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Objectives: Evidence is limited on differences in cesarean rates for nulliparous, term, singleton, vertex (NTSV) births across racial and ethnic groups at the national and state level during the COVID-19 pandemic. We assessed changes in levels and trends of NTSV cesarean rates before and after stay-at-home orders (SAHOs) were implemented in the United States (1) overall, (2) by racial and ethnic groups, and (3) by 50 US states from January 2017 through December 2021. Methods: We used birth certificate data from 2017 through 2021, restricted to hospital births, to calculate monthly NTSV cesarean rates for the United States and for racial and ethnic groups and to calculate quarterly NTSV cesarean rates for the 50 states. We used interrupted time-series analysis to measure changes in NTSV cesarean rates before and after implementation of SAHOs (March 1 through May 31, 2020). Results: Of 6 022 552 NTSV hospital births, 1 579 645 (26.2%) were cesarean births. Before implementation of SAHOs, NTSV cesarean rates were declining in the United States overall; were declining among births to non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women; and were declining in 6 states. During the first month of implementation of SAHOs in May 2020, monthly NTSV rates increased in the United States by 0.55%. Monthly NTSV rates increased by 1.20% among non-Hispanic Black women, 0.90% among Hispanic women, and 0.28% among non-Hispanic White women; quarterly NTSV rates increased in 6 states. Conclusion: In addition to emergency preparedness planning, hospital monitoring, and reporting of NTSV cesarean rates to increase provider awareness, reallocation and prioritization of resources may help to identify potential strains on health care systems during public health emergencies such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Aim: Relatively few obese children and adolescents receive specialist treatment. Our aim was to assess associations between risk of receiving an obesity diagnosis in secondary/tertiary health services by socio-economic position and immigrant background in order ultimately to improve equity in health services. Methods: The study population comprised Norwegian-born children aged 2–18 years between 2008 and 2018 (N =1,414,623), identified via the Medical Birth Registry. Cox regressions were used to calculate hazard ratios (HR) of an obesity diagnosis from secondary/tertiary health services (Norwegian Patient Registry) by parental education and household income and by immigrant background. Results: Higher parental education and household income were associated with a lower hazard of obesity diagnosis regardless of Norwegian versus immigrant background. Compared to having a Norwegian background, having a Latin American (HR=4.12; 95% confidence interval (CI) 3.18–5.34), African (HR=1.54; 95% CI 1.34–1.76) and Asian (HR=1.60; 95% CI 1.48–1.74) background was associated with higher hazard of obesity diagnosis. Adjusted for parental education and household income, corresponding HRs were 3.28 (95% CI 2.95–3.65) for Latin America, 0.95 (95% CI 0.90–1.01) for Africa and 1.08 (95% CI 1.04–1.11) for Asia. Within Asia, those with a background from Pakistan, Turkey, Iraq and Iran had higher hazards than those with a Norwegian background, while those with a background from Vietnam had lower hazards, even after adjusting for parental education and household income. Conclusions: To ensure more equitable treatment, more knowledge is warranted about health-service access and referral patterns, and underlying population prevalence rates, for obese children and adolescents with different immigrant backgrounds. [ABSTRACT FROM AUTHOR]

Objective: This article describes the first digital clinical information system tailored to support the operational needs of a forensic unit in Greece and to maintain its archives. Method: The development of our system was initiated towards the end of 2018, as a close collaboration between the Medical School of the University of Crete and the Forensic Medicine Unit of the University Hospital of Heraklion, Crete, where forensic pathologists assumed active roles during the specification and testing of the system. Results: The final prototype of the system was able to manage the life cycle of any forensic case by allowing users to create new records, assign them to forensic pathologists, upload reports, multimedia and any required files; mark the end of processing, issue certificates or appropriate legal documents, produce reports and generate statistics. For the first 4 years of digitised data (2017–2021), the system recorded 2936 forensic examinations categorised as 106 crime scene investigations, 259 external examinations, 912 autopsies, 102 post-mortem CT examinations, 804 histological examinations, 116 clinical examinations, 12 anthropological examinations and 625 embalmings. Conclusion: This research represents the first systematic effort to record forensic cases through a digital clinical information system in Greece, and to demonstrate its effectiveness, daily usability and vast potential for data extraction and for future research. [ABSTRACT FROM AUTHOR]

Birth certificate data has been identified for its centrality in providing complete and accurate information on demographics, particularly as it relates to families. Often, however, these forms of data collection, are very much hetero-centric, re-embedding normative conceptualizations of identity, particularly as it relates to sex, gender and sexuality. Modes of demographic data collection, such as that of the birth certificate, do not allow for the fluidity and multiplicity of gender and sexual identities that characterize the lived experience of many LGBTQ families. This article will explore the significance of the birth certificate for LGBTQ Irish families, particularly in light of the varying inequalities that emerge from the data gaps they create for both parent and child. In exploring these facets, this article draws upon qualitative semi-structured interviews with LGBTQ parents, exploring how they see the data gaps that emerge on birth certificates and the effects these gaps have on them as an LGBTQ family. Through exploring the ways in which the data gaps and omissions on the Irish birth certificate creates inequalities, this article uses the findings to build on the work of Ruberg and Ruellos (2020) who call for shifting how we see and understand queer identity through data. Through these findings, we argue that systems of data collection, data structures and certification must be changed to build data for queer parenthood and that it is necessary to recalibrate how we design birth certificates to more accurately represent LGBTQ-parent families. [ABSTRACT FROM AUTHOR]

This longitudinal population-based study examines the association between maltreatment victimization experiences and the likelihood of intergenerational (dis)continuity of maltreatment. Our data include all individuals born in 1983/1984 in Queensland (QLD), Australia who are registered as parents via birth records and who experienced system contacts for maltreatment victimization in childhood (n = 2906). Child safety data on system contacts as a child victim and person responsible for harm to a child were obtained from the Department of Children, Youth Justice and Multicultural Affairs. Out-of-home care experiences and maltreatment frequency, timing, and type were examined. Results indicated that childhood maltreatment experiences significantly differed between parents who were not subsequently responsible for harm to a child (cycle breakers) and parents who were subsequently responsible for harm to a child (cycle maintainers). Different patterns of association were observed across sex. These findings highlight the importance of recognizing the heterogeneity of victim maltreatment experiences and associated risk of maltreatment for their children, and can inform effective and targeted interventions by tailoring these by sex and developmental period. [ABSTRACT FROM AUTHOR]

It is unclear if surveillance bias (increased reports to Child Protective Services [CPS] related to program involvement) has a substantial impact on evaluation of home visiting (HV) prevention programs. We estimated surveillance bias using data from Connecticut's HV program, birth certificates, CPS, and hospitals. Using propensity score matching, we identified 15,870 families similar to 4015 HV families. The difference-in-differences approach was used to estimate surveillance bias as the change in investigated reports from the last 6 months of program involvement to the next 6 months. The median age of the children at program exit was 1.2 years (range: 60 days, 5 years). We estimated that 25.6% of investigated reports in the HV group resulted from surveillance bias. We reviewed CPS reports of 194 home-visited families to determine if a home visitor made the report and found that 10% were directly from home visitors. Program evaluations should account for surveillance bias. [ABSTRACT FROM AUTHOR]

Policies about changing gender/sex on identity documents provide insights into definitions of gender/sex, and impact especially transgender and/or nonbinary lives. We investigated these on U.S. driver's licenses and birth certificates to understand variability in these policies, including in comparison to an earlier report in 2014, and to explore what kinds of "bio/logics" (decision rules rooted in biological or biologistic thinking) might be at play. Results show that the most common requirements in 2020 included proof of gender affirming surgery, a letter from a medical doctor, and hormone therapy. Compared to 2014, results showed an increase in requirements for hormone therapy and letters from therapists or medical doctors, and a decrease in requirements for gender affirming surgery. We highlight how this suggests a shift to "pubertal bio/logics": rooting gender/sex definitions in secondary sex characteristics. This contrasts with previous requirements that pointed to "newborn bio/logics": rooted in genital definitions of gender/sex affirmed by a surgico-medical authority. Both support policy framings of gender/sex as a biophenomenon, though with different impacts for trans and/or nonbinary livability. Our study provides insights into U.S. state definitions of gender/sex, and their multiple and contradictory biological views on gender/sex, with implications especially for transgender and/or nonbinary individuals' lives. [ABSTRACT FROM AUTHOR]

This article examines how participants in literacy events mediate the validation and legitimacy of official documents. Through articulating the perspectives of literacy as a social practice, paperwork studies, and the analysis of administrative burdens, we argue that the value of official documents is unstable and can fluctuate between valid and invalid each time applicants and frontline workers redefine the context of use. Through ethnographic observation, we gathered data on the historical production of birth certificates and the social construction of their meaning. We documented a participant's unsuccessful efforts to renew her voter's ID card over several years and in different government offices. We show how government employees rejected or accepted the same official birth certificate she presented, depending on how she framed her paperwork. Its meaning relied on the articulation of the negotiated administrative purpose, the definition of the context of use, and the document's materiality. [ABSTRACT FROM AUTHOR]

Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations. [ABSTRACT FROM AUTHOR]

A Relative Age Effect (RAE), by which young athletes with birthdates early in a calendar year have experienced a team selection advantage that persists throughout their careers, has been found to be prevalent in many sports. However, this phenomenon has not been investigated in the Paralympic sports context. Thus, we aimed to investigate the prevalence of RAE among male and female Brazilian Paralympic swimmers. Data from 694 ranked athletes were collected from the 2021 Brazilian Paralympic Swimmers National rankings. Athletes' birthdates were divided into four quarters (Q1, Q2, Q3, and Q4) according to their month of birth. Chi-Square (χ2) goodness-of-fit tests were used to compare the observed and expected distributions of athletes born in each quarter, based on sex (male and female), impairment type (physical, visual, and intellectual), and swim stroke competition (freestyle, medley, backstroke, butterfly, and breaststroke). The observed birthdates distributions were different from expected in males (χ2 = 11.647; p = 0.009) and females (χ2 = 8.899; p = 0.031), for athletes with physical impairments (χ2 = 10.443; p = 0.015); and for athletes who competed in freestyle (χ2 = 16.683; p = 0.001), medley (χ2 = 12.343; p = 0.006) and backstroke (χ2 = 8.025; p = 0.045) races. Even though our results demonstrated asymmetric distributions of Brazilian Paralympic swimmers' birthdates in many of the analyses, we could not establish the classical prevalence of athletes born at the beginning of the year that defines RAE. Therefore, the selection process of Brazilian Paralympic swimmers does not seem to be influenced by the athletes' time of birth. [ABSTRACT FROM AUTHOR]

Aims: Children of immigrants have a higher incidence of infectious disease than native children. Our aim was to assess the role of parental socioeconomic position for diagnoses of infectious disease among children of immigrants. Methods: Data from the Norwegian Patient Registry (on diagnoses from secondary/tertiary care), Medical Birth Registry of Norway, and Statistics Norway were linked by the national personal identification number. Seven diagnostic infection categories were included from 2008 onwards. The study population included children born in Norway aged 0–10 years between 2008 and 2018 (N = 988,647). Hazards of infection diagnoses by parental region of origin (adjusted for sex, birth year, parental education, household income and mother's parity) and by parental education and household income were assessed by Cox regression. Results: High parental education was associated with lower hazard of infection diagnoses among children of Norwegian-born parents, but associations were less consistent among children with immigrant parents. Lower household income was related to hazard of most infectious diagnoses among children with both Norwegian-born and immigrant parents. Assessed by region diagnoses of viral and bacterial infections and infections of the musculoskeletal system and soft tissue were not associated with household income. Parental education and household income did not explain differences in hazard of infection diagnoses between children born to immigrant versus Norwegian-born parents. Conclusions: Socioeconomic disadvantage did not explain differences in hazard of being diagnosed with infectious disease in secondary/tertiary care between children with immigrant versus Norwegian-born parents. [ABSTRACT FROM AUTHOR]

Transnational surrogacy—the carrying of a child by a woman in one country on behalf of persons in another—is strongly shaped by documents. Of these, identity documents are particularly crucial as they establish the belonging of a child born through such an arrangement both to its parents (birth certificate) and to a country (passport). However, the acquisition of these documents is subject to national laws that may contradict one another in transnational settings where citizens of more than one country are involved. As a result, in the last few years, there have been several cases of children stuck in legal limbo without clear parenthood and citizenship. Based on ethnographic research in India and Germany, we analyze how in such a transnational setting, documents and documentation become part of the making and unmaking of persons and belonging. [ABSTRACT FROM AUTHOR]

Background: Perinatal factors including gestational age, birthweight, size for gestational age, delivery route, maternal parity, maternal age, maternal education, socioeconomic status, race, and sex, are associated with the future risk of obesity and co-morbid conditions. This study evaluated the relationship of birthweight for gestational age and perinatal factors with severe obesity and dyslipidemia in adulthood. Methods: We conducted a population-based, retrospective birth cohort study of infants born to residents of Olmsted County, MN between 1976 and 1982. Outcomes were assessed after age 18 years until October 2020, including severe obesity (BMI ≥ 40 kg/m2) and dyslipidemia (total cholesterol ≥200 mg/dL, non-high density lipoprotein [non-HDL] cholesterol ≥145 mg/dL or HDL cholesterol <40 mg/dL). We obtained mother's age, education level, and parity as well as newborn sex, race, type of delivery, single/multiple birth, gestational age, and birthweight from birth certificate data. Individual-level socioeconomic status (SES) of the household at birth was determined with the HOUSES index. Results: Of 10 938 birth cohort subjects, 7394 had clinic visits after age 18 years and were included, with 2630 having severe obesity (n = 798) or dyslipidemia (n = 2357) as adults. In multivariable models, female sex, singleton birth, less maternal education, and lower SES defined by HOUSES were independently associated with an increased risk of severe obesity in adulthood. Non-white race, singleton birth, and lower birthweight were independently associated with adult dyslipidemia. Birthweight for gestational age was not associated with severe obesity or dyslipidemia. Conclusion: Perinatal factors were associated with both severe obesity and dyslipidemia in adulthood. Lower SES at birth was predictive of severe obesity in adulthood, highlighting the opportunity to investigate modifiable perinatal social determinants to reduce the risk of severe obesity. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity has been growing steadily, at an earlier age, and currently comprises a public health issue. A number of studies have pointed to perinatal factors as possible determinants in the development of childhood obesity. Objective: To evaluate the influence of perinatal factors on the development of obesity in children and adolescents in southern Brazil. Design: Retrospective cohort study in which a linkage was made between anthropometric data of children and adolescents aged 0 to 15 years who had been registered in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2016 and their perinatal data registered in the Live Birth Information System (SINASC) from 2000 to 2014. The SINASC was used to extract maternal covariables (age, schooling, marital status), prenatal variables (parity and number of prenatal visits), and perinatal variables (type of delivery, sex, and birth weight). Variables such as age, inclusion in the Bolsa Família income transfer program, and the number of anthropometric evaluations were extracted from SISVAN. Results: The sample comprised 537 children and adolescents. The median age was 8 years (interquartile range: 2-11 years). The prevalence of obesity was 15.1%. Poisson regression revealed a higher risk of obesity in children born via cesarean delivery (relative risk [RR] = 1.48; 95% CI: 1.01-2.17), children of primiparous mothers (RR = 1.72; 95% CI: 1.16-2.53), girls (RR = 1.77; 95% CI:1.21-2.60), and those aged between 5 and 9 years (RR = 26.8; 95% CI: 3.75-191.55) and older than 10 years (RR = 20.74; 95% CI: 2.89-148.61). Conclusions: The linkage between SINASC and SISVAN allowed identification of prenatal and perinatal risk factors for the development of childhood obesity. These findings should contribute to the development of health promotion and prevention policies. [ABSTRACT FROM AUTHOR]

Background: There is growing concern about the recent increase in oil and gas development using hydraulic fracturing. Studies linking adverse birth outcomes and maternal proximity to hydraulic fracturing wells exist but tend to use individualized maternal and infant data contained in protected health care records. In this study, we extended the findings of these past studies to evaluate if analogous effects detected with individualized data could be detected from non-individualized county-wide aggregated data. Design and methods: This study used a retrospective cohort of 252,502 birth records from 1999 to 2019 gathered from a subset sample of 5 counties in the state of Colorado where hydraulic fracturing activities were conducted. We used Generalized Linear Models to evaluate the effect of county-wide well density and production data over unidentified birth weight, and prematurity data. Covariates used in the model were county-wide statistics sourced from the US Census. Results: Our modeling approach showed an interesting effect where hydraulic fracturing exposure metrics have a mixed effect directional response. This effect was detected on birth weight when well density, production and their interaction are accounted for. The interaction effect provides an additional interpretation to discrepancies reported previously in the literature. Our approach only detected a positive association to prematurity with increased production. Conclusions: Our findings demonstrate two main points: First, the effect of hydraulic fracturing is detectable by using countywide unidentified data. Second, the effect of hydraulic fracturing can be complicated by the number of operations and the intensity of the activities in the area. [ABSTRACT FROM AUTHOR]

Tom was born Antal Ormai 23 February 1934 to a chemist father, at whose insistence he studied mechanical engineering before eventually switching to journalism. I last saw Tom on a visit to Budapest with my daughter Matilda in February 2020. In time, Tom became part of our lives and a proud and generous grandfather to our three girls, Imogen, Helena and Matilda. [Extracted from the article]

Objectives: Having health insurance is associated with improvements in health care access and use, health behaviors, and outcomes. We examined changes in health insurance coverage for California women before, during, and after pregnancy after implementation of the Affordable Care Act (ACA). Methods: We used data from the 2011-2017 California Maternal and Infant Health Assessment, an annual representative survey of women sampled from birth certificates (n = 47 487). We examined health insurance coverage at baseline before ACA implementation (2011-2013) and in each survey year from 2014 to 2017 for 3 periods (before, during, and after pregnancy). We calculated prevalence ratios to evaluate changes in health insurance coverage, adjusting for changes in demographic characteristics. Few women were uninsured during pregnancy before implementation of the ACA; therefore, analyses focused on health insurance before pregnancy and postpartum. Results: Before ACA implementation, 24.4% of women reported being uninsured before pregnancy, which decreased to 10.1% in 2017. About 17% of women reported being uninsured postpartum before ACA implementation, and this percentage decreased to 7.5% in 2017. ACA implementation resulted in a >50% adjusted decline in the likelihood of being uninsured before pregnancy or postpartum, primarily because of substantial increases in Medicaid coverage. Conclusions: ACA implementation resulted in a dramatic reduction in mothers in California who were uninsured before and after pregnancy. Medicaid expansion played a major role in this improvement. [ABSTRACT FROM AUTHOR]

The article focuses on trans-exclusionary radical feminist (TERF) and political landscape of anti-trans politics, and their relationship to older discourses of gender, femaleness and womanhood. It mentions Gender Recognition Act 2004 (GRA) reform plans were largely driven by a proposal to allow trans people to change their birth certificates via self-determination as well. It also mentions growing social acceptance of trans and non-binary people has challenged immutable.

Objectives: In 2011, Wisconsin introduced the 2003 Revision of the US Standard Certificate of Live Birth, which includes a variable for principal payer. This variable could help in estimating Medicaid coverage for delivery services, but its accuracy in most states is not known. Our objective was to validate Medicaid payer classification on Wisconsin birth records. Methods: We linked 128 141 Wisconsin birth records (2011-2012 calendar years) to 54 600 Medicaid claims. Using claims as the gold standard, we measured the payer variable's validity (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) overall and by maternal age, race/ethnicity, education, facility delivery volume, and the Medicaid proportion of facility delivery volume. Multivariable log-binomial regression tested the association between each characteristic and payer misclassification among Medicaid-paid births. Results: Of 128 141 birth records, 50 652 (39.5%) indicated Medicaid as the principal payer and 54 600 (42.6%) linked to a Medicaid claim. The birth record misclassified 10 007 of 54 600 (18.3%) Medicaid-paid births as non-Medicaid and 6059 of 73 541 (8.2%) non-Medicaid births as Medicaid-paid. The payer variable was less sensitive (81.7%) than specific (91.8%), and PPV and NPV were similar (∼88%). Sensitivity was highest among mothers who were Hispanic, had no high school diploma, or delivered in Medicaid-majority delivery facilities. Maternal age ≥40, maternal education >high school, and delivering in a non–Medicaid-majority delivery facility were positively associated with payer misclassification among Medicaid-paid births. Conclusion: Differential misclassification of principal payer in the birth record may bias risk surveillance of Medicaid deliveries. [ABSTRACT FROM AUTHOR]

Objective: A national estimate of births to hepatitis B surface antigen (HBsAg)–positive women can help public health programs plan surveillance, educational, and outreach activities to improve identification and management of at-risk women and infants. Stratifying mothers by country of birth allows for the application of region-specific HBsAg prevalence estimates, which can more precisely estimate the number of at-risk infants. The objective of our study was to estimate the number of births to HBsAg-positive women in the United States with more granularity than previous models. Methods: We developed a model that incorporated maternal country of birth (MCOB) and updated HBsAg prevalence estimates. We assessed birth certificate data by MCOB, and we stratified US-born mothers by race/ethnicity, US territory–born mothers by territory, and non–US-born mothers by region. We multiplied and summed data in each subcategory by using HBsAg prevalence estimates calculated from the 2009-2014 National Health and Nutrition Examination Surveys or Perinatal Hepatitis B Prevention Program. We compared the findings of our MCOB model with a race/ethnicity model. Results: In 2015, an estimated 20 678 infants were born to HBsAg-positive women in the United States, representing 0.5% of all births. Births to US-born and non–US-born women comprised 77.2% and 21.5% of all births, respectively, and 40.1% and 57.9% of estimated births to HBsAg-positive women, respectively. The estimated contribution of births to HBsAg-positive women varied by MCOB region, from 4 (0.03%) infants born to women from Australia/Oceania to 5795 (28.0%) infants born to women from East Asia. Our MCOB model estimated 5666 fewer births to HBsAg-positive women than did the race/ethnicity model. Conclusions: As global vaccine programs reduce HBsAg prevalence, the MCOB model can incorporate evolving HBsAg prevalence estimates for women from various regions of the world. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of gestational diabetes mellitus (GDM) in the United States has increased during the past several decades. The objective of this study was to use birth records and a combination of statistical and geographic information system (GIS) analyses to evaluate GDM rates among subgroups of pregnant women in Michigan. Materials and Methods: We obtained data on maternal demographic and health-related characteristics and regions of residence from 2013 Michigan birth records. We geocoded (ie, matched to maternal residence) the birth data, calculated proportions of births to women with GDM, and used logistic regression models to determine predictors of GDM. We calculated odds ratios (ORs) from the exponentiated beta statistic of the logistic regression test. We also used kernel density estimations and local indicators of spatial association (LISA) analyses to determine GDM rates in regions in the state and identify GDM hot spots (ie, areas with a high GDM rate surrounded by areas with a high GDM rate). Results: We successfully geocoded 104 419 of 109 168 (95.6%) births in Michigan in 2013. Of the geocoded births, 5185 (5.0%) were to mothers diagnosed with GDM. LISA maps showed a hot spot of 8 adjacent counties with high GDM rates in southwest Michigan. Of 11 064 births in the Southwest region, 829 (7.5%) were to mothers diagnosed with GDM, the highest rate in the state and a result confirmed by geospatial analyses. Practice Applications: Birth data and GIS analyses may be used to measure statewide pregnancy-associated disease risk and identify populations and geographic regions in need of targeted public health and maternal–child health interventions. [ABSTRACT FROM AUTHOR]

We assessed potential factors associated with “current” or “ever” self-injurious behaviors, reported in the Autism Diagnostic Interview–Revised, among children with autism spectrum disorder (n = 692) from the Study to Explore Early Development. Data on factors examined were obtained from questionnaires, standardized clinical instruments, and birth certificates. We employed a log-binomial regression to assess these associations. Although most associations were quite similar for currently and ever exhibiting self-injurious behaviors, a few differences were noted. We documented previously unreported associations of current self-injurious behaviors with maternal age and cesarean delivery, and ever self-injurious behaviors with maternal age, child sex, gestational age, and maternal race. We also confirmed previously reported associations with adaptive skills, somatic conditions (sleep, gastrointestinal, and sensory abnormalities), and other behavioral problems. These findings are informative for clinical practice and future research. [ABSTRACT FROM AUTHOR]

This study examines maternity care in a rural state by birth attendant, place of birth, and payer of birth. It is a secondary analysis of birth certificate data in New Hampshire between the years 2005 and 2012. Results revealed that in New Hampshire, the majority of births occurred in the hospital setting (98.6%). Physicians attended 75.8% of births, certified nurse midwives attended 17%, and certified professional midwives attended 1%. Medicaid coverage was the payer source for 28% of all births, compared with 44.9% nationally. Women with a private payer source were more likely than women with Medicaid or other payer sources to have a cesarean section. The findings demonstrate quality of care outcomes among a range of clinicians and settings, providing a policy argument for expanding maternity care options. [ABSTRACT FROM AUTHOR]

Tort laws aim to deter risky medical practices and increase accountability for harm. This research examines their effects on deterrence of a high-risk obstetric practice in the United States: elective early-term (37-38 weeks gestation) induction of labor. Using birth certificate data from the Natality Detail Files and state-level data from publicly available sources, this study analyzes the effects of tort laws on labor induction with multilevel models (MLM) of 665,491 early-term births nested in states. Results reveal that caps on damages are associated with significantly higher odds of early-term induction and Proportionate Liability (PL) is associated with significantly lower odds compared to Joint and Several Liability (JSL). The findings suggest that clinicians are more likely to engage in practices that defy professional guidelines in tort environments with lower legal burdens. I discuss the implications of the findings for patient safety and the deterrence of high-risk practices. [ABSTRACT FROM AUTHOR]

Child welfare data collected for administrative purposes are often used as a source of information for understanding the population impact of child abuse and neglect (CA/N). This study used administrative data linked at the individual level for a cohort of Aotearoa New Zealand (NZ) children to follow and extend a model developed by Drake et al. In this investigation, we aimed to build an understanding of the high representation of indigenous NZ children in administratively sourced measures of CA/N. Variation in rate ratios (RRs) within infant mortality and birth outcomes considered as possible proxies for actual CA/N RRs leaves open a range of interpretations. Our findings indicate that a more nuanced interpretation of the overrepresentation of indigenous children in administratively recorded maltreatment statistics is required. Rather than considering risk and bias as competing explanations, we suggest an acknowledgment of the impact of colonization and the existence of systemic bias generating increased risk as key drivers. As linked administrative data are increasingly used for research and evaluation, and considered for use in supporting decision making, there is a need for a deeper understanding of the drivers of administratively recorded CA/N in order to effectively address the needs of indigenous populations. [ABSTRACT FROM AUTHOR]

Objective. We assessed the validity of selected items on the 2003 revised U.S. Standard Certificate of Live Birth to understand the accuracy of new and existing items. Methods. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of select variables reported on the birth certificate using the medical record as the gold standard for a representative sample of live births in New York City (n=603) and Vermont (n=664) in 2009. Results. In both sites, sensitivity was excellent (>90%) for Medicaid coverage at delivery, any previous live births, and current method of delivery; sensitivity was moderate (70%–90%) for gestational diabetes; and sensitivity was poor (<70%) for premature rupture of the membranes and gestational hypertension. In both sites, PPV was excellent for Medicaid coverage, any previous live births, previous cesarean delivery, and current method of delivery, and poor for premature rupture of membranes. In both sites, almost all items had excellent (>90%) specificity and NPV. Conclusion. Further research is needed to determine how best to improve the quality of data on the birth certificate. Future revisions of the birth certificate may consider removing those items that have consistently proven difficult to report accurately. [ABSTRACT FROM AUTHOR]

This article explores the neglected subject of birth certificates, their meaning and value. The author makes a case for enhanced attention to the birth certificate in general but especially in cases where information about the father has not been entered. It is argued that rather than ‘father unknown’ being recorded, ‘father unregistered’ would be invariably more accurate. The conclusion addresses policy and practice implications for the various professions involved during the birth and registration process and also for children and family and adoption practitioners. [ABSTRACT FROM PUBLISHER]

Legal enactments are de facto definitions of gender/sex and affect the day-to-day lives of trans-identified individuals. We assessed requirements for changing gender/sex designations on US driver's licenses and birth certificates alongside their potential foundations to explore these legal definitions. Analyses showed that surgico-medical authority and sex reassignment surgery were privileged over lived experiences, psychology, and physiology (e.g. genetics; hormones). Though ‘biologism’ is typically theorized to explain legal conceptualizations and treatments of gender/sex and transgender, we argue for a diverse set of ‘bio/logics’ (implicit biological decision rules) that have profoundly different implications for trans lives. Over two other possibilities (trace bio/logics: a conceptual or physiological persistence of sexed origins; and interior bio/logics: a privileging of more embedded and immutable sex features), we conclude that US state enactments of gender/sex rely on ‘newborn bio/logics’: those binaristic features of genital sex immediately observable in newborns and naturalized via surgico-medical authority. [ABSTRACT FROM PUBLISHER]

Objectives. We investigated the reliability and validity of three self-reported indicators from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods. We used 2008 PRAMS (n515,646) data from 12 states that had implemented the 2003 revised U.S. Certificate of Live Birth. We estimated reliability by kappa coefficient and validity by sensitivity and specificity using the birth certificate data as the reference for the following: prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid payment for delivery; and breastfeeding initiation. These indicators were examined across several demographic subgroups. Results. The reliability was high for all three measures: 0.81 for WIC participation, 0.67 for Medicaid payment of delivery, and 0.72 for breastfeeding initiation. The validity of PRAMS indicators was also high: WIC participation (sensitivity = 90.8%, specificity = 90.6%), Medicaid payment for delivery (sensitivity = 82.4%, specificity = 85.6%), and breastfeeding initiation (sensitivity = 94.3%, specificity = 76.0%). The prevalence estimates were higher on PRAMS than the birth certificate for each of the indicators except Medicaid-paid delivery among non-Hispanic black women. Kappa values within most subgroups remained in the moderate range (0.40--0.80). Sensitivity and specificity values were lower for Hispanic women who responded to the PRAMS survey in Spanish and for breastfeeding initiation among women who delivered very low birthweight and very preterm infants. Conclusion. The validity and reliability of the PRAMS data for measures assessed were high. Our findings support the use of PRAMS data for epidemiological surveillance, research, and planning. [ABSTRACT FROM AUTHOR]

Objectives. We compared three measures of maternal smoking status--prepregnancy, during pregnancy, and smoking cessation during pregnancy-- between the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and the 2003 revised birth certificate (BC). Methods. We analyzed data from 10,485 women with live births in eight states from the 2008 PRAMS survey, a confidential, anonymous survey administered in the postpartum period that is linked to select BC variables. We calculated self-reported prepregnancy and prenatal smoking (last trimester only) prevalence based on the BC, the PRAMS survey, and the two data sources combined, and the percentage of smoking cessation during pregnancy based on the BC and PRAMS survey. We used two-sided t-tests to compare BC and PRAMS estimates. Results. Prepregnancy smoking prevalence estimates were 17.3% from the BC, 24.4% from PRAMS, and 25.4% on one or both data sources. Prenatal smoking prevalence estimates were 11.3% from the BC, 14.0% from PRAMS, and 15.2% on one or both data sources. The percentages of prepregnancy smokers who indicated that they quit smoking by the last trimester were 35.1% from the BC and 42.6% from PRAMS. The PRAMS estimates of prepregnancy and prenatal smoking, and smoking cessation during pregnancy were statistically higher than the corresponding BC estimates (t-tests, p<0.05). Conclusions. PRAMS captured more women who smoked before and during the last trimester than the revised BC. States implementing PRAMS and the revised BC should consider information from both sources when developing population-based estimates of smoking before pregnancy and during the last trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Objective. We linked data from two independent birth defects surveillance systems with different case-finding methods in an overlapping geographic area to assess Florida's suveillance of birth defects (e.g., neural tube defects, orofacial clefts, gastroschisis/omphalocele, and chromosomal defects), focusing on sensitivity and completeness of ascertainment measures. Methods. Live-born infants identified from each system born during 2003- 2006 in a nine-county catchment area with specific birth defects were linked to birth certificates. Using the enhanced surveillance system as a gold standard, we calculated the sensitivity of the Florida Birth Defects Registry (FBDR) for identifying infants. Next, we used capture-recapture models to estimate the completeness of case ascertainment and the prevalence of each birth defect in the catchment area. We used multivariable logistic regression models with backward elimination to estimate adjusted odds ratios and 95% confidence intervals for factors significantly associated with the FBDR's failure to capture infants ultimately identified by enhanced surveillance. Results. The FBDR's sensitivity was 89.3%, and the overall completeness of ascertainment was estimated as 86.6%. Defect-specific sensitivity and completeness of ascertainment varied significantly by defect. The combined defect-specific sensitivity for all malformations under study was 86.6%; completeness of ascertainment ranged from 45.6% for anencephaly to 88.6% for Down syndrome, 87.9% for spina bifida without anencephaly, and 87.0% for orofacial clefts. Conclusions. For the defects under study, the FBDR captured nearly nine of every 10 infants born with selected birth defects. However, the FBDR's ability to identify specific defects was both more limited and defect dependent with widely varying defect-specific sensitivities. [ABSTRACT FROM AUTHOR]

Objectives. Approximately 13% of all births occur prior to 37 weeks gestation in the U.S. Some established risk factors exist for preterm birth, but the etiology remains largely unknown. Recent studies have suggested an association with environmental exposures. We examined the relationship between preterm birth and exposure to a commonly used herbicide, atrazine, in drinking water. Methods. We reviewed Kentucky birth certificate data for 2004-2006 to collect duration of pregnancy and other individual-level covariates. We assessed existing data sources for atrazine levels in public drinking water for the years 2000-2008, classifying maternal county of residence into three atrazine exposure groups. We used logistic regression to analyze the relationship between atrazine exposure and preterm birth, controlling for maternal age, race/ethnicity, education, smoking, and prenatal care. Results. An increase in the odds of preterm birth was found for women residing in the counties included in the highest atrazine exposure group compared with women residing in counties in the lowest exposure group, while controlling for covariates. Analyses using the three exposure assessment approaches produced odds ratios ranging from 1.20 (95% confidence interval [CI] 1.14, 1.27) to 1.26 (95% CI 1.19, 1.32), for the highest compared with the lowest exposure group. Conclusions. Suboptimal characterization of environmental exposure and variables of interest limited the analytical options of this study. Still, our findings suggest a positive association between atrazine and preterm birth, and illustrate the need for an improved assessment of environmental exposures to accurately address this important public health issue [ABSTRACT FROM AUTHOR]

This record linkage study aims to examine the coding concordance of delivery outcome and discharge status between the New South Wales (NSW) Midwives Data Collection (MDC) and Admitted Patients Data Collection (APDC) as well as factors that contribute to hospital births not being recorded in the APDC. Births recorded in the APDC and MDC datasets for the calendar year 2005 were used for analysis. Births registered in the NSW Registry of Births Deaths and Marriages for the same period were used as validation. Descriptive analysis was used to examine coding concordance between the APDC and MDC datasets for matched records, and logistic regression analyses were used to identify factors associated with hospital births not being included in the APDC. A total of 90,585 unique births were recorded in the MDC for the calendar year 2005. A total of 79,173 confirmed hospital births were matched to corresponding records in the APDC; 2,249 (3%) confirmed hospital births were not found in the APDC. For unmatched records, logistic regression analyses showed that the level of obstetric hospital in which babies were born was a significant factor associated with information not being recorded in the APDC. As compared with local, small isolated, and small metropolitan hospitals (Levels 1 to 3 hospitals), larger tertiary hospitals (Levels 4 to 6) and private hospitals had decreased odds of hospital births not being recorded in the APDC. For matched records, 95% and 99% of records were found to be coded consistently between the APDC and MDC datasets for outcome of delivery and discharge status respectively. With a high level of coding concordance between the APDC and MDC datasets and only a small percentage of hospital births not being recorded in the APDC, the obstetrics subset of the APDC dataset was found to be of good quality. [ABSTRACT FROM AUTHOR]

A newborn screen designed to predict family risk was examined to: (a) determine whether all families with newborns were screened; (b) evaluate its predictive validity for identifying risk of out-of-home placement, as a proxy for maltreatment; (c) determine which items were most predictive of out-of-home placement. All infants born in Manitoba, Canada from 2000 to 2002 were followed until March 31, 2004 (N = 40,886) by linking four population-based data sets: (a) newborn screening data on biological, psychological, and social risks; (b) population registry data on demographics; (c) hospital discharge data on newborn birth records; (d) data on children entering out-of-home care. Of the study population, 18.4% were not screened and 3.0% were placed in out-of-home care at least once during the study period. Infants not screened were twice as likely to enter care compared to those screened (4.9% vs. 2.5%). Infants screening at risk were 15 times more likely to enter care than those screening “not at risk.” Sensitivity and specificity of the screen were 77.6% and 83.3%, respectively. Screening efforts to identify vulnerable families missed a substantial portion of families needing support. The screening tool demonstrated moderate predictive validity for identifying children at risk of entering care in the first years of life. [ABSTRACT FROM PUBLISHER]

Objectives. Previous studies indicate that nulliparous women (i.e., women having no previous births) are at higher risk for adverse birth outcomes than multiparous women (i.e., women having had at least one previous birth). We examined whether part of the difference in adverse outcome rates is attributable to nulliparous women with poor pregnancy outcomes being less likely (through choice or fecundity differences) to have a subsequent live birth within the same time period as nulliparous women without adverse outcomes. Methods. Using deterministic matching, we linked nulliparous women from the North Carolina Detailed Birth Record to subsequent births. We employed statistical and simulation-based analyses to estimate first birth outcome rate differences between nulliparous women who did have a subsequent live birth vs. those who did not. Our Markov simulations focused on preterm birth (PTB). Results. Among nulliparous women who were not linked to a second birth, maternal age-adjusted rates of multiple adverse outcomes were all statistically higher compared with rates for linked women. These results also held in race/ ethnicity-specific analyses. Simulations found that the relative risk of PTB associated with a history of PTB was underestimated if some women who would have been at risk for PTB did not experience a second birth. Conclusions. The observed differences in rates of adverse outcomes between nulliparous and multiparous women are partly attributable to higher-risk women not having a subsequent live birth, either by choice or due to fecundity differences. [ABSTRACT FROM AUTHOR]

Objective. Maternal marriage has historically been protective against preterm birth (PTB); however, social norms and behaviors surrounding marriage have changed over time in the United States. We analyzed secular trends in the relationship between marriage and PTB. Methods. We collected data about all births in Michigan between 1989 and 2006 to assess (1) the relationship between marital status and PTB and moderately PTB risk by year, and (2) the relationship between married and unmarried status and PTB and moderately PTB by year relative to similar marital status in 1989. Results. Among nearly 2.4 million births between 1989 and 2006, PTB risk among married mothers increased while risk among unmarried mothers decreased. In adjusted models, married status became less protective against PTB relative to unmarried status over time by year, and was associated with higher risk of PTB over time. Moderately PTB risk increased among both married and unmarried groups, but more so among married mothers. Conclusion. Our findings suggest that marriage is becoming less protective against PTB over time. The influence of social factors on risk for adverse birth outcomes is likely dynamic, suggesting that ongoing revisions to our understanding are in order. [ABSTRACT FROM AUTHOR]

This article presents a population-based study of early childhood injury mortality following a nonfatal allegation of maltreatment. Findings are based on a unique data set constructed by establishing child-level linkages between vital birth records, administrative child protective services records, and vital death records. These linked data reflect over 4.3 million children born in California between 1999 and 2006 and provide a longitudinal record of maltreatment allegations and death. Of interest was whether children reported for nonfatal maltreatment subsequently faced a heightened risk of unintentional and intentional injury mortality during the first 5 years of life. Findings indicate that after adjusting for risk factors at birth, children with a prior allegation of maltreatment died from intentional injuries at a rate that was 5.9 times greater than unreported children (95% CI [4.39, 7.81]) and died from unintentional injuries at twice the rate of unreported children (95% CI [1.71, 2.36]). A prior allegation to CPS proved to be the strongest independent risk factor for injury mortality before the age of five. [ABSTRACT FROM AUTHOR]

Objectives. We assessed variations in the sensitivity of birth defect diagnoses derived from birth certificate data by maternal, infant, and hospital characteristics. Methods. We compared birth certificate data for 1995-2005 births in Atlanta with data from the Metropolitan Atlanta Congenital Defects Program (MACDP). We calculated the sensitivity of birth certificates for reporting defects often discernable at birth (e.g., anencephaly, spina bifida, cleft lip, clubfoot, Down syndrome, and rectal atresia or stenosis). We used multivariable logistic regression models to examine associations with sociodemographic and hospital factors. Results. The overall sensitivity of birth certificates was 23% and ranged from 7% for rectal atresia/stenosis to 69% for anencephaly. Non-Hispanic black maternal race/ethnicity, less than a high school education, and preterm birth were independently associated with a lower probability of a birth defect diagnosis being reported on a birth certificate. Sensitivity also was lower for hospitals with >1,000 births per year. Conclusions. The underreporting of birth defects on birth certificates is influenced by sociodemographic and hospital characteristics. Interpretation of birth defects prevalence estimates derived from birth certificate reports should take these issues into account. [ABSTRACT FROM AUTHOR]

Objectives. We inventoried and reviewed the birth and fetal death certificates of all 50 U.S. states to identify nonstandard data items that are environmentally relevant, inexpensive to collect, and might enhance environmental public health tracking. Methods. We obtained online or requested by mail or telephone the birth certificate and fetal death record forms or formats from each state. Every state data element was compared to the 2003 standards promulgated by the National Center for Health Statistics to identify any items that are not included on the standard. We then evaluated these items for their utility in environmentally related analyses. Results. We found three data fields of potential interest. First, although every state included residence of mother at time of delivery on the birth certificate, only four states collected information on how long the mother had lived there. This item may be useful in that it could be used to assess and reduce misclassification of environmental exposures among women during pregnancy. Second, we found that father's address was listed on the birth certificates of eight states. This data field may be useful for defining paternal environmental exposures, especially in cases where the parents do not live together. Third, parental occupation was listed on the birth certificates of 15 states and may be useful for defining parental workplace exposures. Our findings were similar for fetal death records. Conclusion. If these data elements are accurate and well-reported, their addition to birth, fetal death, and other health records may aid in environmental public health tracking. [ABSTRACT FROM AUTHOR]

Objectives. This study provided a population-based estimate of the prevalence of smoking during pregnancy by combining information from two data sources: birth certificates (BCs) and a self-administered questionnaire. Methods, We analyzed data from 39,345 women who delivered live births in one of 24 states and responded to a questionnaire from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing, state- and population-based surveillance system. We compared prevalence of smoking during pregnancy based on the BC, the PRAMS questionnaire, and the two data sources combined. Data were weighted to represent all women delivering live births in each of the 24 states during 2004. Results. The combined estimate indicated that 15.1% of women reported smoking during pregnancy, whereas the BCs alone reported 1014% and the PRAMS questionnaires alone reported 13.4%. Conclusions, Based on the combined BC and PRAMS questionnaire data, the number of infants exposed to tobacco in-utero may be 31% higher than is currently reported on the BCs. Combining the data from the two different sources led to higher ascertainment of prenatal smoking. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to assess the relationship between pre-pregnancy maternal obesity and risk of infant death. Methods. In March 2004, maternal height and pre-pregnancy weight were added to the data collected on the Florida birth certificate. Using birth records linked to infant deaths, these data were used to assess the relationship between pre-pregnancy maternal obesity, as measured by body mass index, and infant death. Results. Pre-pregnancy maternal obesity was associated with increased odds of infant death. The increased risk was found with and without adjustments for maternal race, marital status, age, education, trimester prenatal care began, first birth, and tobacco use. Conclusion. There is a substantial and significant association between pre- pregnancy maternal obesity and infant death. [ABSTRACT FROM AUTHOR]

Objective. Nationally, infertility therapies (IFTs) are increasingly used to over-come fecundity issues. However, it is unclear to what extent noninvasive IFTs are used compared with assisted reproductive technology. To better understand outcomes related to the increasing use of all types of IFTs, we compared self-reported IFT use from a Massachusetts pilot Pregnancy Risk Assessment Monitoring System (MA-PRAMS) to IFT use recorded on birth certificates (BCs). Methods. In 2005, Massachusetts conducted a three-month pilot study modeled after the Centers for Disease Control and Prevention's PRAMS, a population-based surveillance system that monitors pregnancy experiences. Descriptive and bivariate analyses compared responses to MA-PRAMS survey questions regarding IFT use with data collected on BCs from the same women sampled. Results. According to MA-PRAMS, 6.1% of live births were conceived using IFTs compared with 3.1% reported on BCs. Reported IFT use varied by maternal age and plurality. For women aged 18-34 years, IFT use reported on MA-PRAMS (5.0%) was 2.5 times higher than that reported on BCs (2.0%). For women aged 35 years or older, reported IFT use was comparable in both systems. For women giving birth to singletons, IFT use reported on MA-PRAMS (5.5%) was three times higher than that reported on BCs (1.8%). Conclusions. Higher use of IFTs was reported by MA-PRAMS than on BCs, particularly among younger women and those having singleton births. These findings suggest that self-reported IFT use might be a more sensitive method for states to use in assessing population-based IFT usage among women and monitoring trends in adverse birth outcomes. [ABSTRACT FROM AUTHOR]

This study demonstrates the utility of integrating birth certificate record data with an existing disability- tracking database for the purpose of evaluating early identification efforts. The authors examined referral rates of preschool-age children for several known disability risk factors. Low birthweight, low maternal education, and prematurity were associated with increased odds of referral. The authors also examined referral rates for gender, race, and ethnicity. The odds of referral for boys were nearly twice those for girls. Compared to White children, the odds of referral were greater for Native American children and lower for Black and Asian/Pacific Island children. Odds of referral for non-Hispanic/non-Haitian children were greater than those for Hispanic or Haitian children. Identifying factors that are associated with the likelihood of referral will alert clinicians, parents, teachers, and policy makers to the existence of biasing factors and can be used to further improve Child Find procedures. [ABSTRACT FROM AUTHOR]

Objectives. We compared data on race as reported by the mother on North Carolina birth certificates with data on race in officially reported statistics. We also determined to what extent differences in the classification of race affect measures of racial disparity in maternal and child health indicators. Methods. We examined how data on race are collected, coded, and tabulated in North Carolina via live birth certificates, death certificates, the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey, and the Central Cancer Registry case records. We showed how the data on race collected through North Carolina birth and death certificates are translated into 10 fixed racial categories designated by the National Center for Health Statistics (NCHS) for use in official vital statistics. We compared race as reported by the mother on birth certificates to racial tabulations used in the official published birth statistics. We also examined to what extent differences in the determination of race affect measures of racial disparity in maternal and child health indicators. Results. Out of nearly 118,000 live births in North Carolina in 2002, mothers reported more than 600 different versions of race on birth certificates. These entries were collapsed into the 10 standard racial categories outlined in federal coding rules. Approximately two-thirds of mothers of Hispanic ethnicity report their race with a label that can be categorized as "Other" race, but nearly all of these births are re-coded to "white" for the official birth statistics. Measures of racial disparity vary depending on whether self-reported or officially coded race is used. Conclusions. This study shows that, given the opportunity to report their own race, North Carolinians describe their race using a wide variety of terms and concepts. In contrast, health statistics are usually reported using a few standardized racial categories defined by federal policy. The NCHS rules for coding race should be reexamined. As the ethnic and racial diversity of the United States continues to increase, these rules will become increasingly antiquated. [ABSTRACT FROM AUTHOR]