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Adolescent childbearing adversely affects both mothers and infants. The birth rate for US adolescent women of Hispanic origin is higher than that for US adolescents overall. Birth rates among US Hispanic adolescents in the border region are higher than rates among other US Hispanic adolescents, and rates among Mexican border adolescents are higher than rates among other Mexican adolescents. We used binational birth certificate data for US Hispanic and Mexican adolescent women living inside the border region, elsewhere within the border states, and in the US and Mexico overall to compare birth rates and other health indicators among these groups. From 2000 to 2009, birth rates for 15-19 year-olds declined 19-28 % among US Hispanic geographic subgroups and 8-13 % among Mexican geographic subgroups; rates in the border region in 2009 were 73.8/1,000 women ages 15-19 for US Hispanics and 87.2/1,000 for Mexicans and were higher than rates in other US and Mexican subgroups, respectively. Less than one in five US Hispanic and Mexican adolescent mothers in the border region was married. About one in three delivered by cesarean. Late or no prenatal care was more prevalent among US Hispanic (17.6 %) than Mexican (14.3 %) border adolescents. Birth weight and gestational age outcomes were generally poorest in Texas border counties compared with border counties in other US states and in municipios of Mexican states bordering Texas. High birth rates and low prenatal care utilization among adolescents are problems along the US-Mexico border. El embarazo en adolescentes afecta de manera adversa tanto a las madres como a los ninos. La tasa de fecundidad entre mujeres adolescentes estadounidenses de origen hispano es mas alta que la de las adolescentes estadounidenses en general. Las tasas de fecundidad entre adolescentes estadounidenses hispanas en la region fronteriza son mas altas que las tasas entre otras adolescentes hispanas de Estados Unidos, y las tasas entre adolescentes de la frontera mexicana son mas elevadas que las de otras adolescentes mexicanas. Usamos los datos del certificado de nacimiento de ambos paises de mujeres adolescentes estadounidenses hispanas y mexicanas que viven dentro de la region fronteriza, en cualquier otro lugar dentro de los estados fronterizos, asi como en Estados Unidos y en Mexico en general, para comparar las tasas de fecundidad y otros indicadores de salud entre estos grupos. De 2000 a 2009, las tasas de fecundidad entre adolescentes de 15-19 anos disminuyeron 19-28 % entre los subgrupos geograficos estadounidenses hispanos; las tasas en la region fronteriza en 2009 fueron de 73.8/1,000 mujeres de entre 15-19 abos en el caso de estadounidenses hispanas, y de 87.2/1,000 en el caso de las mexicanas, niveles mas altos que las tasas de otros subgrupos de estadounidenses y mexicanas, respectivamente. Menos de una de cada cinco madres adolescentes mexicanas y estadounidenses hispanas en la region fronteriza eran casadas. Aproximadamente una de cada tres dio a luz por cesarea. La atencitSn prenatal tardia o nula fue mas prevalente entre adolescentes fronterizas estadounidenses hispanas (17.6 %) que entre las mexicanas (14.3 %). El peso al nacer y la edad gestacional se presentaron en general con mayores desventajas en los condados fronterizos de Texas en comparacitSn con los condados fronterizos de otros estados de Estados Unidos, y con municipios de estados mexicanos que colindan con Texas. Las altas tasas de fecundidad y el bajo uso de la atencion prenatal entre adolescentes son problemas presentes a lo largo de la frontera entre Mexico y Estados Unidos. Keywords Adolescents * Birth certificates * Birth rates * Hispanic Americans * Mexico, Introduction Childbearing and parenting among adolescents is associated with adverse health and quality of life effects for mothers and infants [1-3]. National initiatives in the US [4] and in Mexico [...]

Cesarean birth (CB) is more prevalent in the US-Mexico border region than among all US Hispanics. Comparable data from US and Mexican birth certificates can be used to compare prevalence and identify risk factors on either side of the border. Using 2009 US and Mexican birth certificates, we compared the characteristics of US Hispanic and Mexican CBs in six geographic subgroups: US and Mexican border counties/municipios, US and Mexican nonborder counties/municipios and the US and Mexico overall. We also explored cesarean prevalence over time. During 2000-2009, CB rates increased from 22.1 to 31.6% among US Hispanics and from 25.9 to 37.9% among Hispanics in the US border region. 2009 rates were 44.5% in Mexico and 43.1% in the Mexican border region. In both countries, CB rates were similar for primiparas and multiparas. Higher education, being married and parity >4 were associated with CB in Mexico; being married was associated in the US. Hispanic rates were higher in the US border than non-border region for all age groups. Along the border, cesarean rates for Hispanics were highest in Texas (43.5%) and neighboring Tamaulipas (49.8%). Higher cesarean prevalence in Mexico than in US Hispanics, while unexplained, is consistent with high prevalence in some Latin American countries. Higher cesarean prevalence among Hispanics in the US border region than among Hispanics nationwide cannot be explained by maternal age or parity. Medical indications are also unlikely to explain such high rates, which are undesirable for mothers and infants. El nacimiento por cesarea es mas prevalente en la region fronteriza Mexico-Estados Unidos que entre todos los estadounidenses hispanos. Datos comparables de los certificados de nacimiento de EE. UU. y de Mexico se pueden usar para analizar la prevalencia e identificar factores de riesgo de cualquier lado de la frontera. Mediante los certificados de nacimiento de 2009 de EE. UU. y Mexico comparamos las caractensticas de los nacimientos por cesarea en estadounidenses hispanas y en mexicanas en 6 subgrupos geograficos: condados/municipios fronterizos de EE. UU. y Mexico, condados/municipios no fronterizos de EE. UU. y Mexico y EE. UU. y Mexico en general. Exploramos tambien las tendencias de la prevalencia de la cesarea en el tiempo. De 2000 a 2009, las tasas de nacimientos por cesarea aumentaron de 22.1% a 31.6% entre estadounidenses hispanas, y de 25.9% a 37.9% entre hispanas en la region fronteriza de EE. UU. Las tasas de 2009 eran de 44.5% en Mexico y de 43.1% en la region fronteriza de Mexico. En ambos paises, las tasas de nacimientos por cesarea fueron similares en primiparas y multiparas. Un mayor nivel educativo, ser casadas y una paridad >4 se asociaron al nacimiento por cesarea en Mexico; en EE. UU. el factor asociado fue ser casada. Las tasas en hispanas fueron mas altas en la region fronteriza estadounidense que en la region no fronteriza en todos los grupos de edad. A lo largo de la frontera, las tasas de cesarea para hispanas fueron las mas elevadas en Texas (43.5%) y en el vecino estado de Tamaulipas (49.8%). La mayor prevalencia de cesarea en Mexico que en las hispanas estadounidenses, aunque sin explication determinante es congruente con la alta prevalencia en algunos paises latinoamericanos. La mayor prevalencia de cesarea entre hispanas en la region fronteriza estadounidense que entre hispanas a nivel nacional no se puede explicar solo en terminos de edad materna o paridad. Es tambien poco probable que las indicaciones medicas, por si solas, expliquen tasas tan altas, que son indeseables para las madres y los bebes. Keywords Reproductive health * Birth certificates * Population surveillance * Hispanic Americans * Mexico * Cesarean section, Background The United States-Mexico border region includes parts of California, Arizona, New Mexico, and Texas in the US, and Baja California, Sonora, Chihuahua, Coahuila, Nuevo Leon, and Tamaulipas in Mexico [...]

Objective. This study compares patterns of tobacco use during pregnancy over time and across population subgroups and examines the impact of maternal smoking on the incidence of low birth weight (LBW). The study also evaluates the use of birth certificates to monitor prenatal smoking. Methods. The birth certificates of all states (except California) and the District of Columbia for 2000 provided to Centers for Disease Control and Prevention's National Center for Health Statistics were analyzed. Trends in maternal smoking were examined with data from birth certificates and other relevant sources. Results. Smoking during pregnancy was reported for 12.2% of women who gave birth in 2000, down 37% from 1989 (19.5%), when this information was first collected on birth certificates. Throughout the 1990s, prenatal smoking rates were highest for older teenagers and women in their early 20s. Among population subgroups, the highest rates were reported for non-Hispanic white women who attended but did not complete high school. The incidence of LBW among singleton infants who were born to smokers was double that for nonsmokers. This relationship was observed in all age groups, for births to Hispanic and non-Hispanic white and black women, and within educational attainment subgroups. Even light smoking ( Conclusion. Although prenatal smoking may be underreported on the birth certificate, the trends and variations in smoking based on birth certificate data have been confirmed with data from other sources. Birth certificate data can be useful in monitoring prenatal smoking patterns. Changes in the birth certificate questions that are to be implemented beginning in 2003 will help to clarify the levels and changes in smoking behavior during pregnancy so that smoking cessation programs can be more effectively designed to meet the needs of the populations at risk. Pediatrics 2003;111:1176-1180; birth, maternal smoking, low birth weight, birth certificates., ABBREVIATIONS. LBW, low birth weight; API, Asian or Pacific Islander; CDC, Centers for Disease Control and Prevention; NSFG, National Survey of Family Growth. Cigarette smoking during pregnancy has been associated [...]

Two newer prenatal care indexes show that the use of prenatal care services increased substantially between 1981 and 1995, but this was not paralleled by a decrease in premature births or low birth weight. A review of 54 million live births between 1981 and 1995 showed that prenatal care use increased from 32.7% to 47% according to the R-GINDEX and from 18.4% to 28.8% according to the Adequacy of Prenatal Care Utilization Index. Older indexes showed no change in use. Older mothers and those with multiple pregnancies were likely to use prenatal care services intensively., Context.--Two measures traditionally used to examine adequacy of prenatal care indicate that prenatal care utilization remained unchanged through the 1980s and only began to rise slightly in the 1990s. In recent years, new measures have been developed that include a category for women who receive more than the recommended amount of care (intensive utilization). Objective.--To compare the older and newer indices in the monitoring of prenatal care trends in the United States from 1981 to 1995, for the overall population and for selected subpopulations. Second, to examine factors associated with receiving intensive utilization. Design.--Cross-sectional and trend analysis of national birth records. Setting.--The United States. Subjects.--All live births between 1981 and 1995 (N=54 million). Main Outcome Measures.--Trends in prenatal care utilization, according to 4 indices (the older indices: the Institute of Medicine Index and the trimester that care began, and the newer indices: the R-GINDEX and the Adequacy of Prenatal Care Utilization Index). Multiple logistic regression was used to assess the risk of intensive prenatal care use in 1981 and 1995. Results.--The newer indices showed a steadily increasing trend toward more prenatal care use throughout the study period (R-GINDEX, intensive or adequate use, 32.7% in 1981 to 47.1% in 1995; the Adequacy of Prenatal Care Utilization Index, intensive use, 18.4% in 1981 to 28.8% in 1995), especially for intensive utilization. Women having a multiple birth were much more likely to have had intensive utilization in 1995 compared with 1981 (R-GINDEX, 22.8% vs 8.5%). Teenagers were more likely to begin care later than adults, but similar proportions of teens and adults had intensive utilization. Intensive use among low-risk women also increased steadily each year. Factors associated with a greater likelihood of receiving intensive use in 1981 and 1995 were having a multiple birth, primiparity, being married, and maternal age of 35 years or older. Conclusions.--The proportion of women who began care early and received at least the recommended number of visits increased between 1981 and 1995. This change was undetected by more traditional prenatal care indices. These increases have cost and practice implications and suggest a paradox since previous studies have shown that rates of preterm delivery and low birth weight did not improve during this time. JAMA. 1998;279:1623-1628

In 1995 the overall birth rate declined to 14.8 live births per 1,000 population, births among teens continued its decline to 56.9 per 1,000 adolescent-aged women, and births to unmarried women declined to 44.9 per 1,000 unmarried women. Smoking during pregnancy declined to 14.6%, women receiving care in the first trimester continued its rise to 81.2%, and the cesarean section rate continued its decline to 20.8%. Low birth weight births rose from 7.2% to 7.3% and the multiple birth weight ratio continued its rise to 25.7 per 1,000 births. Death rates in all age ranges among children declined by 2% to 6%., Recent trends in the vital statistics of the United States continued in 1995 including decreases in the number of births, the birth rate, the age-adjusted death rate, and the infant mortality rate; life expectancy at birth increased to a level equal to the record high of 75.8 years in lffy. Marriages and divorces both decreased. An estimated 3900 089 infants were born during 1995, a decline of 1% from 1994. The preliminary birth rate for 1995 was 14.8 live births per 1000 total population, a decline, and the lowest recorded in nearly two decades. The fertility rate, which relates births to women in the childbearing ages, declined to 65.6 live births per 1000 women 15 to 44 years old, the lowest rate since 1986. According to preliminary data for 1995, fertility rates declined for all racial groups with the gap narrowing between black and white rates. The fertility rate for black women declined 7% to a historic low level (71.7); the preliminary rate for white women (64.5) dropped just 1%. Fertility rates continue to be highest for Hispanic, especially Mexican-American, women. Preliminary data for 1995 suggest a 2% decline in the rate for Hispanic women to 103.7. The birth rate for teenagers has now decreased for four consecutive years, from a high of 62.1 per 100 women 15 to 19 years old in 1991 to 56.9 in 1995, an overall decline off 8%. he rate of childbearing by unmarried mothers dropped 4% from 1994 to 1995, from 46.9 births per 1000 unmarried women 15 to 44 years old to 449, the first decline in the rate in nearly two decades. The proportion of all births occurring to unmarried women dropped as well in 1995, to 32.0% from 32.6% in 1994. Smoking during pregnancy dropped steadily from 1989 (19.5%) to 1994 (14.6%), a decline of about 25%. Prenatal care utilization continued to improve in 1995 with 81.2% of all mothers receiving care in the first trimester compared with 78.9% in 1993. Preliminary data for 1995 suggests continued improvement to 81.2%.The percent of infants delivered by cesarean delivery declined slightly to 20.8% in 1995. The percent of low birth weight (LBW) infants continued to climb in 1994 rising to 7.3% from 7.2% in 1993. The proportion of LBW improved slightly among black infants, declining from 13.3% to 13.2% between 1993 and 1994. Preliminary figures for 1995 suggest continued decline in LBW for black infants (13.0%). The multiple birth ratio rose to 25.7 per 1000 births for 1994, an increase of 2% over 1993 and 33% since 1980., SPECIAL NOTE FROM THE AUTHORS Our request, last year,[1] for comments and suggestions elicited one major them - bring back the international comparisons of infant mortality. Thus, we have included [...]

Analysis of U.S. vital statistics from 1993 and projections for 1994 reveal that an estimated 3,979,000 people were born in 1994, the lowest since 1989. In 1993, fertility rates declined, although rates among Hispanic and black women exceeded rates among white women. 1994 birth rates among women 30 and older continued to rise while rates among 15- to 19-year-olds leveled off. Ninety-nine percent of births occurred in hospitals. In 1993, the number of births attended by midwives rose to 4.8%, the overall cesarean rate fell to 21.8%, the first-time cesarean rate fell to 15.3%, and the vaginal birth rate after cesarean rose to 24.3%. Less than 5% of mothers had no or late prenatal care. Smoking during pregnancy declined to 15.8%. The incidence of low birth weight rose to 7.2%, mostly due to an increase in multiple births. Among black women it was 13.3%. Because birth rates exceeded death rates, 1,693,000 persons were added to the population. The infant death rate fell to 7.9 per thousand, the lowest ever. Because nonwhite and Hispanic races have higher fertility rates, their proportion among children is expected to grow. The proportion of elderly is expected to increase markedly while the proportion of children declines., SPECIAL NOTE FROM THE AUTHORS Since 1950,[1] Myron Wegman has authored this series of reports of the vital statistics of the United States, a record of achievement that few of us will ever,equal, and this calls for special comment. Over the years, his articles have informed, enlightened, and entertained readers. Dr Wegman, a master teacher, has never been shy about expressing his strongly-held views in these articles! The new authors will attempt to maintain this tradition of independent thinking and critical commentary. In addition, we hope over the next few years to introduce some new features and new data sets. The devotees of this annual Wegman paper will note that it now takes four of us to replace one giant! The article is now a collaboration between academics from a school of public health and professionals from a federal agency, recognizing the importance of cooperation between our institutions. The National Center for Health Statistics (NCHS) is the source of the data presented in the paper and assures its accuracy and timeliness. In last year's report,l Dr Wegman explained the sources of the vital statistical data, the different NCHS reports that are used, and the timing of their availability. The shift in authorship from the University of Michigan to Johns Hopkins and NCHS reflects Dr Wegman's long association with these institutions. We wish to request comments and reactions from readers. Please tell us which parts of the article are the most useful and what additional information you would like us to report. Finally, the authors wish to thank the American Academy of Pediatrics and the Editors of Pediatrics for having the confidence in us to pass the baton our way. Recent trends in the vital statistics of the United States continued in 1994, including decreases in the number of births, the birth rate, the age-adjusted death rate, and the infant mortality rate. Life expectancy increased slightly to 75.7 years. Only marriages reversed the recent trend with a slight increase in 1994. An estimated 3 979 000 infants were born during 1994, a decline of, ars. Prenatal care utilization improved in 1993; 79% of women initiated care in the first trimester and ABBREVIATIONS. US, United States; LBW, low birth weight; VLBW, very low birth weight; [...]

To better characterize the health of Hispanic children in the US, data were analyzed from the National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (HHANES). These data allowed investigators to separately analyze results for carefully selected samples of Mexican-Americans, mainland Puerto Ricans, and Cuban-Americans. The particular focus was on pregnancy outcomes (birthweight and prematurity) and the prevalence of chronic medical disorders. Low-birthweight infants were those who weighed less than 5.5 pounds at birth; very-low-birthweight infants weighted less than 3.25 pounds; and premature births took place prior to than 37 weeks' gestation. Results showed that Hispanic mothers younger than 20 have approximately the same proportion of low-birthweight babies as non-Hispanic whites, a rate that is lower than for non-Hispanic blacks. The rate is slightly higher among older mothers, but still far below the rate for blacks. Low birthweight was associated with lower educational levels; this association was stronger for some groups (mainland Puerto Ricans) than for others (Mexican-Americans). The prevalence of very-low-birthweight babies was approximately equal for Mexican- and Cuban-Americans and non-Hispanic whites; it was higher for Puerto Ricans and non-Hispanic blacks. Premature births occurred more frequently among Hispanics than among non-Hispanic whites (11.4 percent); less frequently among non-Hispanic blacks (21.5 percent). The rates for the three groups were: Cuban-Americans, 12.6 percent; Mexican-Americans, 13.5 percent; and Puerto Ricans, 14.6 percent. Puerto Rican children had a higher prevalence of chronic medical conditions than Mexican-American and Cuban-American children (although data were incomplete for this latter group). The disorders included cardiovascular disease (heart valve abnormalities), high blood pressure, seizures, endocrine disorders, and mental retardation. When evaluated as a homogeneous group, Hispanic children do not have poorer health status than non-Hispanic white children. However, clear differences exist among Hispanic subgroups, with mainland Puerto Rican children at the greatest disadvantage. Such differences should be taken into account in health care planning; access to health care is already known to be poorest for Mexican-Americans. The report appears in the January 9, 1991 issue of The Journal of the American Medical Association, which is devoted to the health of, and health care for, Hispanics in the US. (Consumer Summary produced by Reliance Medical Information, Inc.)