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

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.

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%.

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.

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%).

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.

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.

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.

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.

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.