Massachusetts Health Officials Release 2007 Birth Report

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The Massachusetts Department of Public Health (DPH) today released the 2007 Birth Report, an annual publication which provides detailed data on the number and characteristics of births in the state.

This latest Birth Report shows that many birth indicators in Massachusetts compare favorably with the national average, including low birth weight, smoking during pregnancy, infant mortality, and teen birth rates. The report also indicates that rates of gestational diabetes have continued to rise since the 2006 Birth Report, and that the rate of cesarean deliveries in the state continues to be higher than that of the U.S.

“This year’s birth report shows that Massachusetts is doing well on a number of fronts with respect to birth indicators,” said DPH Commissioner John Auerbach. “However, as with any public health report, it is also important to focus on the areas that need improvement. High cesarean delivery rates deserve greater scrutiny, and the continued disparities that we see in birth outcomes must continually inform our policy and programmatic decisions.”

The teen birth rate in Massachusetts (22.0 births per 1,000 women ages 15-19 years) was almost half the U.S. teen birth rate (41.9 births per 1,000 women ages 15-19 years). And the percentage of infants born low birth weight (births less than 5.5 lbs) in Massachusetts (7.9%) was 5% lower than in the U.S. (8.3%).

The report also shows that the percentage of mothers diagnosed with gestational diabetes increased by 12 percent in 2007. Gestational diabetes is associated with an increased risk of developing overt diabetes later in life for both mothers and infants.

“We are very concerned about the 44% increase in the rate of gestational diabetes since 1998. We know that it can not only cause worse outcomes for the mother and baby during pregnancy, but it also increases the risk that the mother develops type 2 diabetes later,” said DPH Medical Director Dr. Lauren Smith. “That’s why we gathered a statewide task force to develop guidelines for screening, diagnosis, management and follow-up of women with gestational diabetes. We’re happy that these guidelines will be issued this spring.”

Health officials believe a number of factors may be responsible for the increase in gestational diabetes including:

* Age of mother giving birth (older maternal age is an established risk factor).

* The trend over the last several years of increasing numbers of overweight and obese adults.

* Increases in populations of persons at greater risk for gestational diabetes (Native Americans, Asians, Hispanics and African Americans).

Cesarean Deliveries High

For the first time since 1998, the proportion of births that were cesarean deliveries in 2007 did not increase significantly from the previous year. Still, more than one-third of all births in Massachusetts were cesarean deliveries (33.7%). The percentage of U.S. babies delivered by cesarean section has been increasing rapidly for years; however the state’s percentage is now 8 percent higher than the national statistic of 31 percent.

Health experts have researched potential causes of increasing cesarean deliveries for years. These include the increasing age and medical risks of childbearing women, the rising number of multiple births, published data suggesting the inadvisability of a vaginal birth after a previous cesarean delivery, malpractice concerns among providers, and the choice of more women to voluntarily undergo cesarean deliveries. However, the rate of cesarean deliveries has increased even among women with no indicated risks of medical conditions or labor complications.

Racial, Ethnic and Geographic Disparities in Birth Outcomes Noted in Report

Several Massachusetts birth outcomes are significantly better than the United States, but significant disparities persist:

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* The infant mortality rate for blacks was 2.6 times higher than for whites (10.2 vs. 3.9 infant deaths per 1,000 live births).

* The teen birth rate for Hispanics was over 5 times higher than that for whites (70.9 vs. 13.3 births per 1,000 women ages 15-19).

Among the largest ethnicity groups, the percentage of women initiating prenatal care in the first trimester was lowest among Cambodian (56.8%), Cape Verdean (69.0%), Haitian (69.1%) and African (69.3%) mothers and highest among Korean (86.7%) and European mothers (86.2%). The state average was 82.0%

Compared with mothers who had a college degree or higher, mothers with a high school education or less were less likely to receive adequate prenatal care, more likely to report smoking during their pregnancies, and less likely to breastfeed their infants.

* Among the 30 largest Massachusetts municipalities, Pittsfield, New Bedford and Springfield recorded the highest percentages of low birth weight infants (10.7%, 10.5%, and 10.4%, respectively).

Other Key Findings of the Report Include

* The average maternal age at first birth in 2007 was 27.6 years, which was a small but significant decrease (0.5 percent) from the 2006 mean age (27.7 years). Mean age at first birth decreased by 0.7 percent for white mothers (from 28.7 in 2006 to 28.5 years in 2007).

* While the number of births remained stable, there was a significant decrease of 1 percent in the number of white non-Hispanic births.

* The percentage of mothers who were not born in the U.S. increased this year to 27 percent, continuing the trend from the mid-1990s.

* Compared with 2006, there was a 13 percent increase in births to mothers whose ancestry was African (175 births). Overall, births to African mothers (1,477) accounted for 2% of Massachusetts births in 2007.

* The percentage of mothers who were not married at the time of delivery increased by 4 percent from 32.2% in 2006 to 33.4% in 2007, which continues an increasing trend since 1996.

* The Massachusetts infant mortality rate (IMR) did not change significantly from the prior year. In 2007, the IMR was 4.9 infant deaths per 1,000 live births compared with 4.8 infant deaths per 1,000 live births in 2006.

* While the percentage of mothers who reported smoking during pregnancy remained stable, there was a significant decline of 21 percent among black non-Hispanic mothers (6.7% in 2006 to 5.3% in 2007).

* The percentage of mothers who had their prenatal care paid by public programs continues to increase. Between 2006 and 2007, it increased by 4 percent, from 34.2% in 2006 to 35.5% in 2007. For white mothers, it increased by 7 percent (24.4% vs. 22.9%).

The percentage of mothers who were breastfeeding or intending to breastfeed in 2007 was 79.2%, which was significantly lower than the 79.9% rate in 2006. The percentage of mothers who were breastfeeding decreased for whites from 78.2% in 2006 to 77.3% in 2007 and for Hispanics, from 82.6% in 2006 to 81.1% in 2007. Only blacks had an increase in the percentage of breastfeeding, from 80.7% in 2006 to 82.8% in 2007.

Compared with the 2006 U.S. rate, the 2007 teen birth rate in Massachusetts (22.0 births per 1,000 women ages 15-19 years) was 48 percent lower than the 2006 U.S. rate of 41.9 births per 1,000 women ages 15-19 years.

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