolapse and pregnancy complications, given known association between myometrial dysfunction and adverse obstetric outcomes, including implantation failure, preterm birth, labor dystocia, and uterine atony [77][78][79] , complications that are becoming more prevalent with rising maternal age 80 . In parallel, we observe coordinated epithelial remodeling across reproductive tissues. ...

Births: Final Data for 2022
  • Citing Article
  • April 2024

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

... Higher prevalence of intellectual disability (along with other neurologic disorders) might be related to higher rates of preterm birth, which is associated with brain injuries and neurodevelopmental impairment and also is linked to SDOH (27)(28)(29)(30)(31)(32). In 2022, a total of 12.3% of births to Black mothers were preterm, compared with 8.7% of births to Hispanic and 7.6% of births to White mothers (33). Other causes of intellectual disability associated with SDOH include lead poisoning and traumatic brain injuries (34,35). ...

Shifts in the Distribution of Births by Gestational Age: United States, 2014-2022
  • Citing Article
  • January 2024

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

... Infants' gestational age and/or comorbidity status may have been misclassified, possibly understating differences in healthcare utilization patterns by comorbidity group. Similarly, we assume that infants with [24], though we would not expect Medicaid infants to be representative of the broader population. Fourth, we did not account for potential selection bias or loss to follow-up [25,26]. ...

Births in the United States, 2022
  • Citing Article
  • August 2023

NCHS data brief

... Nearly one-third of Hispanic people below age 65 are enrolled in Medicaid, an important source of health insurance during the perinatal period. 11 Over four in 10 births in the United States are financed by Medicaid,12 and 35% of Medicaid-insured pregnant people identify as Hispanic. 13 Medicaid Data from phase 8 include the year 2020, during which time the COVID-19 public health emergency affected healthcare utilization and insurance coverage through the Families First Coronavirus Response Act. ...

Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021
  • Citing Article
  • May 2023

NCHS data brief

... 21 The pandemic has been associated with delayed and missed medical care, including prenatal and postnatal maternal care visits and childhood wellness visits, transitions from in-person care to telemedicine, decreased adequacy of prenatal care, and decreased perceived quality of care. [22][23][24][25][26][27][28][29][30] These changes exacerbated social determinants of health-related inequities in health care access and delivery 31 and thus might be associated with disparate decreases in access to quality Safe Sleep education, 20 although this needs further empirical confirmation. Additionally, the pandemic has been associated with increased reports of poor maternal and caregiver mental health [32][33][34][35][36][37][38] and increases in maternal and parental drug and alcohol use. ...

Changes in Prenatal Care Utilization:United States, 2019-2021
  • Citing Article
  • May 2023

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

... Research studies that have included Asian birthing people have demonstrated perinatal health inequities, not only compared to other races, but also among Asian ethnicities. While Black birthing people have the highest rates of cesarean birth in the US, Asian birthing people have the second-highest rate of cesarean birth compared to other races [4]. An analysis of birth registry data in one US state found that Filipino and Indian birthing people had the highest rates of cesarean birth compared to other Asian ethnicities [5]. ...

Births: Final Data for 2021
  • Citing Article
  • January 2023

National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

... Additionally, smoking and alcohol use (Biddinger et al., 2022) have been shown to increase the risk of CVD. Approximately 4.6% of pregnant adults reported smoking during pregnancy (Martin et al., 2023) and 14% reported drinking alcohol (CDC, 2022). Poor mental health may also increase the risk of CVD during pregnancy. ...

Declines in Cigarette Smoking During Pregnancy in the United States, 2016-2021
  • Citing Article
  • January 2023

NCHS data brief