Pregnancy and Reproductive Health
Publications and Materials
Below are selected publications and materials related to pregnancy, birth defects prevention, and reproductive health. Please note the year of publication may be later than the year(s) the data represent..
2008 Publications and Materials
Emergency
Planning Tips if You're Pregnant or Have Young Children (9/5/08)
If you are pregnant or have infants or young children, find out how to plan for
an emergency or disaster.
Increasing
Prevalence of Gestational Diabetes and Pregnancy-Related Hypertension
in Los Angeles County, California, 1991-2003 (9/5/08)
The rates of gestational diabetes and pregnancy-related hypertension are increasing
in Los Angeles County. Further research is needed to determine the causes of
the observed increases and the growing racial/ethnic disparities in those rates.
National
Birth Defects Prevention Study Finds Pre-Pregnancy Diabetes Increases
Risk for Multiple Types of Birth Defects (8/7/08)
Women who receive a diagnosis of diabetes before they become pregnant are
three to four times more likely to have a child with one or even multiple
birth defects than a mother who is not diabetic, according to a study by
CDC, released in the American Journal of Obstetrics and Gynecology.
Assisted
Reproductive Technology (ART) Surveillance- United States, 2005 (8/7/08)
In 2005, a total of 134,260 ART procedures were reported to CDC. These
procedures resulted in 38,910 live-birth deliveries and 52,041 infants.
Approximately 1% of U.S. infants born in 2005 were conceived through ART.
Those infants accounted for 17% of multiple births nationwide.
The HPV Vaccine
and Its Safety (8/7/08)
Based on ongoing assessments of vaccine safety information, FDA and CDC
continue to find that Gardasil is a safe and effective vaccine. FDA and
CDC continue to monitor the safety of this vaccine, with the public's health
and safety the top priority.
Making Sense of Your HPV and Pap
Test Results (8/7/08)
This brochure explains the meaning of Pap and HPV test results and answers
common patient questions about HPV, such as how to talk to your partner
about HPV. It includes ‘questions to ask your doctor' to help prepare women
for next steps and a glossary of terms.
Protect
Your Baby from Group B Strep (8/7/08)
If you or someone you know is pregnant, you need to know about “group B
strep." Group B streptococcal bacteria (also called GBS, group B strep,
or baby strep) is very common in all types of women and can be passed on
to a baby during childbirth. Protect babies from group B strep. If you
are 35-37 weeks pregnant, ask your doctor or nurse about a group B strep
test.
Wildfires:
Information for Pregnant Women and Parents of Young Infants (8/7/08)
Learn what pregnant women and parents of young children can do if they
are, or may be, evacuated from their home.
Breastfeeding
Report Card, 2008 (8/7/08)
The Report Card provides information for each state on key breastfeeding
indicators. It helps show where a state has been successful and where more
work is needed in order to improve breastfeeding practices.
Breastfeeding-Related
Maternity Practices at Hospitals and Birth Centers- United States, 2007 (6/23/08)
This report indicates that 1) a substantial proportion of facilities used
maternity practices that are not evidence-based and are known to interfere
with breastfeeding and 2) states in the southern United States generally
had lower scores, including certain states previously determined to have
the lowest 6-month breastfeeding rates.
Prevention
of Pertussis, Tetanus, and Diphtheria among Pregnant and Postpartum Women
and Their Infants (6/23/08)
This report describes the clinical features of pertussis, tetanus, and
diphtheria among pregnant and postpartum women and their infants; reviews
available evidence of pertussis vaccination; summarizes Tdap vaccination
policy; and presents recommendations for use of Td and Tdap vaccines among
pregnant and postpartum women. See also: Appendix
A and Appendix
B.
Guiding
Principles for Development of ACIP Recommendations for Vaccination during
Pregnancy and Breastfeeding (6/23/08)
This document provides guidance to help standardize procedures for policy
formulation and presentation of the rationale and recommendations for vaccination
of pregnant and breastfeeding women. These principles will be applied to
future Advisory Committee on Immunization Practices vaccine statements
and routine updates of existing statements in which vaccination of pregnant
and breastfeeding women is considered.
Prevalence
of Self-Reported Postpartum Depressive Symptoms- 17 States, 2004-2005 (4/30/08)
Podcast
Postpartum depression (PPD) affects 10-15% of mothers within the first
year after giving birth. Younger mothers and those experiencing partner-related
stress or physical abuse might be more likely to develop PPD. This report
indicates that, during 2004-2005, the prevalence of self-reported postpartum
depressive symptoms in 17 U.S. states ranged from 11.7% (Maine) to 20.4%
(New Mexico).
Pregnancy
Rate Drops for U.S. Women under Age 25
Pregnancy rates for females under age 25, including teenagers, in the United
States declined in 2004 compared to 1990, according to a new report, Estimated
Pregnancy Rates by Outcome for the United States, 1990-2004. The report
says nearly 38 percent of pregnancies in 2004 were to women under age 25,
down from nearly 43 percent in 1990. The proportion of pregnancies among
teens under age 20 dropped from 15 percent in 1990 to 12 percent in 2004.
Smoking
Early In Pregnancy Raises Risks of Heart Defects In Newborns (4/30/08)
Mothers who smoke early in pregnancy are more likely to give birth to infants
with heart defects, according to a study funded by CDC. The study shows
that women who smoked anytime during the month before pregnancy to the
end of the first trimester were more likely to give birth to infants with
certain congenital heart defects compared to women who did not smoke during
this time period.
Pregnant
Women Who are Obese Linked with Greater Health Care Services Use (4/30/08)
Obesity during pregnancy is associated with greater use of health care
services and longer hospital stays, according to a study from CDC and Kaiser
Permanente Northwest Center for Health Research. The study, is the first
to document the effect of obesity during pregnancy on the use of health
care services.
Expanded
Health Data from the New Birth Certificate, 2005 
(4/30/08)
This report presents data for 2005 on checkbox items exclusive to the 2003
U.S. Standard Certificate of Live Birth. Information is shown for check
boxes in the following categories: risk factors in this pregnancy, obstetric
procedures, characteristics of labor and delivery, method of delivery,
abnormal conditions of the newborn, and congenital anomalies of the newborn.
Diabetes
and Pregnancy (5/11/08)
Controlling diabetes before and during pregnancy will help prevent birth
defects and other poor outcomes, such as miscarriage or stillbirth.
Breastfeeding
in the United States: Findings from the National Health and Nutrition
Examination Survey, 1999-2006 (5/11/08)
This report summarizes information on breastfeeding rates in the United
States based on data from the 1999-2006 National Health and Nutrition Examination
Surveys (NHANES). Breastfeeding rates in the United States increased significantly
between 1993 and 2006. Breastfeeding rates increased significantly with
increasing maternal age overall and for all race-ethnicity groups.
Women
and Alcohol (4/30/08)
Drinking alcohol during pregnancy is one of the top preventable causes
of birth defects and developmental disabilities. There is no known amount
of alcohol that is safe to drink while pregnant. There is no safe time
to drink during pregnancy. Alcohol can harm a baby at any time during pregnancy.
Gynecologic
Cancer Awareness: Inside Knowledge Campaign (3/26/08)
This campaign will raise awareness of the five main types of gynecologic
cancer: cervical, ovarian, uterine, vaginal, and vulvar. When gynecologic
cancers are found early, treatment is most effective. It is important for
women to pay attention to their bodies and know what is normal for them
so that they can recognize the warning signs of gynecologic cancers.
Put
Down That Drink If You Are Pregnant (or Trying to Be)! (3/26/08)
This podcast discusses the danger of drinking alcohol during pregnancy.
Pap
Tests and Foreign-Born Women Podcast (2/14/08)
Find out why foreign-born women living in the U.S. are less likely to have
Pap tests to detect cervical cancer than women born in this country, who
these women are, why they are less likely to get a Pap test, and what CDC
is doing about it.
Knowledge
and Practices of Obstetricians and Gynecologists Regarding Cytomegalovirus
(CMV) Infection during Pregnancy- United States, 2007 (2/14/08)
Fewer than half of OB/GYNs surveyed reported counseling their patients
about preventing CMV infection. These results emphasize the need for additional
training and for a better understanding of the reasons that physician knowledge
might not result in patient counseling.
Folic
Acid Awareness (2/14/08)
The B vitamin folic acid helps prevent birth defects. If a woman has enough
folic acid in her body before and while she is pregnant, her baby is less
likely to have a major birth defect of the brain or spine.
Use of
Supplements Containing Folic Acid among Women of Childbearing Age- United
States, 2007 (2/14/08)
Among all women of childbearing age, those aged 18-24 years had the least
awareness regarding folic acid consumption, the least knowledge regarding
when folic acid should be taken, and the lowest reported daily use of supplements
containing folic acid.
2007 Publications and Materials
Abortion
Surveillance- United States, 2004 (12/20/07)
A total of 839,226 legal induced abortions were reported to CDC for 2004
from 49 reporting areas, representing a 1.1% decline from the 848,163
legal induced abortions reported by 49 reporting areas for 2003.
Fetal
and Perinatal Mortality- United States, 2004 (12/20/07)
The fetal mortality rate for non-Hispanic black women (11.25) was 2.3
times the rate for non-Hispanic white women (4.98), whereas the rate
for Hispanic women (5.43) was 9 percent higher than the rate for non-Hispanic
white women.
Diabetes
and Pregnancy: Gestational Diabetes Podcast (12/20/07)
Gestational diabetes happens in a woman who develops diabetes during
pregnancy. This podcast discusses its potential effects and action steps
to avoid complications.
Pap Tests
and Foreign-Born Women Podcast (12/20/07)
Foreign-born women living in the U.S. are less likely to have Pap tests
to detect cervical cancer than women born in this country. The problem
is worse for women from certain countries or regions. Find out why this
is a disturbing trend, who these women are, why they are less likely
to get a Pap test, and what CDC is doing about it.
Pregnant
or Thinking about Getting Pregnant? (11/19/07)
These tips can help you prevent infections that could harm your unborn
baby. You won't always know if you have an infection; sometimes you won't
even feel sick. If you think you might have an infection or think you
are at risk, see your doctor.
You
CAN Help Prevent Birth Defects Podcast (One-Minute Version) (11/19/07)
Six-Minute
Version
To reduce the risk for neural tube defects such as spina bifida or anencephaly,
women of reproductive age should consume at least 400 mcg of synthetic
folic acid daily by eating one serving of fortified breakfast cereal
or taking a supplement.
Trends
in Folic Acid Supplement Intake among Women of Reproductive Age- California,
2002-2006 (11/19/07)
This report indicates that although the overall prevalence of intake
of folic acid-containing supplements remained stable from 2002 (40%)
to 2006 (41%) in California, use of such supplements decreased among
Hispanic women and women with less education.
Mother-to-Child
(Perinatal) HIV Transmission and Prevention (Updated) (11/19/07)
Perinatal HIV transmission is the most common route of HIV infection
in children and is now the source of almost all AIDS cases in children
in the United States. Most of the children with AIDS are members of minority
races/ethnicities.
Pregnant
or Thinking about Getting Pregnant? Ten Tips to Prevent Infections
during Pregnancy (10/23/07)
Learn how to prevent infection and help keep your unborn baby safe.
Cytomegalovirus (CMV) (10/23/07)
CMV is the most common congenital (present at birth) infection in the
United States. Find out what you should know about CMV if you are pregnant.
Does
Breastfeeding Reduce the Risk of Pediatric Overweight? (10/9/07)
This Research to Practice brief explores the relationship between breastfeeding
and pediatric overweight, and it specifically examines: how this relationship
may be influenced by factors such as duration, exclusivity, and age at
follow-up; recent surveillance data on initiation, duration, and exclusivity
of breastfeeding; and research to practice: evidence-based interventions
to promote breastfeeding.
Statistics
on Breastfeeding Practices in the U.S.: Results of the National Immunization
Survey (10/9/07)
This site presents national trends in breastfeeding practices for children
born 1999-2004. Data for trends on exclusive breastfeeding are shown separately
for children whose caregivers were interviewed before and after January
2006 because question changes on the 2006 survey instrument had a large
effect on rates of exclusive breastfeeding.
Immunization
and Pregnancy Flyers (10/9/07)
These flyers focus on the immunizations a woman needs before, during, and
after pregnancy.
Breastfeeding
Trends and Updated National Health Objectives for Exclusive Breastfeeding-
United States, Birth Years 2000-2004 (8/31/07)
The findings in this report indicate that although progress is being made
toward achieving the HP2010 objectives for breastfeeding initiation and
duration, rates of exclusive breastfeeding are below desired levels, especially
among black infants and those born to women who are young, unmarried, have
lower incomes, are less educated, or who live in rural areas.
Medications: Information
for Pregnant and Breastfeeding Women (8/31/07)
It is increasingly important that women talk with their doctor about the
risks and benefits of taking prescription and over-the-counter drugs, vitamins,
and dietary or herbal supplements before getting pregnant, during pregnancy,
and while breastfeeding.
Here's
to an Alcohol-Free Pregnancy (8/31/07)
When a pregnant woman drinks alcohol, so does her unborn baby. Remember,
if a pregnant woman does not drink alcohol, she will prevent serious disabilities
caused by alcohol in her unborn baby.
Assisted
Reproductive Technology Surveillance- United States, 2004 (7/27/07)
In 2004, a total of 127,977 ART procedures were reported to CDC. These
procedures resulted in 36,760 live-birth deliveries and 49,458 infants.
The highest numbers of ART procedures were performed among residents of
California (17,303), New York (11,123), Illinois (9,306), Massachusetts
(8,906), and New Jersey (8,513).
One
Test. Two Lives (7/27/07)
The One Test. Two Lives. campaign focuses on ensuring that all
women are tested for HIV early in their pregnancy. One Test. Two Lives.
provides quick access to a variety of resources for providers, and materials
for their patients, to help encourage universal voluntary prenatal testing
for HIV.
Assisted Reproductive
Technology (ART) Report: 2005 Preliminary Clinic Data by State and National
Summary (6/12/07)
The findings represent data from 422 fertility clinics in operation in
2005. The 134,242 ART cycles performed at these reporting clinics resulted
in 38,910 live births (deliveries of one or more living infants) and 52,041
infants. This information is preliminary.
Characteristics
of Births to Single Race and Multiple Race Women- California, Hawaii,
Pennsylvania, Utah, and Washington, 2003 (6/12/07)
In 2003, 2.5 percent of births in California, Hawaii, Pennsylvania, Utah,
and Washington were to women who reported two or more races, with levels
varying from 1 percent (Utah) to 33 percent (Hawaii).
Trends
in Preterm-Related Infant Mortality by Race and Ethnicity- United States,
1999-2004 (6/12/07)
In 2004, 36.5% of all infant deaths in the United States were preterm-related,
up from 35.4% in 1999. The preterm-related infant mortality rate for non-Hispanic
black mothers was 3.5 times higher and the rate for Puerto Rican mothers
was 75% higher than for non-Hispanic white mothers.
CDC's
Pregnancy Information Center (6/12/07)
If you're pregnant or planning to get pregnant, you probably have a lot
of questions. This website will help you learn how to be healthy (before,
during, and after pregnancy) and give your baby a healthy start to life.
Reproductive
Health Assessment Toolkit for Conflict-Affected Women (6/12/07)
Using the Toolkit, workers collect information about safe motherhood, family
planning, sexual history, sexually transmitted infections, HIV/AIDS, gender-based
violence, female genital cutting, and emotional health. With this, organizations
can determine how to improve the reproductive health of refugee women and
their families.
Expanded
Health Data from the New Birth Certificate, 2004 (6/12/07)
This is the first report to present maternal and infant health information
exclusive to the 2003 revision of the U.S. Standard Certificate of Live
Birth.
Drinking and
Reproductive Health: A Fetal Alcohol Spectrum Disorders (FASD) Prevention
Tool Kit (6/12/07)
This tool kit aims to teach women's health care providers how to screen
and advise all of their patients of reproductive age about risky drinking
and encourage the use of effective contraception among patients who continue
to engage in risky drinking. It also addresses drinking during pregnancy.
DES
Daughters (4/17/07)
DES Daughters are women born between 1938 and 1971 who were exposed to
diethylstilbestrol (DES) before birth (in the womb). Research has confirmed
that DES Daughters are at an increased risk for several diseases and conditions.
Learn what you can do to protect your health.
Maternal
Mortality and Related Concepts (3/5/07)
This report presents data on U.S. deaths to pregnant or recently pregnant
women, summarizes long-term processing issues, and examines recent changes
affecting the data and the impact of the changes on the statistics for
these women. Maternal deaths increased with the introduction of the ICD-10
and with changes associated with the addition of a separate pregnancy status
question on the U.S. Standard Certificate of Death. These changes may result
in better identification of maternal deaths.
Fetal
and Perinatal Mortality- United States, 2003 (3/5/07)
This report presents 2003 fetal and perinatal mortality data by a variety
of characteristics, including maternal age, marital status, race, Hispanic
origin, and state of residence; and by infant birthweight, gestational
age, plurality, and sex. Trends in fetal and perinatal mortality are also
examined. The rate of fetal deaths occurring at 20 weeks of gestation or
more (also known as stillbirths) declined substantially between 1990 and
2003. Although fetal mortality rates declined among all racial and ethnic
groups from 1990-2003, the rate for non-Hispanic black women was more than
double that of non-Hispanic white women (11.56 per 1,000 vs. 4.94 per 1,000).
QuickStats:
Percentage of Total Births that were Preterm, by Gestational Age- United
States, 1990 and 2005 (3/5/07)
The proportion of total births that were preterm increased from 9.7 percent
in 1990 to 11.0 percent in 2005. Most of the increase was among births
occurring at 34-36 weeks (i.e., late preterm), which increased from 6.8
percent to 8.1 percent.
QuickStats:
Birth Rates among Females Aged 15-19 Years, by State- United States,
2004 (3/5/07)
Age of mother is a predictor of maternal and infant health risk. Pregnant
teens aged 15-19 years are less likely to receive timely prenatal care
and gain appropriate weight and more likely to smoke during pregnancy than
pregnant women aged 20 years and older.
Folate
Status in Women of Childbearing Age, by Race/Ethnicity- United States,
1999-2000, 2001-2002, and 2003-2004 (2/1/07)
PDF
This report uses National Health and Nutrition Examination Survey data
to update findings and assess trends in serum folate and red blood cell
folate levels by race/ethnicity from the 1999-2000 survey through the 2003-2004
survey. The results of these comparisons indicated that median serum folate
concentrations among nonpregnant women of childbearing age decreased 16%
from 1999-2000 through 2003-2004, and RBC folate concentrations decreased
8%. All women of childbearing age who are capable of becoming pregnant
should consume 400 µg of folic acid daily to reduce the occurrence
of NTD-affected pregnancies.
Assisted
Reproductive Technology (ART) Success Rates: National Summary and Fertility
Clinic Reports, 2004 (2/1/07)
The 2004 report of pregnancy success rates is the tenth to be issued under
the law. This report is based on the latest available data on the type,
number, and outcome of ART cycles performed in U.S. clinics. The full on-line
version and hardcopies of the report will be available February
20, 2007.
Recent
Trends in Teenage Pregnancy in the United States, 1990-2002 (1/8/07)
In 2002, an estimated 757,000 pregnancies among teenagers 15-19 years resulted
in 425,000 live births, 215,000 induced abortions, and 117,000 fetal losses.
The overall teenage pregnancy rate was estimated at 76.4 pregnancies per
1,000 females aged 15-19 years.
The Costs
of an Outreach Intervention for Low-Income Women with Abnormal Pap Smears (1/8/07)
PDF
In a health care system in which many women fail to get follow-up care
for an abnormal Pap smear, outreach workers were more effective than usual
care (mail or telephone reminders) at increasing follow-up rates. The results
suggest that outreach workers should manage their effort based on the degree
of abnormality; most effort should be placed on women with the most severe
abnormality (high-grade squamous intraepithelial lesion).
2006 Publications and Materials
Births:
Preliminary Data for 2005 (12/1/06)
This report from CDC summarizes 2005 preliminary births and birth rates and selected
2005 preliminary maternal and infant health birth data for the United States.
The number of births and the general fertility rate increased slightly, whereas
the crude birth rate remained unchanged from 2004 to 2005. Births rose for Hispanic,
American Indian or Alaska Native, Asian or Pacific Islander, and non-Hispanic
black women, but declined slightly for non-Hispanic white women. The birth rate
for teenagers declined 2 percent in 2005, falling to 40.4 births per 1,000 women
aged 15-19 years, a 35-percent drop compared with the most recent peak in 1991
(61.8), and the lowest ever recorded in the 65 years for which a consistent series
of rates is available. Childbearing by women in their thirties and forties continued
to increase.
Abortion
Surveillance- United States, 2003 (12/1/06)
PDF
A total of 848,163 legal induced abortions were reported to CDC for 2003
from 49 reporting areas, representing a 0.7% decline from the 854,122 legal
induced abortions reported by 49 reporting areas for 2002. The abortion
ratio, defined as the number of abortions per 1,000 live births, was 241
in 2003, a decrease from the 246 in 2002.
Monitoring
Progress toward Achieving Maternal and Infant Healthy People 2010 Objectives-
19 States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003 (11/29/06)
PRAMS data indicate variability among states regarding progress toward
achieving HP 2010 objectives in the area of maternal and child health.
More progress has been made in achieving objectives focused on the period
during and after pregnancy.
Revised
Recommendations for HIV Testing of Adults, Adolescents, and Pregnant
Women in Health-Care Settings (11/29/06)
These recommendations for HIV testing are intended for all health-care
providers in the public and private sectors. The recommendations address
HIV testing in health-care settings only.
Infertility
and STDs (11/29/06)
CDC recommends annual chlamydia screening for all sexually active females
aged 25 and under and for women older than 25 with risk factors such as
a new sex partner or multiple partners.
Prophylaxis
and Treatment of Pregnant Women for Emerging Infections and Bioterrorism
Emergencies (11/29/06)
Recent experiences with outbreaks of severe acute respiratory syndrome,
monkeypox, and anthrax, as well as response planning for bioterrorism and
pandemic influenza, illustrate the challenges of making recommendations
about treatment and prophylaxis for pregnant women. Understanding the physiology
of pregnancy, the factors that influence the teratogenic potential of medications
and vaccines, and the infection control measures that may stop an outbreak
will aid planners in making recommendations for the care of pregnant women
during large-scale infectious disease emergencies.
Emerging
Infections and Pregnancy (11/29/06)
Pregnant women's altered response to infectious diseases should be considered
when planning a response to emerging infectious disease threats.
QuickStats:
Percentage of Infants Born during 1990-1993 and 1997-2000 Who Were Ever
Breastfed, by Race/Ethnicity of Mother- United States (11/29/06)
The percentage of infants ever breastfed increased from 55 percent among
those born during 1990-1993 to 67 percent among those born during 1997-2000,
bringing the levels of breastfeeding initiation closer to the Healthy
People 2010 objective of 75 percent among mothers in all racial/ethnic
groups.
Preconception
Care: Science, Practice, Challenges, and Opportunities (10/31/06)
(Non-CDC site)
This special supplement of the Maternal and Child Health Journal includes
over 25 original papers on preconception care.
Breastfeeding
Practices: Results from the 2005 National Immunization Survey (8/21/06)
Since January 2003, breastfeeding questions have been asked of all National
Immunization Survey (NIS) respondents to assess the population's breastfeeding
practices. As a result, the 2005 NIS results not only provide overall population
estimates for the initiation, duration, and exclusivity of breastfeeding,
but also geographically-specific breastfeeding rates.
Final
Births for 2004 (8/1/06)
This CDC report summarizes the 2004 final births and birth rates for the
United States. The number of births rose very slightly, the birth rate
for teenagers declined one percent in 2004, and for the second consecutive
year, all measures of childbearing by unmarried women rose sharply.
Reduction
in Perinatal Transmission of HIV Infection- United States, 1985-2005 (7/28/06)
Estimates of the number of perinatal HIV infections peaked in 1991 at 1,650
and declined to an estimated range of 144-236 in 2002 (CDC, unpublished
data, 2006). This reduction is attributed to routine HIV screening of pregnant
women, use of antiretroviral drugs for treatment and prophylaxis, avoidance
of breastfeeding, and use of elective cesarean delivery when appropriate.
With these interventions, rates of HIV transmission during pregnancy, labor,
or delivery from mothers infected with HIV have been reduced to less than
2 percent, compared with transmission rates of 25-30 percent with no interventions.
Smallpox
during Pregnancy and Maternal Outcomes (7/28/06)
This article examines the outcomes of pregnancy complicated by smallpox
in historical records from the 19th and 20th centuries. Literature dating
back to the 19th century was collected and reviewed. Technical details
of the literature review are provided. All selected publications were retrospective
studies based on epidemiologic observations of outbreaks that reported
case fatalities, miscarriages, or premature births. Nineteen outbreaks
were identified from historical records, and of these, 16 allowed estimates
to be made of case fatality, and 15 allowed estimates of the proportion
of miscarriage or premature birth. Of 1,074 pregnant patients, 368 died;
and of 830 pregnant patients, 331 miscarried or gave birth prematurely.
Achievements
in Public Health: Reduction in Perinatal Transmission of HIV Infection-
United States, 1985-2005 (6/19/06)
During 2005, an estimated 92% of AIDS cases reported among children aged <13
years in the United States were attributed to mother-to-child transmission
of HIV. Every perinatal HIV infection often indicates a woman who had undiagnosed
HIV infection before pregnancy or did not receive appropriate interventions
to prevent transmission of the virus to her infant.
Group
B Strep Frequently Asked Questions (6/19/06)
Group B streptococcus (group B strep) is a type of bacteria that causes
illness in newborn babies, pregnant women, the elderly, and adults with
other illnesses. Group B strep is the most common cause of life-threatening
infections in newborns. Find out what you can do to prevent and treat group
b strep.
The CDC
Guide to Breastfeeding Interventions (6/19/06)
This guide provides state and local community members information to choose
the breastfeeding intervention strategy that best meets their needs. The
Guide builds upon the research evidence demonstrating effective interventions
as well as the expertise of the nation's leading scientists and experts
in breastfeeding management and interventions.
Guidelines
for Vaccinating Pregnant Women (6/19/06)
Benefits of vaccinating pregnant women usually outweigh potential risks
when the likelihood of disease exposure is high, when infection would pose
a risk to the mother or fetus, and when the vaccine is unlikely to cause
harm.
Fertility,
Contraception, and Fatherhood: Data from the 2002 National Survey of
Family Growth (Media Advisory) (6/19/06)
Full Report
CDC has issued a comprehensive report on fertility, contraception, and
fatherhood indicators among men 15-44 years of age in the United States.
The data are from the National Survey of Family Growth conducted in 2002.
It's the latest survey of this type, and--for the first time--this large-scale,
nationwide survey includes men. Whenever appropriate, the findings for
men and women are contrasted. Men's and women's reproductive experiences
vary significantly, and often sharply, by characteristics such as education,
income, and Hispanic origin and race.
Assisted
Reproductive Technology Surveillance- United States, 2003 (6/19/06)
PDF
In 2003, a total of 122,872 ART procedures were reported to CDC. These
procedures resulted in 35,785 live-birth deliveries and 48,756 infants.
Nationwide, 74% of ART procedures used freshly fertilized embryos from
the patient's eggs; 14% used thawed embryos from the patient's eggs; 8%
used freshly fertilized embryos from donor eggs; and 4% used thawed embryos
from donor eggs. Overall, 42% of ART transfer procedures resulted in a
pregnancy, and 35% resulted in a live-birth delivery (delivery of one or
more live-born infants). The highest live-birth rates were observed among
ART procedures using freshly fertilized embryos from donor eggs (51%).
The highest numbers of ART procedures were performed among residents of
California (15,911), New York (15,534), Massachusetts (8,813), Illinois
(8,676), and New Jersey (8,299). These five states also reported the highest
number of infants conceived through ART. Of 48,756 infants born through
ART, 51% were born in multiple-birth deliveries.
Mother-to-Child
(Perinatal) HIV Transmission and Prevention (6/19/06)
PDF
HIV transmission from mother to child during pregnancy, labor, delivery,
or breastfeeding is called perinatal transmission. Research published in
1994 showed that zidovudine (ZDV) given to pregnant HIV-infected women
reduced this type of HIV transmission. Since then, the testing of pregnant
women and treatment for those who are infected have resulted in a dramatic
decline in the number of children perinatally infected with HIV.
Birth
and Fertility Rates for States by Hispanic Origin Subgroups- United States,
1990 and 2000 (Media Advisory) (6/19/06)
Full Report
The report, from CDC's National Center for Health Statistics, is the first-ever
comprehensive look at birth and fertility rates among the growing U.S.
Hispanic population, and contains detailed findings by state showing trends
in births and fertility rates among Hispanics in the United States in 1990
and again in 2000. Selected highlights: Overall, the states with the fastest
growing Hispanic population are Arkansas, Georgia, North Carolina and Tennessee;
these same four states lead the nation in increases in the number of total
live births among Hispanic mothers. Mexican mothers had the highest fertility
rate among Hispanics in the United States, followed by Puerto Rican mothers
and Cuban mothers. The states with the highest fertility rate among Mexican
mothers are North Carolina and Georgia.
Recommendations to
Improve Preconception Health and Health Care- United States (4/24/06)
This report provides recommendations to improve both preconception health
and care. The goal of these recommendations is to improve the health of
women and couples before conception of a first or subsequent pregnancy.
The recommendations should be used by consumers, clinical care providers,
public health professionals, researchers, policy makers, and others concerned
with the health of women, children, and families.
Racial
and Socioeconomic Disparities in Breastfeeding- United States, 2004 (3/30/06)
PDF (p. 335)
To obtain current estimates of racial and economic disparities in breastfeeding
among U.S. children, CDC analyzed data from the 2004 National Immunization
Survey. This report describes the results of that analysis, which indicated
that 71.5% of non-Hispanic white children were ever breastfed compared
with 50.1% of non-Hispanic black children. Among those ever breastfed,
53.9% of non-Hispanic white and 43.2% of non-Hispanic black children continued
breastfeeding until at least age 6 months. Disparities between black and
white children existed within most socioeconomic subgroups studied.
QuickStats:
Percentage of Births Attended by Midwives- United States, 2003 (2/30/06)
In 2003, approximately 8.0% of births were attended by midwives, more than
double the 1990 rate of 3.9%. In six states (Alaska, Georgia, New Hampshire,
New Mexico, Oregon, and Vermont), rates were at least twice as high as
the national rate.
Improved
National Prevalence Estimates for 18 Selected Major Birth Defects- United
States, 1999-2001 (1/30/06)
PDF
Press Release
This report describes estimates of national prevalence and number of affected
births in the United States each year during 1999-2001 for 18 selected
major birth defects. The findings indicated that 10 of the 18 defects affected
more than 1,000 infants each year in the United States. The conditions
with the highest prevalence included orofacial clefts, which affect approximately
6,800 infants annually, and Down syndrome, which affects approximately
5,500 infants annually.
Births:
Preliminary Data for 2004 (1/30/06)
This report presents preliminary data for 2004 on births in the United
States. U.S. data on births are shown by age, race, and Hispanic origin
of mother. Data on marital status, tobacco use, prenatal care, cesarean
delivery, preterm births, and low birth-weight are also presented. Birth
rates for teenagers 15-19 years declined modestly. The rate for 10-14 year-olds
increased slightly. The birth rate for women aged 20-24 years declined
1 percent to 101.8, a record low for the Nation. Childbearing by unmarried
women rose to a record high of almost 1.5 million births in 2004. A record
high cesarean delivery rate was reported in 2004, at 29.1 percent of all
births, a 6-percent increase from 2003.
Trends
in Spina Bifida and Anencephalus in the United States, 1991-2003 (1/30/06)
This Health e-stat provides a 13-year trend for two neural tube defects,
spina bifida and anencephalus. After a significant increase in the spina
bifida rate from 1992 to 1995, there was a significant decline from 1995
to 1999. The rate was stable from 1999 to 2003. The rate for 2003 was significantly
lower than in 1998. The rate of spina bifida in 2003 was 18.89 per 100,000
live births, the lowest rate reported in this analysis.
Rates
of Cesarean Delivery among Puerto Rican Women- Puerto Rico and the U.S.
Mainland, 1992-2002 (1/30/06)
PDF (p. 68)
To compare trends in cesarean delivery during 1992-2002 among Puerto Rican
women who delivered in Puerto Rico and on the U.S. mainland, CDC and the
Puerto Rico Department of Health analyzed birth certificate data from the
National Vital Statistics System. This report summarizes the results of
that analysis, which determined that, during 1992-2002, total and primary
cesarean rates were consistently higher in Puerto Rico than among Puerto
Rican women on the mainland. From 1996 to 2002, total and primary cesarean
rates increased for Puerto Rican women in both places of delivery, but
rates increased more sharply for women in Puerto Rico than on the mainland.
In Puerto Rico, the greatest increase was in the youngest group (aged <20
years), doubling from 18.5% to 37.6%. On the mainland, the greatest increase
was among women aged 35-39 years, increasing 23% from 33.2% to 40.9%. During
2002, the highest rates both in Puerto Rico and on the mainland were for
women aged >40 years (63.9% and 44.6%, respectively).
2005 Publications and Materials
Fertility,
Family Planning, and Reproductive Health of U.S. Women (12/30/05)
This report presents national estimates of fertility, family planning, and reproductive
health indicators among females 15-44 years of age in the United States in 2002
from the National Survey of Family Growth. Women’s reproductive experiences
vary significantly, and often sharply, by demographic characteristics such as
education, income, and Hispanic origin and race.
2003 Assisted Reproductive
Technology Success Rates (12/30/05)
Press Release
This report helps potential assisted reproductive technology (ART) users
make informed decisions about ART by providing some of the information
needed to answer the questions: “What are my chances of having a
child by using ART?” and “Where can I go to get this treatment?”
QuickStats:
Total Fertility Rates, by State– United States, 2003 (12/30/05)
On the basis of 2003 birth rates, U.S. women have an average of 2.0 births
during their lives. The total fertility rate (i.e., the estimated average
number of births per woman in a lifetime, based on the age-specific birth
rates observed in a given year) varies by state, ranging from 1.7 in Vermont
to 2.6 in Utah.
Early-Onset
and Late-Onset Neonatal Group B Streptococcal Disease- United States,
1996-2004 (12/30/05)
PDF (p. 1205)
To assess the impact of the guidelines on multi-state trends in neonatal
GBS disease incidence, CDC analyzed data from the Active Bacterial Core
surveillance system from 1996-2004. This report summarizes the results
of that analysis, which determined that incidence of GBS disease in infants
aged 0-6 days (i.e., early-onset disease) in 2004 had decreased by 31%
from 2000-2001, the period immediately before universal screening was implemented.
Incidence of GBS disease in infants aged 7-89 days (i.e., late-onset disease)
remained unchanged during the 9-year period reviewed. Continued monitoring
is needed to assess the impact of the 2002 guidelines on early-onset disease
and the long-term effect of widespread intrapartum use of antimicrobial
agents on neonatal GBS disease.
QuickStats:
Rate of Very Low Birthweight, by Age of Mother and Multiple-Birth Status- United
States, 2003 (12/30/05)
The risk of giving birth to a very low birthweight infant is higher for
both younger and older mothers. Much of the added risk among older women
is attributable to higher multiple birth rates. On average, infants born
in multiple births are smaller than infants born in single births.
Contraceptive
Use- United States and Territories, BRFSS, 2002 (12/30/05)
PDF
Errata
To characterize contraceptive use in the United States and its territories,
the Behavioral Risk Factor Surveillance System, for the first time, asked
both men and women about their birth-control use for the prevention of
pregnancy during 2002. This report presents survey findings, which found
that the majority of persons at risk for pregnancy were using birth control.
Among female respondents using birth control, the pill was the most common
method reported. Among men, vasectomy was the most commonly reported method.
The prevalence of use for the four most commonly reported methods (pills,
vasectomy, tubal ligation, condoms) varied as much as six-fold among states
for vasectomy and three- to four-fold for condoms, pills, and tubal ligation.
Lymphocytic
Choriomeningitis Virus (LCMV) and Pregnancy: Facts and Prevention (12/30/05)
This fact sheet answers five questions: what is LCMV and how is it spread,
what are the risks of LCMV infection during pregnancy, how can I prevent
becoming infected with LCMV, is there treatment for LCMV infection during
pregnancy, and where can I go for more information.
Critical
Needs in Caring for Pregnant Women during Times of Disaster for Non-Obstetric
Health Care Providers (12/30/05)
Three questions are answered in the fact sheet: what are the critical reproductive
health care messages for women and their health care providers, what are
the critical issues for prenatal care, and what signs and symptoms require
emergency obstetric services.
Abortion
Surveillance– United States, 2002 (11/30/05)
PDF
A total of 854,122 legal induced abortions were reported to CDC for 2002
from 49 reporting areas, representing a 0.1% increase from the 853,485
legal induced abortions reported by the same 49 reporting areas for 2001.
The abortion ratio, defined as the number of abortions per 1,000 live births,
was 246 in 2002, the same as reported for 2001. The abortion rate was 16
per 1,000 women aged 15-44 years for 2002, the same as for 2001. For the
same 48 reporting areas, the abortion rate remained relatively constant
during 1997-2002. The highest percentages of reported abortions were for
women who were unmarried (82%), white (55%), and aged <25 years (51%).
Of all abortions for which gestational age was reported, 60% were performed
at <8 weeks' gestation and 88% at <13 weeks.
Preliminary
Births for 2004: Infant and Maternal Health (11/30/05)
This CDC report summarizes selected 2004 preliminary maternal and infant
health birth data for the United States. An earlier report highlighted
demographic results from the 2004 birth data. Key findings for this report
show: the cesarean delivery rate rose 6 percent in 2004 to 29.1 percent
of all births, the highest rate ever reported in the United States; no
improvement in timely receipt of prenatal care was seen in 2004; tobacco
use during pregnancy declined slightly in 2004; more than a half million
infants were born preterm in 2004, the highest number reported since comparable
national data on gestational age have been available; and infants were
more likely to be born low birthweight in 2004.
Preliminary
Births Data for 2004 (Fact Sheet) (11/30/05)
Health
E-Stats
This report from CDC’s National Center for Health Statistics summarizes
the 2004 preliminary birth data for the United States. There were 4.1 million
births in 2004, nearly 1 percent more than in 2003. Childbearing by unmarried
women reached a record high of almost 1.5 million births in 2004, up 4
percent from 2003. Teenage birth rates declined again in 2004, but at a
much slower pace than observed since the declines started after 1991. Births
to older women continue to increase.
Guidelines
for Identifying and Referring Persons with Fetal Alcohol Syndrome (11/30/05)
PDF
Appendix– CNS
Abnormalities Associated with FAS
This report summarizes the diagnostic guidelines drafted by the scientific
working group, provides recommendations for when and how to refer a person
suspected of having problems related to prenatal alcohol exposure, and
assesses existing practices for creating supportive environments that might
prevent long-term adverse consequences associated with FAS. The guidelines
were created on the basis of a review of scientific evidence, clinical
expertise, and the experiences of families affected by FAS regarding the
physical and neuropsychologic features of FAS and the medical, educational,
and social services needed by persons with FAS and their families. The
guidelines are intended to facilitate early identification of persons affected
by prenatal exposure to alcohol so they and their families can receive
services that enable them to achieve healthy lives and reach their full
potential. This report also includes recommendations to enhance identification
of and intervention for women at risk for alcohol-exposed pregnancies.
QuickStats:
Rate of Triplet and Other Higher-Order Multiple Births- United States,
1980-2003 (10/30/05)
The rate of triplet and other higher-order multiple births increased substantially,
from 37 per 100,000 live births in 1980 to 194 in 1998, a trend largely
attributable to increased usage of fertility therapies. During 1999-2003,
the rate of triplet and higher-order multiple births has remained stable.
Diabetes
and Pregnancy (10/30/05)
Diabetes is often detected in women during their childbearing years and
can affect the health of both the mother and her unborn child. Poor control
of diabetes in a woman who is pregnant increases the chance for birth defects
and other problems for the baby and might cause serious complications for
the woman. Proper health care before and during pregnancy will help prevent
birth defects and other poor outcomes, such as miscarriage and stillbirth.
The page features frequently asked questions and answers.
Pregnancy,
Travel, and Malaria: A Cautionary Tale (10/30/05)
All travelers to malaria-risk areas should take precautions against this
dangerous mosquito-borne disease. Pregnant women who are at especially
high risk should avoid traveling to malaria-risk areas if at all possible.
If a pregnant woman must travel to a malaria-risk area, she should make
sure to take all necessary precautions (including antimalaria pills) against
malaria.
Influenza
Vaccination in Pregnancy: Practices among Obstetrician-Gynecologists-United
States, 2003-2004 Influenza Season (10/30/05)
PDF (p. 1050)
To assess understanding of the Advisory Committee on Immunization Practices
(ACIP) recommendations among obstetrician-gynecologists (OB/GYNs), the
American College of Obstetricians and Gynecologists, with support from
CDC, surveyed a national sample of OB/GYNs in May 2004. This report describes
the results of that survey, which indicated that 52% of OB/GYNs surveyed
would recommend influenza vaccination for a healthy woman in the first
trimester of pregnancy, 95% would recommend the vaccine for a healthy pregnant
woman beyond the first trimester, and 63% would recommend vaccination for
a woman with a medical condition in the first trimester. However, of the
physicians who would recommend vaccination, 36%-38% reported that influenza
vaccination was not offered in their practices. Increased efforts are needed
to improve vaccine availability and to educate OB/GYNs regarding the updated
ACIP recommendations on the use of influenza vaccine in the first trimester
for both healthy pregnant women and pregnant women at high risk.
QuickStats:
Leading Causes of Neonatal and Postneonatal Deaths- United States, 2002 (10/30/05)
Substantial differences were observed in the leading causes of death during
the neonatal versus postneonatal periods. Congenital malformations, although
ranked first for infant mortality overall, ranks second for both neonates
and postneonates. Disorders related to short gestation and low birthweight
not elsewhere classified were the leading cause of neonatal death. In contrast,
SIDS was the leading cause of death during the postneonatal period.
Children
and Teens Told by Doctors that They were Overweight- United States, 1999-2002 (9/30/05)
PDF (p. 848)
The percentage of children and teens aged 6-19 years in the United States
who are overweight nearly tripled to 16% during 1980-2002. To determine
what percentage of overweight children (or their parents) and teens were
ever told their weight status by doctors or other health-care professionals,
CDC analyzed data from the 1999-2002 National Health and Nutrition Examination
Survey. This report summarizes the results of that analysis, which determined
that 36.7% of overweight children and teens aged 2-19 years had been told
by a doctor or other health-care professional that they were overweight,
and teens aged 16-19 years were more likely to be told than parents of
children aged 2-11 years. Among racial/ethnic populations, overweight non-Hispanic
black females were significantly more likely to be told that they were
overweight than non-Hispanic white females (47.4% versus 31.0%). Among
those informed of overweight status, 39% of non-Hispanic black females
were severely overweight (BMI >99th percentile for age and sex), compared
with 17% of non-Hispanic white females.
Sexual
Behavior and Selected Health Measures: Men and Women 15-44 Years of Age- United
States, 2002 (9/30/05)
PDF
Plan and
Operation of Cycle 6 of the NSFG
This report presents national estimates of several measures of sexual behavior
among males and females 15-44 years of age in the United States in 2002,
as collected in the 2002 National Survey of Family Growth (NSFG). These
data are relevant to demographic and public health concerns, including
fertility and sexually transmitted diseases among teenagers and adults.
Data from the 2002 NSFG are compared with previous national surveys.
Trends
in Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk
Women- United States, 1990-2003 (Fact Sheet) (9/30/05)
PDF Report
With a decrease between 1990 and 1996 and an increase between 1996 and
2003, the trend in the cesarean rate for low-risk women having a first
birth paralleled trends in the primary (regardless of parity) and total
cesarean rates. During 1996-2003 the cesarean rate for low-risk women having
a first birth has consistently been at least 13 percent lower than the
rate for all women having a first birth. For 2003 the cesarean rate for
all primiparous women was 27.1 percent; for low-risk women the rate was
23.6 percent.
Births:
Final Data for 2003 (9/16/05)
In 2003 there were 4,089,950 live births reported in the United States,
2 percent more than the number in 2002. Childbearing among teenagers and
birth rates for women aged 20-24 years declined, whereas rates for women
aged 25-44 years increased 2-6 percent, reaching highs not reported since
the mid to late 1960s. The cesarean delivery rate jumped another 5 percent
to another all-time high, and the rate of vaginal birth after previous
cesarean dropped 16 percent, an all-time low.
Perinatal
Group B Streptococcal Disease Prevention, Minnesota (8/30/05)
PDF
As part of the Minnesota Department of Health Emerging Infections Program,
prenatal care providers in Minnesota were surveyed in April 1998 to determine
strategies to prevent perinatal GBS disease. In November 2002, a similar
survey was undertaken to determine the extent to which Minnesota providers
have adopted the revised 2002 CDC guidelines.
QuickStats:
Percentage of Never-Married Teens Aged 15-19 Years Who Reported Ever Having
Sexual Intercourse, by Sex and by Age Group- United States, 1995 and 2002 (8/30/05)
The percentage of male teens who reported ever having sexual intercourse
decreased significantly for both younger (aged 15-17 years) and older (aged
18-19 years) teens from 1995 to 2002. Among females, the percentage who
reported ever having sexual intercourse declined significantly for those
aged 15-17 years.
Pregnancy-Planning
Education Program (8/30/05)
Learn what you need to know now to have a safe pregnancy and healthy baby.
CDC has a new online education program available for women who are planning
to get pregnant. CDC, other federal agencies, and medical societies have
developed email-based education programs that are offered through the Interactive
Health Record (iHealthRecord), located online at www.ihealthrecord.org.
By going to www.ihealthrecord.org,
and enrolling, you can receive health information via email every other
week for 3 months as you prepare for pregnancy.
Clostridium
sordellii Toxic
Shock Syndrome after Medical Abortion with Mifepristone and Intravaginal
Misoprostol- United States and Canada, 2001-2005 (7/30/05)
PDF
The Food and Drug Administration, CDC, and local and state health departments
continue to investigate the cases of four women in the United States who
died after medical abortions during 2003-2005 with Mifeprex® (mifepristone,
formerly RU-486) and intravaginal misoprostol. A fifth death after medical
abortion with the same drugs was reported in 2001, in Canada. Three of
the deaths have been linked to infection with Clostridium sordellii.
Disparities
in Universal Prenatal Screening for Group B Streptococcus- North Carolina,
2002-2003 (7/30/05)
PDF (p. 700)
To examine prenatal Group B streptococcus (GBS) screening among pregnant
women in North Carolina, CDC analyzed 2002 and 2003 data from the North
Carolina Pregnancy Risk Assessment Monitoring System. The proportions of
women reporting prenatal screening for GBS were similar in 2002 and 2003
(70% and 74%, respectively); however, for both years, women of Hispanic
ethnicity and women who received prenatal care at a hospital or health
department clinic were less likely to report prenatal screening for GBS.
Trend
Analysis of the Sex Ratio at Birth in the United States (Press Release)
(6/30/05)
PDF Report
For the 63rd year in a row, the number of boys born in the United States
outnumbers births of girls - in 2002 94,232 more boys than girls were born.
Combining all the years studied, older mothers (40 to 44 years of age and
45 years and over) have the lowest total sex birth ratios (1,038 and 1,039,
respectively) and mothers 15 to 19 years of age had the highest sex birth
ratio (1,054). The more children a woman has the more likely she is going
to give birth to an equal number of boys and girls. For all available years
combined, Chinese mothers (1,074) and Filipino mothers (1,072) had the
highest differences between the number of boys born compared with girls,
whereas non-Hispanic black mothers (1,031) and American Indian mothers
(1,031) had the lowest.
Assisted
Reproductive Technology Surveillance- United States, 2002 (6/30/05)
PDF
In 2002, a total of 115,392 ART procedures were reported to CDC. These
procedures resulted in 33,141 live-birth deliveries and 45,751 infants.
Patients who undergo ART treatments are more likely to deliver multiple-birth
infants than women who conceive naturally. Multiple births are associated
with increased risk for mothers and infants (e.g., pregnancy complications,
premature delivery, low-birthweight infants, and long-term disability among
infants). Approximately 1% of U.S. infants born in 2002 were conceived
through ART. The highest numbers of ART procedures were performed among
residents of California (15,117), New York (13,276), Massachusetts (8,631),
New Jersey (7,744), and Illinois (7,492). These five states also reported
the highest number of infants conceived through ART.
QuickStats:
Average Age of Mothers at First Birth, by State- United States, 2002 (5/30/05)
The average age of mothers at first birth increased steadily during the
preceding 30 years, to 25.1 years in 2002, an all-time high for the nation.
In 2002, by state, the average age of mothers at first birth ranged from
23 years to 28 years. Mothers living in northeastern states were the oldest
at first birth; mothers living in Arkansas, Louisiana, Mississippi, New
Mexico, Oklahoma, and Wyoming were the youngest.
Parent, Pregnancy,
and Birth Factors Found Possible Associations with the Risk of Autism (Press
Release) (5/30/05)
Pregnancy factors, parental psychiatric history, and preterm delivery may
be associated with the risk of autism. Some of the specific factors that
the study found to be associated with the risk of autism included: breech
presentation at birth, delivery before 35 weeks, a parent who had a diagnosis
of schizophrenia-like psychosis before the date that autism was diagnosed
in the child, and low birth weight at delivery. The study also found many
of these factors were independently associated with autism. For example,
there was an association between adverse pregnancy events and autism, regardless
of whether one of the parents had a diagnosed psychiatric illness.
Medication
Use during Pregnancy and Breastfeeding (5/30/05)
Learn answers to frequently asked questions about medication use during pregnancy
and while breastfeeding.
Quick
Facts: Perinatal HIV/AIDS Prevention, April 2003-March 2005 (4/30/05)
This document includes data and information on the challenges and accomplishments
of preventing perinatal HIV infection.
Interleukins-1,
-4, -6, -10, Tumor Necrosis Factor, Transforming Growth Factor-[beta], FAS,
and Mannose-Binding Protein C Gene Polymorphisms in Australian Women: Risk
of Preterm Birth (4/30/05)
This case-control study examined the relationship between preterm birth
before 35 weeks gestation and 22 single nucleotide polymorphisms in genes
that encode inflammatory cytokines and mediators of host defense and apoptosis.
This analysis showed that preterm birth (PTB) at <29 weeks gestation
was associated with the interleukin-4 -590 C/C genotype, the TNF haplotype
+488A/-238G/-308G and MBL2 54Asp. The presence of the IL10 haplotype1082A/-819T/-592A
was associated with the risk of PTB < 29 weeks as well as preterm premature
rupture of the membranes (PPROM). Analysis of demographic factors showed
that smoking was associated with preterm birth <29 weeks gestation.
Alcohol use was associated with increased PTB risk at < 35 weeks, <29
weeks and PPROM. Any substance use was associated with PTB risk at < 35
weeks as well as PPROM. None of these associations were significant when
corrected by the Bonferroni method. The authors concluded polymorphisms
that modulate the immune response might have a role in preterm birth and
PPROM. These findings are preliminary and the impact of this research on
public health remains to be seen.
Fetal Alcohol Syndrome
Curricula (3/30/05)
In 2001, CDC funded four nonprofit organizations to develop and evaluate
educational curricula for various audiences about fetal alcohol syndrome
(FAS) and other prenatal alcohol-related disorders and how to access appropriate
services for children with FAS and their families. After being tested through
multiple trainings and found to be effective, materials from these four
organizations are now available.
Congenital
Pulmonary Tuberculosis Associated with Maternal Cerebral Tuberculosis- Florida,
2002 (3/30/05)
PDF (p. 249)
In 2002, congenital tuberculosis (TB), a rare disease with nonspecific
signs and symptoms, was diagnosed in an infant in Florida. If untreated,
congenital TB is fatal, which underscores the importance of suspecting
congenital TB in newborns and infants who are at risk and who have unexplained
febrile illnesses. This report summarizes the investigation of the case
in Florida. Health-care practitioners should administer a tuberculin skin
test to women who have risks for Mycobacterium tuberculosis infection and
treat those who have latent TB infection to prevent maternal and congenital
TB disease.
Secular Trends
in Age at Menarche, Smoking, and Oral Contraceptive Use among Israeli Girls (3/30/05)
This study was designed to identify secular trends in age at menarche,
at first cigarette, and at first use of oral contraceptives among a large
population-based sample of young Israeli women and to assess whether these
trends are associated with sociodemographic factors.
Notice to Readers:
Surgeon General's Advisory on Alcohol Use in Pregnancy (3/30/05)
In February 2005, the U.S. Surgeon General issued an Advisory on Alcohol
Use in Pregnancy to raise public awareness about this important health
concern. Research demonstrates that prenatal alcohol exposure can result
in a spectrum of birth defects that can affect a child's growth, appearance,
cognitive development, and behavior. Fetal alcohol spectrum disorders are
preventable if a woman abstains from drinking alcohol while pregnant.
QuickStats:
Primary Contraceptive Methods among Women Aged 15-44 Years- United States,
2002 (2/28/05)
In 2002, the most frequent contraceptive method among women aged 15-44
years was oral contraception. Other leading methods were female sterilization
and the male condom. A smaller, but significant, number of women were using
the newer, long-acting hormonal methods, including injectables, implants,
and the patch.
QuikStats
- Pregnancy, Birth, and Abortion Rates for Teenagers Aged 15-17 Years-
United States, 1976-2003 (2/28/05)
PDF (p. 100)
Since 1990, pregnancy rates have declined substantially for teenagers aged
15-17 years. From 1990 to 2000, the pregnancy rate decreased 33%, from
80.3 per 1,000 females to 53.5, a record low. The birth rate declined 42%,
from its peak at 38.6 in 1991 to 22.4 in 2003. The induced abortion rate
peaked in 1983 at 30.7 and decreased by more than half to 14.5 by 2000.
QuickStats:
Total and Primary Cesarean Rate and Vaginal Birth after Previous Cesarean
(VBAC) Rate- United States, 1989-2003 (1/30/05)
PDF (p. 46)
Preliminary data for 2003 indicated that 27.6% of all births in the United
States resulted from cesarean deliveries, an increase of 6% from 2002 and
the highest percentage ever reported in the United States. After declines
during 1989-1996, the total cesarean rate and the primary cesarean rate
(i.e., percentage of cesareans among women with no previous cesarean delivery;
19.1% in 2003) have increased each year.
2002 Assisted
Reproductive Technology Success Rates (1/30/05)
Press Release
CDC's eighth annual ART clinic success rate report contains information
provided to CDC by 391 reporting fertility clinics throughout the United
States. It is meant to help consumers make informed decisions about having
a baby through assisted reproductive technology (ART) treatment. Among
the findings, more than 45,000 babies were born in the United States with
the help of ART procedures carried out in 2002. Also, the younger a woman
is when assisted reproductive technology is used, the more likely she is
to have a live birth using her own eggs.
Cervical
Cancer and Pap Test Information (1/30/05)
On this page, the following topics are discussed: why get a pap test, basic
facts and risk factors, screening interval recommendations, strategies
for reaching underserved populations, and additional resources.
2004 Publications and Materials
Alcohol
Consumption among Women Who Are Pregnant or Who Might Become Pregnant-
United States, 2002 (12/30/04)
PDF (p. 1178)
To determine the alcohol consumption patterns among all women of childbearing
age, including those who are pregnant or might become pregnant, CDC analyzed
data for women aged 18-44 years from the 2002 Behavioral Risk Factor Surveillance
System survey. The results of that analysis indicated that approximately
10% of pregnant women used alcohol, and approximately 2% engaged in binge
drinking or frequent use of alcohol. The results further indicated that
more than half of women who did not use birth control (and therefore might
become pregnant) reported alcohol use and 12.4% reported binge drinking.
Dental Care
Use among Pregnant Women in the United States Reported in 1999 and 2002 (12/30/04)
PDF
The purpose of this study was to determine national and state-specific
estimates of dental care use among adult pregnant women in the United States
using data from two 12-month periods. The study also determined person-level
characteristics that may predict a lack of dental care use within this
subgroup. Overall, 70% of pregnant women in 1999 and 2002 had received
dental care in the previous 12 months.
Teenagers in the
United States: Sexual Activity, Contraceptive Use, and Childbearing,
2002 (Press Release) (12/30/04)
PDF
Fact
Sheet
This report presents national estimates of sexual activity, contraceptive
use, and births among males and females 15-19 years of age in the United
States in 2002 from the National Survey of Family Growth (NSFG). Data are
also presented from the 1988 and 1995 NSFGs, and from the 1988 and 1995
National Survey of Adolescent Males. In 2002, about 47 percent of female
teenagers (4.6 million), and about 46 percent of male teenagers (4.7 million)
had had sexual intercourse at least once. Teenagers showed increases in
the use of contraceptives. About 3 out of 4 teens used a method of contraception
at their first intercourse. About 91 percent of males and 83 percent of
females used a method at their last (most recent) sex.
Use of Contraception
and Use of Family Planning Services in the United States- 1982-2002 (Press
Release) (12/30/04)
PDF
Fact Sheet
This report presents national estimates of contraceptive use and method
choice based on the 1982, 1995, and 2002 National Surveys of Family Growth.
It also presents data on where women obtained family planning and medical
services, and some of the services that they received. The leading method
of contraception in the United States in 2002 was the oral contraceptive
pill, used by 11.6 million women; the second leading method was female
sterilization, used by 10.3 million women. The condom was the third-leading
method, used by about 9 million women and their partners. Nearly all women
of reproductive age have used contraception: 98 percent of all women who
had ever had intercourse had used at least one contraceptive method.
Abortion
Surveillance- United States, 2001 (11/30/04)
PDF
A total of 853,485 legal induced abortions were reported to CDC for 2001
from 49 reporting areas, representing a 0.5% decrease from the 857,475
legal induced abortions reported by the same 49 reporting areas for 2000.
The abortion rate was 16 per 1,000 women aged 15-44 years for 2001, the
same as for 2000. The highest percentages of reported abortions were for
women who were unmarried (82%), white (55%) and aged <25 years (52%).
Of all abortions for which gestational age was reported, 59% were performed
at <8 weeks' gestation and 88% at <13 weeks. In 2000 (the
most recent year for which data are available), 11 women died as a result
of complications from known legal induced abortion. No deaths were associated
with known illegal abortion.
Introduction
of Routine HIV Testing in Prenatal Care- Botswana, 2004 (11/30/04)
PDF
To assess the early impact of routine testing on HIV-test acceptance and
rates of return for care, the CDC Global AIDS Program and the prevention
of mother-to-child transmission of HIV program in Botswana evaluated routine
prenatal HIV testing at four clinics in Francistown, the second largest
city in Botswana, where HIV prevalence has been >40% since 1995.
This report describes the results of that assessment, which indicated that,
during February-April 2004, the first 3 months of routine testing, 314
(90.5%) of 347 pregnant women were tested for HIV, compared with 381 (75.3%)
of 506 women during October 2003-January 2004, the last 4 months of the
opt-in testing period. However, many women who were tested never learned
their HIV status because of logistical problems or not returning to the
clinic.
Births:
Preliminary Data for 2003 (11/30/04)
PDF
State-Specific
Detailed Tables
This report presents preliminary data for 2003 on births in the United
States. U.S. data on births are shown by age, race, and Hispanic origin
of mother. Data on marital status, tobacco use, prenatal care, cesarean
delivery, preterm births, and low birth-weight are also presented. The
crude birth rate rose to 14.1 births per 1,000 population in 2003, an increase
of 1 percent from 2002 (13.9). The birth rate for women aged 30-34 years
increased 4 percent to 95.2 births per 1,000 women compared with 2002.
The proportion of mothers smoking during pregnancy continued to steadily
decline in 2003, from 11.4 percent in 2002 to 11.0 percent. In 2003, 27.6
percent of all births were delivered by cesarean delivery, a marked rise
of 6 percent over the 2002 level, and one-third higher than that for 1996.
Preterm and low birthweight rates both rose between 2002 and 2003. The
preterm rate increased from 12.1 to 12.3 and low birthweight rate rose
from 7.8 to 7.9 percent.
Births to 10-14
Year-Old Mothers, 1990-2002: Trends and Health Outcomes (Press Release)
(11/30/04)
PDF
This report presents the number and rate of U.S. births for 10-14 year
olds, for 1990-2002 by race and Hispanic origin and by State. Pregnancy
risk factors and outcomes by selected maternal and infant characteristics
are shown. In 2002, 7,315 females aged 10-14 years delivered a live birth
in 2002. The rate of births to 10-14 year olds was 0.7 per 1,000 in 2002,
half of the rate during 1989-94. Large declines in young teenage childbearing
were seen among all racial and ethnic subgroups, as well as almost all
States. These young mothers were least likely to receive timely prenatal
care compared with mothers of older age groups. Compared with infants of
mothers aged 20-39 years, infants of the youngest mothers experienced almost
twice the rates of preterm delivery (21.3 percent) and low birthweight
(12.6 percent).
SLC19A1
(RFC1) A80G Polymorphism, Maternal Multivitamin with Folate Use,
and Orofacial and Conotruncal Heart Defects (11/30/04)
This study evaluates an association between a gene other than methylenetetrahydrofolate
involved in the folate metabolic pathway. Although the findings were only
‘suggestive' of an interaction between reduced folate carrier-1genotype
and perinatal folic acid intake in association with conotruncal heart defects,
they further support the value of food fortification with folic acid and
maternal periconceptional vitamin use.
Folic
Acid Publications in English and Spanish (11/30/04)
Free folic acid educational materials, including brochures, print ads,
and posters, can be ordered in English or Spanish. The materials are designed
for women who are currently thinking about pregnancy or who think they
may become pregnant some time in the future.
Smoking
during Pregnancy- United States, 1990-2002 (10/30/04)
PDF
CDC analyzed state-specific trends in maternal smoking during 1990-2002
by using data collected on birth certificates. This report summarizes the
results of those analyses, which indicated that whereas participating areas
observed a significant decline in maternal smoking during the surveillance
period, 10 states reported recent increases in smoking by pregnant teens.
State Estimates
of Neonatal Health-Care Costs Associated with Maternal Smoking- United States,
1996 (10/30/04)
PDF (p. 915)
To characterize costs by state, CDC analyzed pregnancy risk surveillance
and birth certificate data to estimate the association between maternal
smoking and the probability of infant admission to a neonatal intensive
care unit. This report summarizes the results of that analysis, which estimated
smoking-attributable neonatal expenditures (SAEs) of $366 million in the
United States in 1996, or $704 per maternal smoker, and indicated wide
variations in SAEs among states.
Newborn Screening
for Cystic Fibrosis (10/30/04)
PDF
In November 2003, CDC and the Cystic Fibrosis Foundation cosponsored a
workshop to review the benefits and risks associated with newborn screening
for cystic fibrosis (CF). This report discusses the peer-reviewed evidence
presented at the workshop, which supports the clinical utility of newborn
screening for CF.
Effect of Revised
Population Counts on County-Level Hispanic Teen Birthrates- United States,
1999 (10/30/04)
PDF (p. 946)
CDC analyzed county-level estimates of Hispanic teen birthrates for 1999.
This report summarizes the results of that analysis, which indicated that
Hispanic teen birthrates for 1999, when calculated on the basis of the
2000 census, were lower than birthrates based on the 1990 census for the
majority of counties with substantial Hispanic populations.
Assessment
of Increase in Perinatal Exposure to HIV among Hispanics- 20 Counties, Georgia,
1994-2002 (10-30-04)
PDF (p. 944)
This report summarizes the results of an assessment of perinatally HIV-exposed
Hispanic infants in the Atlanta metropolitan area, which suggest that the
increase in the number of perinatally HIV-exposed Hispanic infants was
associated with multiple factors, including the growth of the Hispanic
population, increasing HIV prevalence and fertility among Hispanics, and
lower preconception awareness of HIV serostatus among those with HIV. The
findings suggest a need for improved access to voluntary HIV counseling
and testing and increased opportunities for reducing the risk for unintended
pregnancy among Hispanics in these counties.
Enhanced Perinatal
Surveillance- United States, 1999-2001 (10/30/04)
This report describes the population of HIV-infected women who gave birth
during the years 1999, 2000, and 2001. These data provide essential information
for further focusing perinatal prevention efforts in the United States.
An estimated 6000 to 7000 HIV-infected women gave birth in the United States
during the year 2000; an estimated 280-370 infants were infected.
SARS during
Pregnancy, United States (9/30/04)
Two of eight persons with laboratory-confirmed severe acute respiratory
syndrome-associated coronavirus (SARS-CoV) infection in the United States
during 2003 were pregnant women. Data concerning the second patient are
reported, with follow-up 1 month after the child's birth.
Use of
Vitamins Containing Folic Acid Among Women of Childbearing Age- United
States, 2004 (9/30/04)
PDF (p. 847)
This report presents results from the Gallup Organization/March of Dimes
Birth Defects Foundation 2004 survey, which indicated that although no
substantial increase in the proportion of women who use vitamins containing
folic acid daily occurred during 1995-2003, a substantial increase was
observed in 2004, with 40% of women aged 18-45 years reporting daily consumption
of a vitamin containing folic acid. This report also presents information
about women's dieting behaviors. Regardless of dieting status, public health
programs should stress the importance of women in their childbearing years
consuming 400 µg of folic acid daily through supplements, fortified foods,
and a diet containing folate-rich foods.
Malaria during Pregnancy (9/30/04)
Pregnant women are particularly vulnerable to malaria. In areas where malaria
is common, health ministries now strive to make malaria prevention part
of normal antenatal care. Infection with P. falciparum during pregnancy
increases the mother's risk of developing severe disease and anemia, and
increases the risk of stillbirth and prematurity.
Can Changes in Sexual Behaviors Among High School Students Explain the
Decline in Teen Pregnancy Rates in the 1990s? (8/30/04)
Journal
of Adolescent Health (Non-CDC
site)
This recent article published in the Journal of Adolescent Health explores
the national decline in teen pregnancy and birth rates. Overall, 53% of
the decline in pregnancy rates can be attributed to decreased sexual experience
and 47% to improved contraceptive use. These data suggest that both delayed
initiation of sexual intercourse and improved contraceptive practice contributed
equally to declines in pregnancy rates among high school-aged teens during
the 1990s. Journal of Adolescent Health 2004 Aug;35(2):80-90.
PRAMS and Postpartum Depression (8/30/04)
Data from three states indicate that nearly 12% of women reported being
moderately depressed after they delivered their baby, and 6% reported being
very depressed after delivery. Analysis is based on responses to the question, "In
the months after your delivery, would you say that you were a) not depressed
at all, b) a little depressed, c) moderately depressed, d) very depressed,
or e) very depressed and had to get help?" The responses were collapsed
into three depression categories: none (a), low to moderate (b or c), and
severe (d or e).
Fetal
Alcohol Syndrome: Guidelines for Referral and Diagnosis (8/30/04)
These guidelines update and refine diagnostic and referral criteria in
light of the scientific and clinical advances in the understanding of this
disorder during the past 30 years. The guidelines are organized into several
sections: background information; revised and refined diagnostic and referral
criteria for FAS; comparison of the guidelines with other diagnostic methods
currently in use; a discussion of the essential services for affected individuals;
identifying and intervening with women at risk for an alcohol-exposed pregnancy;
and future needs and efforts related to FAS and other prenatal alcohol-related
disorders.
Congenital
Syphilis- United States, 2002 (8/30/04)
PDF (p. 716)
This report summarizes 2002 congenital syphilis (CS) surveillance data,
which indicated that CS rates have decreased among all racial/ethnic minority
populations and in all regions of the United States except the Northeast.
During 2000-2002, the rate of CS decreased 21.1%, from 14.2 to 11.2 cases
per 100,000 live births. Among the 451 cases of CS reported in 2002, a
total of 333 (73.8%) occurred because the mother had no documented treatment
or received inadequate treatment of syphilis before or during pregnancy;
many of these cases occurred among infants born to women who had no prenatal
care or no documented prenatal care.
Breastfeeding
Practices: Results from the 2003 National Immunization Survey (Press
Release) (8/30/04)
Since January 2003, breastfeeding questions have been asked of National
Immunization Survey (NIS) respondents to assess the population's breastfeeding
practices. Fourteen states have achieved the national Healthy People 2010
objective of 75% of mothers initiating breastfeeding; whereas only 6 and
8 states have achieved the objective of having 50% of mothers breastfeeding
their children at 6 months of age and 25% of mothers breastfeeding their
children at 12 months of age, respectively. Consistent with previous research,
the NIS breastfeeding data reveal that non-Hispanic blacks and socioeconomically
disadvantaged groups have consistently lower breastfeeding rates.
Racial/Ethnic
Disparities in Neonatal Mortality- United States, 1989-2001 (7/30/04)
PDF (p. 655)
This report summarizes the results of an analysis of linked birth/infant
death data sets for 1989-1991 and 1995-2001, which indicated that 1) extremely
preterm infants (i.e., born at <28 weeks' gestation) accounted for 49%-58%
of neonatal deaths during 1989-2001 and 2) racial/ethnic disparities persisted
despite neonatal mortality rate declines among infants of all gestational
ages. Implementation of new therapies and recommendations (surfactant therapy,
folic acid consumption by women of childbearing age, and intrapartum antimicrobial
prophylaxis for women with or at risk for maternal-infant transmission
of group B streptococcal infection) likely contributed to the decline;
however, the effects of these advances might differ within racial/ethnic
populations.
Surveillance
for Disparities in Maternal Health-Related Behaviors- Selected States,
Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001 (7/30/04)
PDF
This report summarizes PRAMS data for 2000-2001 from eight states (Alabama,
Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, and North Carolina)
on four behaviors (smoking during pregnancy, alcohol use during pregnancy,
breastfeeding initiation, and use of the infant back sleep position) for
which such disparities have been identified previously. Overall, the prevalence
of smoking during pregnancy ranged from 9.0% to 17.4%, prevalence of alcohol
use during pregnancy ranged from 3.4% to 9.9%, prevalence of breastfeeding
initiation ranged from 54.8% to 89.6%, and use of the back sleep position
for infants ranged from 49.7% to 74.8%.
Diminishing
Racial Disparities in Early-Onset Neonatal Group B Streptococcal Disease-
United States, 2000-2003 (6/30/04)
PDF (p. 502)
In 2002, CDC and the American College of Obstetricians and Gynecologists
revised guidelines for prevention of early-onset GBS disease to recommend
late prenatal screening of all pregnant women and intrapartum antibiotic
prophylaxis for GBS carriers. This report updates early-onset incidence
trends since 1999 and indicates that 1) after a plateau in early-onset
disease incidence during 1999-2002, rates declined 34% in 2003 and 2) although
racial disparities in incidence persist, rates for blacks now approach
the 2010 national health objective of 0.5 cases per 1,000 live births.
Continued implementation of screening and prophylaxis guidelines by clinicians
and public health practitioners should lead to further declines in racial
disparities.
Estimated
Pregnancy Rates for the United States, 1990-2000: An Update (6/30/04)
This report presents pregnancy rates for 1990-2000, by age, race, Hispanic
origin, outcome, and by marital status. The data in this report, together
with previously published pregnancy rates for earlier years, provide a
consistent series of rates for the United States for 1976-2000. In 2000
an estimated 6,401,000 pregnancies resulted in 4.06 million live births,
1.31 million induced abortions, and 1.03 million fetal losses. The 2000
pregnancy rate of 104.0 pregnancies per 1,000 women aged 15-44 years is
10 percent lower than the 1990 peak of 115.6.
Public Health Service Task
Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected
Women for Maternal Health and Interventions to Reduce Perinatal HIV-1
Transmission in the United States (6/30/04)
These recommendations update the November 26, 2003 guidelines developed
by the Public Health Service for the use of zidovudine (ZDV) to reduce
the risk for perinatal human immunodeficiency virus type 1 (HIV-1) transmission*.
This report provides health care providers with information for discussion
with HIV-1 infected pregnant women to enable such women to make an informed
decision regarding the use of antiretroviral drugs during pregnancy and
use of elective cesarean delivery to reduce perinatal HIV-1 transmission.
Various circumstances that commonly occur in clinical practice are presented,
and the factors influencing treatment considerations are highlighted in
this report.
PRAMS and Unintended Pregnancy (5/30/04)
The 1999 PRAMS data on unintended pregnancy resulting in a live birth in
17 states indicated a prevalence range of 34%-52%. From 27% to 36% of pregnancies
were mistimed, and 6%-14% were unwanted. Recent PRAMS data show little
change in the prevalence of unintended pregnancy resulting in a live birth.
Trends
in Characteristics of Births by State: United States, 1990, 1995, and
2000-2002 (Press Release) (5/30/04)
PDF
This report presents U.S. and State-level data on births, birth rates,
fertility rates, sex ratio, marital status, and educational attainment
by race and Hispanic origin for 1990, 1995, and 2000-2002. In 2002 there
were 4,021,726 live births in the United States, 136,486 fewer than in
1990. The proportion of births to unmarried mothers increased nationally
and in every State between 1990 and 2002. The highest proportion of unmarried
births is in the Southeast. Nationally the percentage of mothers with fewer
than 12 years of education fell, and the percentage with 16 or more years
increased for all racial and ethnic groups.
Spina
Bifida and Anencephaly Before and After Folic Acid Mandate- United States,
1995-1996 and 1999-2000 (5/30/04)
PDF (p. 362)
To update the estimated numbers of neural tube defects (NTD)-affected pregnancies
and births, CDC recently analyzed data from 23 population-based surveillance
systems that include prenatal ascertainment of these birth defects. This
report summarizes the results of that analysis, which indicate that the
estimated number of NTD-affected pregnancies in the United States declined
from 4,000 in 1995-1996 to 3,000 in 1999-2000. This decline in NTD-affected
pregnancies highlights the partial success of the U.S. folic acid fortification
program as a public health strategy. To reduce further the number of NTD-affected
pregnancies, all women capable of becoming pregnant should follow the USPHS
recommendation and consume 400 µg of folic acid every day.
Risk of
Venous Thromboembolism after Air Travel: Interaction with Thrombophilia
and Oral Contraceptives (4/30/04)
A case-control study was conducted to establish whether air travel is a
risk factor for venous thromboembolism (VTE), and to investigate the interaction
between air travel and thrombophilia. They also evaluated the interaction
between air travel and oral contraceptive use (a common and independent
risk factor for VTE). In general, the interaction between air travel, thrombophilia,
and oral contraceptive use in determining VTE is significant. More research
must be conducted to assess interaction among thrombophilia, oral contraceptive
use, and VTE.
Assisted
Reproductive Technology Surveillance- United States, 2001 (4/30/04)
PDF
Fact Sheet
In 2001, about 1% of U.S. infants born in 2001 were conceived through assisted
reproductive technology (ART). Patients who undergo ART treatments are
more likely to deliver multiple-birth infants than women who conceive naturally,
and multiple births are associated with pregnancy complications, premature
delivery, low-birthweight infants, and long-term disability among infants.
In 2001, a total of 29,344 live-birth deliveries and 40,687 infants resulted
from 107,587 ART procedures at 384 medical centers in the United States
and its territories.
Implication
of an AGT Haplotype in a Multigene Association Study with Pregnancy Hypertension (4/30/04)
This study addressed two main purposes: to validate previously published
associations related to preeclampsia and chronic essential hypertension
by examining ten different polymorphisms in nine genes, from nine different
studies; and to determine whether polymorphisms previously found to be
associated with preeclampsia are associated with essential hypertension
and vice versa.
Reproduction
Rates for 1990-2002 and Intrinsic Rates for 2000-2001: United States (Fact
Sheet) (3/30/04)
PDF
This report provides information on fertility patterns critical to understanding
population growth and change in the United States. The rates of reproduction
and intrinsic rates are intended as useful adjuncts to the birth and fertility
rates published by CDC. Whereas birth and fertility rates measure the fertility
of women in a given year, the rates of reproduction summarize the fertility
of women over a generation, that is, the total or average number of births
expected for a group of women during their lifetime given particular fertility
and mortality rates. Rates of reproduction, the intrinsic rate of natural
increase, and the intrinsic birth rate were lower in 2001 (and 2002) than
1990. Among the race and Hispanic subgroups, the reproduction rates were
lower for all groups except Cubans and whites (total).
Maternal
Malaria and Perinatal HIV Transmission, Western Kenya (3/30/04)
This evaluation of perinatal HIV transmission in a malarious area of western
Kenya demonstrated that approximately 20% of infants born to HIV-infected
mothers acquired HIV by 4 months of age, similar to rates reported in other
sub-Saharan African settings. Consistent with other studies, maternal viral
load in peripheral blood at the time of delivery and having an episiotomy
or perineal tear were risk factors for perinatal mother-to-child HIV transmission
(MTCT). Women with placental malaria had lower rates of perinatal MTCT
than women without placental malaria. However, women with high-density
malaria had significantly higher rates of perinatal MTCT than parasitemic
women with low-density malaria. Malaria during pregnancy is a serious problem
in sub-Saharan Africa, affecting an estimated 24 million pregnant women;
malaria prevalence may exceed 50% among primigravid and secundigravid women
in malaria-endemic areas.
Evaluation
of an Association Between Loratadine and Hypospadias- United States,
1997-2001 (3/30/04)
PDF (p. 219)
Fact Sheet
CDC analyzed data from the National Birth Defects Prevention Study (NBDPS)
to assess any potential association between loratadine (a nonsedating antihistamine
commonly used for seasonal allergies) and hypospadias. This report summarizes
the results of that analysis, which determined that no increased risk for
second- or third-degree hypospadias existed among women who used loratadine
in early pregnancy. Infants with first-degree hypospadias are not included
in NBDPS because the mildest form of hypospadias is much less completely
ascertained by routine surveillance. These results might be useful for
women and health-care providers to address concerns about loratadine use
and hypospadias. During 1998-1999, loratadine was the drug most advertised
directly to consumers and was used by 3% of women of childbearing age.
Promising
Practices in Perinatal HIV Prevention (3/30/04)
Selected summaries of plenary session presentations are provided from the
2003 grantees meeting. Summaries focus on communication, linkage, outreach,
integration, system changes, correctional health, counseling and testing,
training, social marketing, rural programs, reproductive health, surveillance,
and international activities.
Interim Guidelines
for the Evaluation of Infants Born to Mothers Infected with West Nile Virus
(WNV) During Pregnancy (2/27/04)
PDF (p. 154)
To develop guidelines for evaluating infants born to mothers who acquire
WNV infection during pregnancy, on December 2, 2003, CDC convened a meeting
of specialists in the evaluation of congenital infections. This report
summarizes the interim guidelines established during that meeting. Neither
the proportion of WNV infections during pregnancy that result in congenital
infection nor the spectrum of clinical abnormalities associated with congenital
WNV infection is known. To evaluate the possible effects of WNV infection
during pregnancy, CDC is gathering clinical and laboratory data on outcomes
of pregnancies of women who were known or suspected to be infected with
WNV during pregnancy.
Pregnancy,
Breast-Feeding, and Travel: Factors Affecting the Decision to Travel (1/30/04)
Pregnant women considering international travel should be advised to evaluate
the potential problems associated with international travel as well as
the quality of medical care available at the destination and during transit.
Pregnant women should be advised to consult with their health-care providers
before making any travel decisions. Collaboration between travel health
experts and obstetricians is helpful in weighing benefits and risks based
on destination and recommended preventative and treatment measures.
Sexually
Transmitted Diseases (STDs) and Pregnancy- Updated Fact Sheet (1/22/04)
This fact sheet answers the following questions: can pregnant women become
infected with STDs; how common are STDs in pregnant women in the United
States; how do STDs affect a pregnant woman and her baby; should pregnant
women be tested for STDs; can STDs be treated during pregnancy; how can
pregnant women protect themselves against infection; and where can I get
more information.
SARS and
Pregnancy: A Case Report (1/22/04)
A laboratory-confirmed case of severe acute respiratory syndrome (SARS)
is reported in a pregnant woman. Although the patient had respiratory failure,
a healthy infant was subsequently delivered, and the mother is now well.
There was no evidence of viral shedding at delivery. Antibodies to SARS
virus were detected in cord blood and breast milk.
2003 Publications and Materials
Pregnancy,
Breastfeeding, and Travel
Pregnant women considering international travel should be advised to evaluate
the potential problems associated with international travel as well as the quality
of medical care available at the destination and during transit. According to
the American College of Obstetrics and Gynecology, the safest time for a pregnant
woman to travel is during the second trimester (18-24 weeks) when she usually
feels best and is in least danger of experiencing a spontaneous abortion or premature
labor. A woman in the third trimester should be advised to stay within 300 miles
of home because of concerns about access to medical care in case of problems
such as hypertension, phlebitis, or premature labor. Pregnant women should be
advised to consult with their health-care providers before making any travel
decisions.
Births:
Final Data for 2002 (Fact Sheet) (12/18/03)
PDF
This report shows that the teen birth rate declined by 30 percent over
the past decade to an historic low and that the rate for black teens was
down by more than 40 percent. Data are presented for maternal demographic
characteristics including age, live-birth order, race, Hispanic origin,
marital status, and educational attainment; maternal characteristics (medical
risk factors, weight gain, tobacco, and alcohol use); medical care utilization
by pregnant women (prenatal care, obstetric procedures, complications of
labor and/or delivery, attendant at birth, and method of delivery); and
infant characteristics (period of gestation, birthweight, Apgar score,
abnormal conditions, congenital anomalies, and multiple births). Also presented
are birth and fertility rates by age, live-birth order, race, Hispanic
origin, and marital status.
Assisted Reproductive
Technology Success Rates, 2001 (12/17/03)
Press Release
More than 40,000 babies were born in the United States as a result of assisted
reproductive technology (ART) procedures carried out in 2001. CDC's seventh
annual ART report summarizes national trends and provides information on
success rates for 384 fertility clinics around the country. For the first
time, the report includes live-birth rates for births involving only one
baby - called “singleton� births. Overall, 27 percent of ART procedures
resulted in the birth of a baby for women who used their own fresh eggs.
Interactive
Atlas of Reproductive Health (12/17/03)
The Interactive Atlas of Reproductive Health is a web-based interactive
geographic information system dedicated to reproductive health issues such
as infant mortality, fertility and low birth weight. The atlas provides
viewers with access to a unique collection of national geographically and
spatially enabled datasets that describe reproductive health. The viewer
can use GATHER together with the reproductive health data to reveal geographic
patterns in reproductive health data.
Public Health Service Task
Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected
Women for Maternal Health and Interventions to Reduce Perinatal HIV-1
Transmission in the United States - November 26, 2003 (12/17/03)
(Non-CDC site)
These recommendations update the September 22, 2003 guidelines developed
by the Public Health Service for the use of zidovudine (ZDV) to reduce
the risk for perinatal human immunodeficiency virus type 1 (HIV-1) transmission.
This report reviews the special considerations regarding use of antiretroviral
drugs for pregnant women; updates the results of PACTG 076 and related
clinical trials and epidemiologic studies; discusses the use of HIV-1 RNA
and antiretroviral drug resistance assays during pregnancy; provides updated
recommendations on antiretroviral chemoprophylaxis for reducing perinatal
transmission; and provides recommendations related to use of elective cesarean
delivery as an intervention to reduce perinatal transmission.
Abortion
Surveillance- United States, 2000 (11/27/03)
PDF
Fact Sheet
A total of 857,475 legal induced abortions were reported to CDC for 2000
from 49 reporting areas, representing a 0.5% decrease from the 861,789
legal induced abortions reported by 48 reporting areas for 1999 and a 1.3%
decrease for the same 48 reporting areas that reported in 1999. The highest
percentages of reported abortions were for women aged <25 years (52%),
women who were white (57%), and unmarried women (81%).
Surveillance
for Selected Maternal Behaviors and Experiences Before, During, and After
Pregnancy: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000 (11/18/03)
PDF
The data highlighted in this report were collected with the Phase Four
version of the PRAMS questionnaire, which was implemented with the 2000
birth cohort. The four topics presented in this report represent three
new indicators and one revised indicator from the PRAMS survey. The new
indicators are multivitamin use, infant checkups within 1 week of hospital
discharge among those discharged within 48 hours, and postpartum contraceptive
use. The revised indicator is pregnancy-related complications requiring
hospitalization. Prevalence estimates are presented by state and by selected
demographic characteristics (age, race, Hispanic ethnicity, education,
and Medicaid status). The data presented in this report can be used to
assist in program planning and evaluation, to inform policy decisions,
and to monitor progress toward Healthy People 2010 objectives.
Healthy
Mothers Have Healthier Babies with Folic Acid: Emma's Story (11/7/03)
Order Form
This booklet was developed for pregnancy contemplators with low to average
literacy skills. It tells the story of a woman and her husband who are
preparing for pregnancy and learn the importance of taking folic acid every
day. Reading level: 6th grade. Available in English and Spanish. Free.
Revised
Pregnancy Rates, 1990-97, and New Rates for 1998-99: United States (Fact
Sheet) (11/3/03)
PDF
This report presents detailed pregnancy rates for 1990-99. In 1999, an
estimated 6.23 million pregnancies resulted in 3.96 million live births,
1.31 million induced abortions, and 1.0 million fetal losses. The pregnancy
rate in 1999 was 102.1 pregnancies per 1,000 women aged 15-44 years. The
teenage pregnancy rate dropped steadily through the 1990s, reaching a record
low of 86.7 per 1,000 aged 15-19 years in 1999, 25 percent lower than the
1990 peak (116.3).
Work and Reproductive
Health
Although numerous occupational exposures have been demonstrated to impair
fertility (e.g., lead, some pesticides, and solvents), the overall
contribution of occupational exposures to male and female infertility is
unknown. Moreover, observed global trends in men's decreasing sperm counts
have elevated concerns about the role of chemicals encountered at work
and in the environment at large. Learn more about male and female reproductive
hazards in the workplace.
Assisted
Reproductive Technology Surveillance - United States, 2000
PDF
In 2000, a total of 25,228 live-birth deliveries and 35,025 infants resulting
from 99,629 ART procedures were reported to CDC from 383 medical centers
that performed ART in the United States and U.S. territories. Nationally,
live-birth rates were highest for women aged <35 years (38%). Of the
35,025 infants born, 44% were twins, and 9% were triplet and higher order
multiples, for a total multiple-infant birth rate of 53%. The five states
that reported the highest number of ART procedures were California, New
York, Massachusetts, Illinois, and New Jersey.
Revised
Birth and Fertility Rates for the 1990s and New Rates for Hispanic Populations,
2000 and 2001: United States (Press Release)
PDF
This report presents rates for the 1990s through 2001 by age, marital status,
race, and Hispanic origin of mother; by age and race of father; birth order
of child; and State. This report also presents new birth and fertility
rates for 2000 and 2001 for Hispanic subgroups (Mexican, Puerto Rican,
and Cuban). The report compares the revised trends with previously published
rates based on the 1990 census. Revised population-based birth and fertility
rates from 1991 to 1999, based on the 2000 census, are with few exceptions
lower than the rates previously published based on populations projected
from the 1990 census.
Listeriosis
and Pregnancy: What is Your Risk?
Listeriosis, a serious infection caused by eating food contaminated with
the bacterium Listeria monocytogenes, is recognized as an important public
health problem in the United States. The disease affects primarily pregnant
women, newborns, and adults with weakened immune systems. It can be avoided
by following a few simple recommendations.
Eating Dirt
This article explores what appears to be nonpathological dirt eating in
pregnant women (especially in sub-Saharan Africa), migrants from sub-Saharan
cultures to other parts of the world (notably the United States), and children
worldwide.
Public Health Service Task
Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected
Women for Maternal Health and Interventions to Reduce Perinatal HIV-1
Transmission in the United States - June 16, 2003
These recommendations update the November 22, 2002 guidelines developed
by the Public Health Service for the use of zidovudine (ZDV) to reduce
the risk for perinatal human immunodeficiency virus type 1 (HIV-1) transmission.
This report provides health care providers with information for discussion
with HIV-1 infected pregnant women to enable such women to make an informed
decision regarding the use of antiretroviral drugs during pregnancy and
use of elective cesarean delivery to reduce perinatal HIV-1 transmission.
Various circumstances that commonly occur in clinical practice are presented,
and the factors influencing treatment considerations are highlighted in
this report. On the NIH web site.
Use
of Hormone Replacement Therapy (HRT) Among Postmenopausal Women in the
United States, 1988-1994
This fact sheet draws data from NHANES III (1988-94) to show patterns of
HRT use in the United States, and factors associated with HRT use. NHANES
III data showed that nearly one-half of postmenopausal U.S. women have
used different forms of HRT at some time, and over one-third of HRT pill
users have been on the therapy for more than 10 years. Questions discussed
include: when did women start using HRT, in what form, and for how long;
and how does HRT use differ by menopausal type, race/ethnicity, education,
or poverty status.
Births:
Preliminary Date for 2002 (Press Release)
http://www.cdc.gov/nchs/pressroom/03news/lowbirth.htm
PDF
This report presents preliminary data for 2002 on births in the United
States. U.S. data on births are shown by age, race, and Hispanic origin
of mother. Data on marital status, prenatal care, cesarean delivery, preterm
births, and low birthweight are also presented. The crude birth rate was
13.9 per 1,000 population in 2002, a decrease of 1 percent from 2001 (14.1).
This is the lowest birth rate reported for the United States since national
data have been available. The birth rate for teenagers continued to decline
in 2002, dropping 5 percent to 42.9 births per 1,000 women aged 15-19 years.
The birth rate for unmarried women was down slightly in 2002 to 43.6 births
per 1,000 unmarried women aged 15-44 years. Prenatal care utilization continued
to slowly but steadily improve; 83.8 percent of women began prenatal care
in the first trimester of pregnancy in 2002 compared with 83.4 in 2001.
More than one fourth of all births (26.1 percent) were cesarean deliveries
in 2002, the highest rate ever reported in the United States; the primary
cesarean rate jumped 7 percent to 18 percent and the rate of vaginal births
after previous cesarean delivery plummeted 23 percent to 12.7 percent.
Preterm (12.0 percent) and low birthweight (7.8 percent) rates were up
slightly for 2002. The low birthweight rate is the highest reported in
more than three decades.
Women
with Smallpox Vaccine Exposure During Pregnancy Reported to the National
Smallpox Vaccine in Pregnancy Registry - United States, 2003
PDF (p. 386)
To prevent inadvertent exposure of pregnant women to vaccinia virus, screening
for pregnancy is a component of pre-event smallpox vaccination programs.
This report summarizes data from the National Smallpox Vaccine in Pregnancy
Registry about women exposed to smallpox vaccines while pregnant. The registry
includes women found to be pregnant when vaccinated, those who became pregnant
within 28 days of vaccination, and those who, while pregnant, were in close
contact with a person vaccinated within 28 days. Overall, 103 women have
inadvertently received smallpox vaccine while pregnant or have conceived
within 4 weeks of vaccination. CDC and the Advisory Committee on Immunization
Practices recommendations to screen for pregnancy as a contraindication
to smallpox vaccination appear to be effective at preventing inadvertent
exposures.
Crucial Role
of Mothers in Children's Health (Press Release)
What a woman does before, during and after pregnancy can significantly
affect the health of her children. That is the focus of a special Mother's
Day supplement of Pediatrics sponsored by the CDC, "Maternal Influences
on Child Health: Pre-conception, Prenatal and Early Childhood." The original
scientific research reported in this issue provides data to support and
clarify many of the current recommendations such as the use of folic acid
to reduce birth defects and maintaining a healthy weight during pregnancy.
It also reveals progress and challenges in reaching national goals for
promotion of healthy mother-child relationships, including breastfeeding
and child vaccinations.
Fact Sheets on six of the articles (PDF documents):
- Attention-Deficit/Hyperactivity
Disorder in School-aged Children: Association with Maternal Mental
Health and Use of Health Care Resources
- Maternal
Obesity and Risk for Birth Defects
- Sharing
Medication Among Teenage Girls: Potential Danger to Unplanned/Undiagnosed
Pregnancies
- Reducing
the Risk of Alcohol-exposed Pregnancies: A Study of Motivational Counseling
in Community Settings
- Fertility
Treatments and Craniosynostosis, California, Georgia, and Iowa, 1993-1997
- Do
Multivitamin Supplements Reduce the Risk for Diabetes-Associated Birth
Defects?
Motivational
Intervention to Reduce Alcohol-Exposed Pregnancies- Florida, Texas, and
Virginia, 1997-2001
PDF (p. 441)
This report describes the association between baseline drinking measures
and the success women have achieved in reducing their risk for an alcohol-exposed
pregnancy. The analysis compares the impact of the motivational intervention
at 6-month follow-up on women drinking at high-, medium-, and low-risk
drinking levels. The findings indicate that although 69% of the women in
the study reduced their risk for an alcohol-exposed pregnancy, women with
the lowest baseline drinking measures achieved the highest rates of outcome
success, primarily by choosing effective contraception and, secondarily,
by reducing alcohol use. Women with higher baseline drinking measures chose
both approaches equally but achieved lower success rates for reducing their
risk for an alcohol-exposed pregnancy. A randomized controlled trial of
the motivational intervention is under way to further investigate outcomes
of the phase I study.
Hormonal
Replacement Therapy, Prothrombotic Mutations and the Risk of Venous Thrombosis
Consistent with current literature, the authors found an increased risk
for venous thromboembolism (VTE) among HRT users as well as among the women
with prothrombotic mutations. The results from this study raise concerns
about prescription of HRT for women who are genetically predisposed to
thrombosis. The authors argue that screening for Factor V Leiden in postmenopausal
women and the subsequent withholding of HRT in women tested positive would
prevent 5-25 thrombotic events per year per 10,000 women. However, because
recent evidence suggests that HRT may not help prevent cardiovascular disease,
withholding HRT may be more prudent and more cost-effective, as the authors
point out, in women with other risk factors for VTE, such as obesity and
familial risk.
Safe Motherhood:
Promoting Health for Women Before, During, and After Pregnancy 2003
Safe motherhood begins before conception with proper nutrition and a healthy
lifestyle. It continues with appropriate prenatal care, the prevention
of complications when possible, and the early and effective treatment of
any complications that do occur. The ideal result is a labor at term without
unnecessary interventions, the delivery of a healthy infant, and a healthy
postpartum period in a positive environment that supports the physical
and emotional needs of the woman, infant, and family.
Early and
Definitive Diagnosis of Toxic Shock Syndrome by Detection of Marked Expansion
of T-Cell-Receptor Vβ2-Positive T Cells
PDF
Two cases are reported of Toxic Shock Syndrome (TSS) with puerperal infection
that could be diagnosed at the early stage of the clinical course by detecting
a marked expansion of T-cell-receptor V 2-positive T cells, as measured
by flow cytometric analysis. The symptoms of one patient were too complex
to permit diagnosis according to the clinical criteria without evaluation
of the TSST-1-reactive T cells. The role of T-cell analysis in peripheral
blood mononuclear cells in the diagnosis of TSS is discussed. From the
Emerging Infectious Diseases journal.
Diethylstilbestrol
(DES) Update (Press Release)
DES Web Site
CDC's Des Update Web site includes information and resources with downloadable
versions of all DES Update materials and an interactive Self-Assessment
Guide. The site includes sections for consumers, health care professionals,
and partners. In the United States, an estimated five to 10 million people
were exposed to DES, between 1938 and 1971. DES is a synthetic estrogen
that was prescribed to prevent miscarriages or premature delivery. However,
in 1971, the Food and Drug Administration (FDA) issued a "Drug
Bulletin" advising physicians to stop prescribing DES to pregnant
women. Subsequent research links DES exposure to health risks among the
women who were prescribed DES while pregnant and the children born to these
women. Women who were prescribed DES while pregnant are at a modestly increased
risk for breast cancer. Women exposed to DES in the womb-DES Daughters-experience
lifelong, increased risks that include a rare vaginal and cervical cancer,
reproductive complications, and infertility. Men exposed to DES-DES Sons-face
an increased risk for noncancerous epididymal cysts (growths on the testicles).
From Data to Action:
Using Surveillance to Promote Public Health. Examples from the Pregnancy
Risk Assessment Monitoring System
This booklet highlights selected examples from the larger, more comprehensive
book entitled "From Data to Action: Using Surveillance to Promote
Public Health, Examples from the Pregnancy Risk Assessment Monitoring System
(PRAMS)". PRAMS states have used their data to focus on a variety
of special maternal and child health issues. Topic areas featured in this
publication include unintended pregnancy, tobacco use, violence, prenatal
care, folic acid, infant sleep position, and breast-feeding. All of the
examples are based on data collected from PRAMS, a population-based surveillance
system of women who have recently given birth to a live infant. These examples
illustrate the critical role that maternal and child health surveillance
data can play in effecting improvements in the content and delivery of
services for women and children.
Notice
to Readers: National Smallpox Vaccine in Pregnancy Registry
PDF (p. 256)
CDC has established the National Smallpox Vaccine in Pregnancy Registry,
a surveillance system to monitor the outcomes in women who inadvertently
received smallpox vaccine during pregnancy, became pregnant within 28 days
after vaccination, or were a close contact with a vaccinee within 28 days.
The Magnitude
of Maternal Morbidity During Labor and Delivery, United States, 1993-1997 (Fact
Sheet)
This is the first report of maternal morbidity during labor and delivery
in the United States. During the study period (1993-1997), almost 4 million
women annually gave birth. About 43 percent of these women had some kind
of maternal morbidity, which is defined as a condition that has an adverse
impact on a woman's physical health during childbirth, beyond what would
be expected in a normal delivery. Primary prevention is possible for some
complications. For others, the goal is appropriate management to prevent
them from becoming severe or even life-threatening. The article is published
in the April issue of the American Journal of Public Health.
Pregnancy
in Perinatally HIV-Infected Adolescents and Young Adults, Puerto Rico,
2002
PDF
Erratum
The number of perinatally HIV-infected females in the United States who
are becoming both sexually active and pregnant is increasing. During August
1998-May 2002, a total of 10 pregnancies were identified among eight perinatally
HIV-infected adolescents and young adults in Puerto Rico; in April 2002,
the Puerto Rico Department of Health asked CDC to assist in assessing such
pregnancies. This report describes these pregnancies and discusses factors
associated with sexual activity and pregnancy. The findings suggest that
increasing numbers of pregnancies will occur among perinatally HIV-infected
adolescents and young adults and that appropriately tailored reproductive
health interventions should be developed.
Pregnancy-Related
Mortality Surveillance-United States, 1991-1999
PDF
Press Release
Fact Sheet
During 1991-1999, a total of 4,200 deaths were determined to be pregnancy-related.
The overall pregnancy related mortality ratio was 11.8 deaths per 100,000
live births and ranged from 10.3 in 1991 to 13.2 in 1999. Older women,
particularly women aged >35 years and women who received no prenatal
care, were at increased risk for pregnancy-related death. The distribution
of the causes of death differed by pregnancy outcome. Among women who died
after a live birth (i.e., 60% of the deaths), the leading causes of death
were embolism and pregnancy-induced hypertension. In addition, racial disparity
in pregnancy-related mortality ratios persists; since 1940, mortality ratios
among blacks have been at least three to four times higher than those for
whites.
Safe Motherhood
in the United States: Maternal and Child Health (MCH) Journal:
Special Issue
MCH Journal Web
Site
http://www.kluweronline.com/issn/1092-7875/contents (Non-CDC site)
This special issue outlines some of the major research, health care practice,
and policy issues pertaining to safe motherhood. There are articles related
to ectopic pregnancy, surveillance, racial disparities, depression, diabetic
pregnant women, and maternal death.
SART
Clinic Self Validation of the 2000 Assisted Reproductive Technology (ART)
Data Set
To ensure the quality of data published in the ART Success Rates reports
from 1995-1999, CDC has overseen on-site data validation visits for a random
sample of the clinics included in the report. In each year that these visits
were conducted, the rates of discrepancy between the medical records and
the data submitted to CDC were low. In nearly all cases, data on pregnancies
and live births were found to be accurately reported. For the current report
(based on ART procedures performed in 2000), random validation visits were
not conducted. However, the Society for Assisted Reproductive Technology
(SART) established a clinic self-validation process and requested that
their member clinics participate. SART submitted a summary of this self-validation
process and their findings to CDC. Although CDC did not oversee this process,
and therefore cannot officially certify the results, we are publishing
the SART findings as a supplement to the 2000 Assisted Reproductive Technology
Success Rates report.
Fetal
Alcohol Syndrome - South Africa, 2001
PDF (p. 660)
This report summarizes the findings of a prevalence study, which indicate
a high prevalence of fetal alcohol syndrome (FAS) among first-grade children
in four nonwine-growing communities around Johannesburg. Because South
Africa has limited resources and many competing health problems, integrating
prenatal alcohol-exposure prevention activities with existing prevention
programs should be explored.
No Link Between
Taking Folic Acid and Having Twins (Press Release)
New results from a study involving almost a quarter of a million women
in China show that taking folic acid to reduce the risk of neural tube
birth defects does not increase a woman's chances of giving birth to twins.
Study results published in the February 1 issue of Lancet.
Alcohol
Use and Pregnancy
Maternal prenatal alcohol use is one of the leading preventable causes
of birth defects and developmental disabilities. Approximately one in 30
pregnant women in the United States reports "risk drinking" (seven
or more drinks per week, or five or more drinks on any one occasion). More
than half of all women of childbearing age in the United States report
that they drink alcohol. Prenatal alcohol-related disorders are 100% preventable.
2002 Publications and Materials
Mean Age of Mother,
1970 to 2000 (Press Release)
PDF
This report presents trends in the mean age of mothers giving birth for
the United States for the last three decades. Data are presented by live-birth
order, race, Hispanic origin, and State of residence of the mother. The
mean age of mother has increased steadily in the United States over the
last three decades. Mothers having their first and second live births had
the largest increase in mean age. Among racial and Hispanic origin subgroups,
Japanese women had the highest mean age in 2000. Puerto Rican women had
the lowest mean age. Massachusetts had the highest mean age in 2000 and
Mississippi had the lowest.
State-Specific
Trends in U.S. Live Births to Women Born Outside the 50 States and the
District of Columbia - United States, 1990 and 2000
PDF (uncorrected version)
(p. 1091)
Erratum
This report presents state-specific comparisons of live births in 1990
and 2000 to women born outside the 50 states and DC and compares maternal
characteristics and live-birth outcomes for these women with those of state-born
mothers (i.e., women born inside the 50 states and DC). The findings indicate
that women born outside the 50 states and DC had better birth outcomes
than their state-born racial/ethnic counterparts. However, a larger percentage
of these women began prenatal care later and had other problems accessing
health care, which might reflect economic, cultural, and language barriers.
Teenage
Births in the United States: State Trends, 1991-2000, an Update (Fact
Sheet)
PDF
This report provides State-specific birth rates for teenagers for 1991
and 2000, and the percent change between the time periods. Birth rates
for teenagers 15-19 years declined significantly in all States, the Virgin
Islands and Guam, between 1991 and 2000. Declines by State ranged from
12 to 39 percent. Rates also fell significantly for teenage subgroups 15-17
and 18-19 years. Teenage birth rates vary substantially by State. In 2000
rates for teenagers 15-19 ranged from 23.4 per 1,000 in New Hampshire to
72.0 in Mississippi. Although not directly comparable, because it is a
city, the highest rate was for the District of Columbia, 80.7.
Vaginal Birth
After Cesarean Birth-California, 1996-2000
PDF (p. 996)
This report summarizes an analysis of California's VBAC rates during 1996-2000,
which indicates that the VBAC rate in California decreased by 35%, from
23% in 1996 to 15% in 2000. After maternal race/ethnicity, age, insurance
status, and education were stratified, a consistent downward trend in VBAC
rates was observed for all populations. By race/ethnicity, Asian/Pacific
Islander women had the highest VBAC rates, ranging from 25% in 1996 to
18% in 2000; VBAC rates among American Indian/Alaska Native women declined
the most, and rates among non-Hispanic black women declined the least.
In 2000, of all births in the United States, 23% were cesarean, approximately
37% of which were repeat cesarean births.
Births: Preliminary
Data for 2001 (Press Release)
PDF
This report presents preliminary data for 2001 on births in the United
States. Data on births are shown by age, race, and Hispanic origin of mother.
Data on marital status, prenatal care, cesarean delivery, and low birthweight
are also presented. The number of births, the crude birth rate, and the
fertility rate all declined slightly between 2000 and 2001. Teenagers were
less likely to give birth in 2001; the teen birth rate continued to fall,
dropping 5 percent between 2000 and 2001 to 45.9 births per 1,000 females
aged 15-19 years, another record low. Birth rates for women aged 20-24
declined by 2 percent, whereas rates for women 25-44 years increased. Childbearing
among women aged 40-54 years was stable. The birth rate for unmarried women
decreased modestly to 44.9 births per 1,000 unmarried women 15-44 years
in 2001, still remaining below the peak reached in 1994. The proportion
of women who began prenatal care in the first trimester of pregnancy improved
slightly to 83.4 percent, but the rate of low birthweight held at 7.6 percent.
The total cesarean delivery rate jumped 7 percent between 2000 and 2001
to 24.4 percent of all births, the highest level ever reported from this
data source; the primary rate of cesarean deliveries rose 5 percent, and
the rate of vaginal births after previous cesarean delivery tumbled 20
percent.
2000 Assisted Reproductive
Technology Success Rates Report
Press Release
The data for this national report come from the 383 fertility clinics in
operation in 2000 that provided and verified data on the outcomes of all
ART cycles started in their clinics. The 99,639 ART cycles performed at
these reporting clinics in 2000 resulted in 25,228 live births (deliveries
of one or more living infants) and 35,025 babies. The national report consists
of graphs and charts that use 2000 data to answer specific questions related
to ART success rates. The 2000 national summary table, which is based on
data from all clinics included in this report, immediately precedes the
individual clinic tables.
Safe Motherhood:
Promoting Health for Women Before, During, and After Pregnancy, 2002
Approximately 6 million American women become pregnant each year, and more
than 10,000 give birth each day. Safe motherhood begins before conception
with proper nutrition and a healthy lifestyle. It continues with appropriate
prenatal care, the prevention of complications when possible, and the early
and effective treatment of any complications that do occur. The ideal result
is a labor at term without unnecessary interventions, the delivery of a
healthy infant, and a healthy postpartum period in a positive environment
that supports the physical and emotional needs of the woman, infant, and
family.
HIV Testing
Among Pregnant Women - United States and Canada, 1998-2001
PDF
To assess the effectiveness of three different prenatal HIV-testing approaches,
CDC reviewed prenatal HIV-antibody testing rates associated with these
approaches. Medical record data suggest that the "opt-in" voluntary
testing approach is associated with lower testing rates than either the "opt-out" voluntary
testing approach or the mandatory newborn HIV testing approach. Prenatal
HIV testing affords the best opportunity for the prevention of perinatal
HIV transmission. On the basis of clinical trial data, perinatal HIV-transmission
rates among HIV-infected women who begin antiretroviral treatment during
pregnancy are as low as <2%, compared with 12%-13% early transmission
rates among women who do not begin preventive treatment until labor and
delivery or after birth and 25% among women who receive no preventive treatment.
State
Prenatal Smoking Databook, 1999
(Non-CDC site)
This report provides a national overview of smoking prevalence during pregnancy,
as well as state-by-state statistics on prenatal smoking, smoking-attributable
infant deaths, and related health care costs. The publication also summarizes
information on state-level maternal and child health smoking cessation
programs, cigarette taxes and regulatory policies, and federal and state
programs to reduce smoking among pregnant women.
Public Health
Dispatch: Outbreak of Listeriosis - Northeastern United States, 2002
PDF (p. 950)
A multistate outbreak of Listeria monocytogenes infections with 46 culture-confirmed
cases, seven deaths, and three stillbirths or miscarriages in eight states
has been linked to eating sliceable turkey deli meat. Eating food contaminated
with L. monocytogenes can result in listeriosis, an uncommon but potentially
fatal disease. The majority of listeriosis cases occur among pregnant women,
the elderly, and persons with weakened immune systems. Illness in pregnant
women can result in miscarriage, stillbirth, or severe illness or death
of a newborn infant. Listeriosis begins often with influenza-like symptoms,
and sometimes with diarrhea, which might occur within one week after eating
contaminated food.
Smoking
Cessation for Pregnant Women
The Centers for Medicare and Medicaid Services and CDC are exploring the
possibility of providing coverage for smoking cessation services for pregnant
and post-partum women through Medicaid. Both agencies are dedicated to
working with state Medicaid agencies and state health departments to develop
and implement innovative, cost-effective ways to reduce the public health
burden of tobacco use.
Prevention
of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC
PDF
Data collected after the issuance of the 1996 guidelines prompted reevaluation
of prevention strategies. The new recommendations are based on available
evidence and expert opinion where sufficient evidence was lacking. Although
many of the recommendations in the 2002 guidelines are the same as those
in 1996, they include some key changes: 1) Recommendation of universal
prenatal screening for vaginal and rectal GBS colonization of all pregnant
women at 35-37 weeks' gestation; 2) Updated prophylaxis regimens for women
with penicillin allergy; 3) Detailed instruction on prenatal specimen collection
and expanded methods of GBS culture processing; 4) Recommendation against
routine intrapartum antibiotic prophylaxis for GBS-colonized women undergoing
planned cesarean deliveries who have not begun labor or had rupture of
membranes; 5) A suggested algorithm for management of patients with threatened
preterm delivery; and 6) An updated algorithm for management of newborns
exposed to intrapartum antibiotic prophylaxis. Group B streptococcus (GBS)
remains a leading cause of serious neonatal infection despite great progress
in perinatal GBS disease prevention in the 1990s.
Prenatal Screening
is Most Effective Strategy to Prevent Newborn Strep B Infections (Press
Release)
NEJM Web Site
Routine screening for group B streptococcus late in pregnancy is the most
effective way to prevent transmission of the bacteria from mother to child
during delivery. The data were published in the July 25, 2002 issue of
the New England Journal of Medicine (NEJM). Guidelines issued in 1996 to
prevent transmission of the bacteria from mother to newborn recommend that
health care providers use one of two methods. The new data show that the
prenatal screening method was more than 50 percent more effective in preventing
transmission than the clinical risk factor method. The new guidelines will
be published in the CDC Morbidity and Mortality Weekly Report. Group B
streptococcal disease remains a leading infectious cause of illness and
death among newborns in the United States, resulting in approximately 1,600
illnesses and 80 deaths each year.
Hysterectomy
Surveillance - United States, 1994-1999
PDF
From 1994 through 1999, an estimated 3,525,237 hysterectomies were performed
among U.S. women aged >15 years, and the overall hysterectomy rate for
U.S. female, civilian residents was 5.5 per 1,000 women. Although statistically
significant increases for hysterectomy rates were observed from 1994 (5.1/1,000)
through 1998 (5.8/1,000), the increase was limited and the curve remained
nearly flat. Women aged 40-44 years had a significantly higher hysterectomy
rate compared with any other age group. During the study period, 52% of
all hysterectomies were performed among women aged <44 years. Uterine
leiomyoma, endometriosis, and uterine prolapse were the most frequent diagnoses
for women aged >15 years. Hysterectomy is the second most frequently
performed surgical procedure, after cesarean section, for women of reproductive
age in the United States. Approximately 600,000 hysterectomies are performed
annually in the United States, and approximately 20 million U.S. women
have had a hysterectomy.
Few Women Regret
Sterilization Procedures (NIH Web Site)
(Non-CDC site)
Few of the women who undergo tubal sterilization or whose husbands undergo
vasectomy later go on to regret either procedure, according to a study
funded by the National Institute of Child Health and Human Development,
NIH, and conducted by the CDC. The study appears in the June issue of Obstetrics & Gynecology.
The study found the proportion of women who experience regret was essentially
the same - about 6 to 7 percent - five years after their husbands' vasectomy
or their own tubal sterilization. The study also found that substantial
conflict between a woman and her husband increases the risk of regret after
either vasectomy or tubal sterilization.
Nonoxynol-9
Spermicide Contraception Use - United States, 1999
PDF
To determine the extent of N-9 contraceptive use among U.S. women, CDC
assessed data provided by U.S. family planning clinics for 1999. This report
summarizes the results of that assessment, which indicate that some U.S.
women are using N-9 contraceptives. In 1999, a total of 7%-18% of women
attending Title X clinics reported using condoms as their primary method
of contraception. Data on the percentage of condoms lubricated with N-9
were not available. A total of 1%-5% of all women attending Title X clinics
reported using N-9 contraceptives (other than condoms) as their primary
method of contraception. Sexually active women should consider their individual
HIV/STD infection risk when choosing a method of contraception. Prevention
of both unintended pregnancy and HIV/STD infection among U.S. women is
needed. In 1994, a total of 49% of all pregnancies were unintended. Furthermore,
26% of women experience an unintended pregnancy during the first year of
typical use of spermicide products. Providers of family planning services
should inform women at risk for HIV/STDs that N-9 contraceptives do not
protect against these infections.
Prevalence
of Selected Maternal Behaviors and Experiences, Pregnancy Risk Assessment Monitoring
System (PRAMS), 1999
PDF
Appendix
This report covers data from 1993 through 1999 and examines various maternal
behaviors and experiences before, during, and after pregnancy. Areas include
unintended pregnancy, late or no entry into prenatal care, smoking during
pregnancy, physical abuse, breast-feeding initiation and duration, and
back sleep position for infants. For surveillance during 1993-1999, the
majority or all states observed increases in breast-feeding initiation,
breast-feeding for at least 4 weeks, and back sleep position. Approximately
one half of the states observed decreases for late or no entry into prenatal
care and smoking during the last 3 months of pregnancy. Little or no progress
was observed in the prevalence of unintended pregnancy or physical abuse
during pregnancy. With few exceptions, the 17 states failed to meet the
Healthy People 2000 objectives for the seven reported behaviors in 1999.
Certain demographic and socioeconomic characteristics of women were associated
with an increased risk for several of the behaviors, including younger
age, black race, less education, and receipt of Medicaid just before or
during pregnancy. The Pregnancy Risk Assessment Monitoring System (PRAMS)
is an ongoing, state- and population-based surveillance system designed
to monitor selected self-reported maternal behaviors and experiences that
occur before, during, and after pregnancy among women who deliver a live-born
infant.
Factor
V Leiden Mutation and the Risk of Venous Thrombolembolism in Pregnant Women
This is an E-Journal Club review from the Human Genome Epidemiology Network
(HuGENeT) of the Tormene D et al article published in Haematologica 2001;86:1305-9.
It includes a detailed abstraction of the article.
Alcohol Use
Among Women of Childbearing Age - United States, 1991-1999
PDF
Erratum
Telebriefing
To characterize trends in alcohol use among women of childbearing age,
CDC analyzed representative survey data from the Behavioral Risk Factor
Surveillance System (BRFSS) during 1991-1999. This report summarizes the
results of the analysis, which indicate that the rate of any alcohol use
(i.e., at least one drink) during pregnancy has declined since 1995. However,
rates of binge drinking (i.e., >5 drinks on any one occasion) and frequent
drinking (i.e., >7 drinks per week or >5 drinks on any one occasion)
during pregnancy have not declined, and these rates also have not declined
among nonpregnant women of childbearing age. Pregnant women who are unmarried
and older tend to have the highest rates of alcohol use. Women who drink
alcohol are more likely than other women to be white, unmarried, younger,
and working full time outside the home. Prenatal drinking patterns are
highly predictive of alcohol use during pregnancy. Health-care providers
should routinely screen women of childbearing age for alcohol use and counsel
them about the adverse effects of alcohol use during pregnancy. Prenatal
exposure to alcohol is one of the leading preventable causes of birth defects,
mental retardation, and neurodevelopmental disorders in the United States.
Safe Motherhood:
Promoting Health for Women Before, During, and After Pregnancy - At A Glance
2002
PDF
(modified/tagged version)
PDF
This fact sheet focuses on complications in pregnancy, disparities, deaths,
surveillance, state programs, and research. Approximately 6 million American
women become pregnant each year, and more than 10,000 give birth each day.
Safe motherhood begins before conception with proper nutrition and a healthy
lifestyle. It continues with appropriate prenatal care, the prevention
of complications when possible, and the early and effective treatment of
any complications that do occur. The ideal result is a labor at term without
unnecessary interventions, the delivery of a healthy infant, and a healthy
postpartum period in a positive environment that supports the physical
and emotional needs of the woman, infant, and family.
Strategies to Reduce
Pregnancy-Related Deaths: From Identification and Review to Action
PDF (Tagged)
Order Publication
This 2001 manual describes strategies for conducting pregnancy-related
or maternal mortality surveillance in the United States. This surveillance
is an on-going process of identifying pregnancy-related deaths, reviewing
the factors that led to those deaths, analyzing and interpreting the information
gathered, and acting on the results to reduce future deaths. The manual
addresses issues and tasks that are important for health departments, clinicians,
vital statistics personnel, pregnancy-related mortality review committees,
legislators, and community groups. Approximately 214 pages.
Barriers to
Dietary Control Among Pregnant Women with Phenylketonuria-United States, 1998-2000
PDF
Press Release
This report describes the pregnancies of three women with phenylketonuria
(PKU) and underscores the importance of overcoming the barriers to maintaining
the recommended dietary control of blood phenylalanine levels before and
during pregnancy. When women with PKU do not adhere to their diet before
and during pregnancy, infants born to them have a 93% risk for mental retardation
(MR) and a 72% risk for microcephaly. An estimated 3,000-4,000 U.S.-born
women of reproductive age with PKU have not gotten severe MR because as
newborns their diets were severely restricted in the intake of protein-containing
foods and were supplemented with medical foods (e.g., amino acid-modified
formula and modified low-protein foods).
FAQs:
Guidelines for Pregnant Women Who Have Been Exposed to Anthrax But Do Not Have
Symptoms
These questions and answers discuss medicine to prevent anthrax in pregnant
women who have been exposed to anthrax, but who do not have symptoms of
anthrax disease. For CDC guidelines for treating anthrax disease, see MMWR,
October 26, 2001/Vol. 50/No. 42.
Births: Final Data
for 2000 (Press Release)
PDF
This report presents 2000 data on U.S. births according to a wide variety
of characteristics. The number of births rose 3 percent in 2000; birth
and fertility rates rose 1 to 2 percent. Data are presented for maternal
demographic characteristics; birth and fertility rates by age, live-birth
order, race, Hispanic origin, and marital status; mother's State of residence,
month and day of birth, sex ratio, and age of father; and trends in fertility
patterns and maternal and infant characteristics.
Infant Mortality
Statistics from the 1999 Period Linked Birth/Infant Death Data Set (Fact
Sheet)
PDF
Infant mortality rates were higher for mothers who began prenatal care
late or had none at all, were teenagers, had 9-11 years of education, were
unmarried, or smoked during pregnancy. Infant mortality rates were also
higher for male infants, multiple births, and infants born preterm or at
low birthweight. Almost 28,000 infants died in the first year of life in
1999. The three leading causes of infant death--congenital malformations,
low birthweight, and sudden infant death syndrome--together accounted for
almost one-half of all infant deaths in 1999.
Use of Assisted
Reproductive Technology - United States, 1996 and 1998
PDF (p. 97)
This report examines state specific use of ART in 1996 and 1998 and provides
data on ART live-born and multiple infant birth rates in 1998. Findings
indicate that the use of ART is increasing in most states and that more
than half the infants born as a result of these procedures are multiple
births. These high-risk births contribute disproportionately to health-care
costs and might negatively affect maternal and child health outcomes, particularly
in states where large numbers of ART procedures are performed.
Progress Toward
Elimination of Perinatal HIV Infection-Michigan, 1993-2000
PDF
This report summarizes surveillance data collected through December 31,
2001, on children born to HIV-infected women in Michigan during 1993-2000.
The report highlights rapid adoption of PHS guidelines that resulted in
the reduction of perinatally acquired HIV infection to historically low
levels in Michigan. Improving levels of prenatal care (PNC) for HIV-infected
pregnant women, especially substance users, and routine HIV counseling
and voluntary testing for all pregnant women are needed to further reduce
perinatal HIV infection.
Trends
in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-99 (Press
Release)
PDF
This report tracks trends in rates of cesarean delivery and vaginal births after
previous cesarean (VBAC) delivery for 1991-99. The report shows that from 1991
to 1996 the cesarean rate declined while the VBAC rate steadily increased. Since
1996, trends have reversed with cesareans now on the rise and the rate of VBACs
declining to early 1990 levels.
Abortion Surveillance-United
States, 1999
PDF
This report summarizes and describes data reported to CDC regarding legal induced
abortions obtained in the United States in 1999. A total of 861,789 legal abortions
were reported to CDC for 1999, representing a 2.5 percent decrease from 884,273
legal induced abortions reported by the same 48 reporting areas for 1998. The
abortion ratio, defined as the number of abortions per 1,000 live births, was
256 in 1999, compared with 264 reported for 1998; the abortion rate for these
48 reporting areas was 17 per 1,000 women aged 15-44 for 1999, the same as in
1997 and 1998.
Abortion Surveillance-United
States, 1998
PDF
Fact Sheet
This report summarizes and reviews information reported to CDC regarding legal
induced abortions obtained in the United States in 1998. In 1998, 884,273 legal
induced abortions were reported to CDC, representing a 2% decrease from the 900,171
legal induced abortions reported by the same 48 reporting areas for 1997. Women
undergoing an abortion were likely to be young (i.e., age <25 years), white,
and unmarried; slightly more than one half were obtaining an abortion for the
first time. Of all abortions for which gestational age was reported, 56% were
performed at <8 weeks of gestation, and 88% were performed before 13 weeks.
Overall, 19% of abortions were performed at the earliest weeks of gestation (<6
weeks), 18% at 7 weeks, and 19% at 8 weeks. The availability of information about
characteristics of women who obtained an abortion in 1998 varied by state and
by the number of states reporting each characteristic. The total number of legal
induced abortions by state is reported by state of residence and state of occurrence;
characteristics of women obtaining abortions in 1998 are reported by state of
occurrence.
Fetal Alcohol Syndrome
Prevention Campaign
The targeted media campaign is one strategy to enhance current prevention efforts
related to fetal alcohol syndrome (FAS) and other prenatal alcohol-related effects.
Evidence-based approaches to the design, implementation, and evaluation of these
types of projects are needed and are currently underway to determine the most
effective strategies for use in media campaigns aimed at reducing prenatal alcohol
use.
National Task
Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect: Defining the National
Agenda for Fetal Alcohol Syndrome and Other Prenatal Alcohol-Related Effects
PDF
This report describes the structure, function, mission, and goals of the Task
Force and provides their first recommendations. An explanation of how the Task
Force recommendations were generated and the Task Force's next steps are also
reported. Prenatal alcohol exposure can lead to serious birth defects and developmental
disabilities. A need exists to develop effective strategies for both children
with fetal alcohol syndrome (FAS) or other prenatal alcohol-related effects and
for women at high risk for having an alcohol-exposed pregnancy. Text version
-
Folic Acid and Prevention
of Spina Bifida and Anencephaly: 10 Years After the U.S. Public Health Service
Recommendation
This issue of the MMWR Recommendations and Reports presents data to assess the
impact of efforts to prevent neural tube defects through increased folic acid
consumption.
Five articles are included:
- Introduction
- Serum Folate Levels Among Women Attending Family Planning Clinics-Georgia, 2000
- Spina Bifida and Anencephaly Prevalence-United States, 1991-2001
- Sociodemographic Patterns in Spina Bifida Birth Prevalence Trends - North Carolina, 1995-1999
- Folic Acid Awareness and Use Among Women with a History of a Neural Tube Defect Pregnancy - Texas, 2000-2001
Folate
Status in Women of Childbearing Age, by Race/Ethnicity - United States,
1999-2000
PDF (p. 808)
To assess temporal changes in serum and red blood cell (RBC) folate concentrations
among childbearing-aged women, CDC compared folate concentrations for childbearing-aged
women who participated during 1988-1994 and 1999-2000 in the National Health
and Nutrition Examination Survey. This report outlines the results of this
comparison and describes serum and RBC folate levels by race/ethnicity.
The results indicate that over the period studied, the median serum folate
concentration for women aged 15-44 years increased approximately threefold,
and the median RBC folate concentration increased approximately twofold.
These findings indicate that the national health objective for 2010 to
increase the median RBC folate level among women of childbearing age to
220 ng/mL RBC (objective 16.16b) has been met for Mexican-American* and
non-Hispanic white women but not for non-Hispanic black women. Women of
childbearing age in the United States who are capable of becoming pregnant
should consume 400 µg (0.4 mg) of folic acid per day to reduce their risk
for having a pregnancy affected with spina bifida or other neural tube
defects.
Trends
in Spina Bifida and Anencephalus in the United States, 1991-2001
This Health e-stat provides an 11-year trend for two neural tube defects,
spina bifida and anencephalus. After a significant increase in the rate
from 1992 to 1995 there was a significant decline from 1995 to 1998. The
rate was stable from 1999 to 2001. The rates for 1999, 2000, and 2001 were
significantly lower than in 1997. The rate of spina bifida in 2001 was
20.09 per 100,000 live births. In 1992 the U.S. Public Health Service recommended
that women of childbearing age increase consumption of the vitamin folic
acid to reduce spina bifida and anencephalus.
Fetal Alcohol
Syndrome - Alaska, Arizona, Colorado, and New York, 1995-1997
PDF (p. 433)
This report summarizes the results of an analysis of the Fetal Alcohol
Syndrome Surveillance Network (FASSNet) data on children born during 1995-1997,
which indicate that FAS rates in Alaska, Arizona, Colorado, and New York
ranged from 0.3 to 1.5 per 1,000 live-born infants and were highest for
black and American Indian/Alaska Native populations. This report demonstrates
that maternal alcohol use during pregnancy continues to affect children.
Recent data indicate that the prevalence of binge (i.e., >5 drinks on
any one occasion) and frequent drinking (i.e., >7 drinks per week or >5
drinks on any one occasion) during pregnancy reached a high point in 1995
and has not declined. The number of children affected adversely by in-utero
exposure to alcohol is probably underestimated.
2001 Publications and Materials
The 1999 Assisted
Reproductive Technology Success Rates Report
The goal of this report is to help potential assisted reproductive technology
(ART) users make informed decisions about ART by providing some of the
information needed to answer the following questions: What are my chances
of having a child by using ART? Where can I go to get this treatment?
Revised Recommendation
for Avoiding Pregnancy After Receiving a Rubella-Containing Vaccine
PDF
On October 18, 2001, the Advisory Committee on Immunization Practices (ACIP)
reviewed data from several sources indicating that no cases of congenital
rubella syndrome (CRS) had been identified among infants born to women
who were vaccinated inadvertently against rubella within 3 months or early
in pregnancy. On the basis of these data, ACIP shortened its recommended
period to avoid pregnancy after receipt of rubella-containing vaccine from
3 months to 28 days. Data were available from 680 live births to susceptible
women who were inadvertently vaccinated 3 months before or during pregnancy
with one of three rubella vaccines. None of the infants was born with CRS.
The Ethnicity, Needs, and Decisions
of Women (ENDOW) Study
(Non-CDC site)
The Ethnicity, Needs, and Decisions of Women (ENDOW) study was designed
to examine the factors that influence women's choices and decision-making
regarding hysterectomy, oophorectomy, and use of hormone replacement therapy,
with a focus on the potential influences of cultural identity and ethnicity.
Materials were developed to enhance decision making about reproductive
health care, using hysterectomy as an example. This link to the ENDOW Web
site provides visitors with an overview of the study, relevant publications,
presentations, and contact information. Funded by the National Institutes
of Health and CDC.
Lessons
Learned from Contraceptive Logistics Experience
Since 1973, CDC has provided technical assistance in contraceptive logistics
matters to family planning programs in 65 countries in Asia, Africa, Latin
America, and Eastern Europe. In more than 25 years of logistics work, maxims
have emerged.
Revised Guidelines for
HIV Counseling, Testing, and Referral (CTR) and Revised Recommendations for
HIV Screening of Pregnant Women
The new Guidelines and Recommendations replace guidelines previously issued
by CDC and the Public Health Service. The new Counseling, Testing and Referral
guidelines include the following significant revisions: providing guidance
to all providers of voluntary HIV counseling, testing and referral (CTR),
both in the public and private sectors; underscoring the importance of
early knowledge of HIV status by making testing more accessible and available;
acknowledging providers' need for flexibility in implementing the guidelines,
given their particular client base, setting, HIV prevalence level, and
available resources; recommending that CTR be targeted efficiently through
risk screening and other strategies; and addressing ways to improve the
quality and provision of HIV CTR. Major revisions to the 1995 Screening
of Pregnant Women recommendations include: emphasizing HIV testing as a
routine part of prenatal care; strengthening the recommendation that all
pregnant women be tested for HIV; recommending simplification of the testing
process and making the consent process more flexible; recommending that
providers explore and address reasons for refusal of testing; and emphasizing
HIV testing and treatment at the time of delivery for women who have neither
received prenatal testing nor antiretroviral drugs, if HIV-positive.
- HIV Counseling, Testing, and Referral (CTR) http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a1.htm
- HIV Screening of Pregnant Women http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a2.htm
Notice
to Readers: Updated Recommendations for Antimicrobial Prophylaxis Among
Asymptomatic Pregnant Women After Exposure to Bacillus anthracis
PDF
Pregnant women are likely to be among the persons receiving antimicrobial
prophylaxis for exposure to B. anthracis. Clinicians, public health officials,
and women who are candidates for treatment should weigh the possible risks
and benefits to the mother and fetus when choosing an antimicrobial for
postexposure anthrax prophylaxis. Women who become pregnant while taking
antimicrobial prophylaxis should continue the medication and consult a
health-care provider or public health official to discuss these issues.
The antimicrobial of choice for initial prophylactic therapy among asymptomatic
pregnant women exposed to Bacillus anthracis is ciprofloxacin, 500 mg twice
a day for 60 days.
Folic Acid Supplements
During Pregnancy and the Risk for
Miscarriage (Press Release)
CDC Folic Acid Web Site
Findings from a new study in China show that consumption
of folic acid as a vitamin pill to reduce the risk of neural tube
birth defects is safe, and does not increase a woman's risk of having a
miscarriage. Published in the September 8 issue of Lancet.
Smoking During Pregnancy
in the 1990s (Press Release)
PDF
The rate of smoking during pregnancy dropped 33 percent between 1990 and
1999, so that in 1999 just over 12 percent of all women reported smoking
during their pregnancies, according to a new report from the CDC. The greatest
success in reducing smoking was for women in their late twenties and early
thirties, where there was over a 40 percent drop since 1990. The report
includes data for most States, the District of Columbia and New York City,
all of which reported a drop in smoking rates from 1990 to 1999. The District
of Columbia reported the largest single decline, a 77 percent drop, followed
by Massachusetts and Arizona which cut their rates by more than 50 percent.
New York City, the District of Columbia, Texas, Arizona, and Hawaii have
the lowest smoking during pregnancy rates--below 8 percent in 1999.
Preventing Exposure
During Pregnancy to Medications Known to Cause Birth Defects (Press Release)
CDC reported today that despite prevention efforts some women who take
Accutane®, a prescription medication given for severe acne and known to
cause birth defects, still become pregnant while on this medication. The
CDC also reported that a symbol intended to remind women that they must
not get pregnant while taking these medications is commonly misinterpreted.
The two studies, "Continued Occurrence of Accutane®-exposed Pregnancies" and "Interpretations
of a Teratogen Warning Symbol", are published in the September issue
of the journal Teratology.
Evaluation
of a Regional Pilot Program to Prevent Mother-Infant HIV Transmission - Thailand,
1998-2000
PDF
In 1998, the Thailand Ministry of Public Health initiated a pilot program
to prevent mother-infant HIV transmission in region 7, a rural area in
northeastern Thailand with an antenatal HIV prevalence of approximately
1%, to assess program feasibility, effectiveness, and acceptability. This
report summarizes an evaluation of the 2-year pilot program, which indicated
that acceptance of HIV testing and adherence to zidovudine were high and
HIV transmission was reduced. The findings demonstrate the feasibility
of implementing programs to prevent mother-infant HIV transmission on a
large scale in a developing country.
Control
and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks,
Rubella in Pregnant Women, and Surveillance for Congenital Rubella Syndrome
PDF
Health-care providers should be aware of the need for rubella prevention
and control among women of childbearing age and of the appropriate follow-up
for pregnant women exposed to rubella. This report describes seven steps
for evaluating and managing suspected rubella outbreaks. This report also
provides guidelines for evaluating and managing rubella in pregnant and
nonpregnant women and evaluating infants for congenital rubella infection.
Family
Planning Practices and Pregnancy Intervention, 1997
This report is a compilation of results highlighting family planning practices
and pregnancy intention for births occurring in 1997 in 13 states (Alabama,
Alaska, Arkansas, Colorado, Florida, Georgia, Maine, New York, North Carolina,
Oklahoma, South Carolina, Washington, and West Virginia). This report provides
benchmarks for 11 family planning practice and pregnancy intention indicators
(e.g., use of contraception at time of pregnancy and during the postpartum
period, prenatal care counseling regarding postpartum use of contraception,
use of contraception by pregnancy intention, method of contraception used,
and reasons for nonuse of contraceptives) that can be examined across participating
states.
Births: Preliminary
Data for 2000 (Press Release)
PDF
This report presents preliminary data for 2000 on births in the United
States. Data on births are shown by age, race, and Hispanic origin of mother.
Data on marital status, prenatal care, cesarean delivery, and low birthweight
are also presented. The number of births rose 3 percent between 1999 and
2000. The birth rate for teenagers, which has been falling since 1991,
declined 2 percent in 2000 to 48.7 births per 1,000 females aged 15-19
years, another historic low. Birth rates for all of the older age groups
increased for 1999-2000: 1 percent among women aged 20-24 years, 3 percent
for women aged 25-29 years, and 5 percent for women in their thirties.
Rates for women aged 40-54 years were also up for 2000.
Births: Final
Data for 1999 (Press Release)
PDF
CDC's National Center for Health Statistics released "Births: Final
Data for 1999." The report provides a comprehensive overview of birth
statistics for the U.S. as well as data by State for key indicators such
as number of births and birth rates, low birth weight infants, prenatal
care, births to teens, nonmarital births, tobacco use during pregnancy,
and other aspects of pregnancy and childbirth. Finally, the report noted
that the number of triplets is going down for the first time in a decade,
the number of twins is still going up, and teen births have declined.
Births to
Teenagers in the United States, 1940-2000 (Fact Sheet)
PDF
This report tracks teen birth rates for more than half a century. It
also includes the latest analysis of data by State and shows that rates
decline> d significantly in all States over the past decade, with declines
of 11 to 36 percent reported. The 2000 rate (49 births per 1,000 women
15-19) is about half the peak rate recorded in 1957.
PRAMS
1998 Surveillance Report
The Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based
survey of women delivering a live-born infant. This survey collects information
on women's experiences and behaviors before, during, and shortly after
pregnancy. Thus, states participating in PRAMS gain unique and invaluable
information for public health administrators, policymakers, and researchers
as they develop programs and policies to improve the health of women and
children. This report provides benchmarks of 15 states for 25 MCH indicators
(including unintended pregnancy; prenatal care; Medicaid coverage; participation
in the Special Supplemental Nutrition Program for Women, Infants, and Children;
breast-feeding; cigarette smoking; drinking; infant sleep position; prenatal
HIV prevention and test counseling; physical abuse; contraceptive use;
awareness of the importance of folic acid in preventing some birth defects;
and prenatal discussion of seat belt use). Selected highlights and 6-year
trends for each indicator are also presented; 3-year trends are presented
for indicators introduced in 1996.
Early Opportunities
for Prevention: Infections of Pregnant Women and Young Infants Panel Summary
from the 2000 Emerging Infectious Diseases Conference in Atlanta, GA
Infectious agents are a leading cause of pregnancy complications and contribute
to serious illness, death, and disability in infants. Substantial prevention
opportunities exist. Issues discussed include: role of infectious agents
in adverse consequences of pregnancy, maternal immunization, control of
infectious diseases through breast-feeding, and prevention success stories.
Trends in Pregnancy
Rates for the United States, 1976-97: An Update (Press Release)
PDF
This report presents detailed pregnancy rates for 1996 and 1997 to update
a recently published comprehensive report on pregnancies and pregnancy
rates for U.S. women. In 1997 an estimated 6.19 million pregnancies resulted
in 3.88 million live births, 1.33 million induced abortions, and 0.98 million
fetal losses. The 1997 pregnancy rate of 103.7 pregnancies per 1,000 women
aged 15-44 years is the lowest recorded since 1976 (102.7), the first year
for which a consistent series of national pregnancy rates is available.
The 1997 rate was 10 percent lower than the peak rate in 1990 (115.6).
The teenage pregnancy rate dropped steadily through 1997, falling to a
record low of 94.3 pregnancies per 1,000 teenagers 15-19 years, 19 percent
below the 1990 level (116.3). Rates for younger teenagers declined more
than for older teenagers.
ABC's
of Healthy Pregnancy: Pregnancy Tips
Not all birth defects can be prevented, but a woman can take some actions
that increase her chance of having a healthy baby. Many birth defects happen
very early in pregnancy, sometimes before a woman even knows she is pregnant.
Remember that about half of all pregnancies are unplanned.
Pregnancy-Related
Deaths Among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native
Women-United States, 1991-1997
PDF
Press Release
Fact Sheet
This report presents pregnancy-related mortality ratios (PRMR) among Hispanic,
Asian/Pacific Islander, and American Indian/Alaska Native women in the
United States during 1991-1997. The findings indicate that these groups
have higher PRMRs than non-Hispanic white (white) women and lower ratios
than non-Hispanic black (black) women and underscore the need for targeted
interventions that address the maternal health needs of racial/ethnic minority
women. During 1991-1997, 3193 pregnancy-related deaths occurred. The overall
PRMR was 11.5. PRMR among American Indians/Alaska Natives was 12.2, among
Asians/Pacific Islanders was 11.3, and among Hispanics was 10.3. PRMR was
29.6 and 7.3 among blacks and whites, respectively.
Safe Motherhood: Preventing
Pregnancy-Related Illness and Death, 2001 At-A-Glance
PDF
A pregnancy-related death is one that occurs during pregnancy or within
1 year after a pregnancy and is caused by pregnancy-related complications.
Each day in the United States, between two and three women die of pregnancy-related
causes. Although the risk of dying of pregnancy-related complications has
decreased dramatically in the United States over the
past 50 years, this risk has not declined since 1982. An estimated half
of all pregnancy-related deaths could be prevented through improved access
to health care, better quality of care, and changes in health and lifestyle
habits.
Q&A
About Tubal Sterilization and Menstruation
Researchers conducted a study using data from the U.S. Collaborative Review
of Sterilization to determine if menstrual abnormalities were greater among
women who had undergone tubal sterilization than among women who had not.
This fact sheet is a brief summary of the study that was published in the
December 7, 2000, issue of the New England Journal of Medicine. For nearly
a half century, there has been some concern that tubal sterilization may
result in menstrual abnormalities, such as an increase in menstrual pain
and bleeding. Results of this study show that tubal sterilization is not
associated with menstrual problems.
1998 Assisted Reproductive
Technology Report Success Rates Reports
Press Release
PDF
Assisted reproductive technology (ART) has been used in the United States
since 1981 to help women become pregnant. For many people, deciding whether
to undergo this expensive and time-consuming treatment can be difficult.
The goal of this report is to help potential ART users make informed decisions
about ART by providing some of the information needed to answer the following
questions: What are my chances of having a child by using ART? and Where
can I go to get this treatment?
Are Women with
Recent Live Births Aware of the Benefits of Folic Acid?
PDF
The B vitamin folic acid can reduce the incidence of certain birth defects
by 50%-70%. To examine folic acid awareness among women who had recently
delivered a live-born infant, CDC analyzed Pregnancy Risk Assessment Monitoring
System (PRAMS) data for 1995-1998. The question used to measure awareness
was, "Have you ever heard or read that taking the vitamin folic acid
can help prevent some birth defects?" During the study period, overall
folic acid awareness increased 15%, from 64% in 1996 to 73% in 1998, although
changes varied by state. This study indicates that gaps persist among women
in low socioeconomic groups. Overall, PRAMS data indicated an increase
in folic acid awareness among women with recent deliveries. However, this
awareness might be too late for the pregnancy that has occurred, indicating
a continued need to educate all reproductive-aged women regarding the need
to take folic acid before they become pregnant.
Knowledge/Use-Folic
Acid Among Women of Reproductive Age-Michigan, 1998
PDF
This report summarizes findings from the 1998 Behavioral Risk Factor Surveillance
System (BRFSS) about multivitamin use and folic acid knowledge among women
of reproductive age in Michigan. The findings suggest that public health
campaigns that promote the consumption of folic acid should target women
who are young, unmarried, obese, smoke, eat few fruits and vegetables,
and have a low level of education.
Related Links
Pregnancy and Reproductive Health: Women's
Health Topics A-Z
View women's health resources related to pregnancy and reproductive health.
ABC's...Pregnancy
Tips (A-Z): Having a Healthy Pregnancy
Learn tips A-Z to help you have a healthy pregnancy.
Are
you Pregnant? Protect Your Baby from Group B Strep
Learn how pregnancy women can protect their baby from group b strep.
Birth Defects and Developmental Disabilities
Learn more about birth defects and developmental disabilities.
Breastfeeding
Learn more about breastfeeding.
Diabetes
- Take Charge of Your Pregnancy
Learn information about becoming pregnant when you have diabetes, protecting
your baby and yourself, having diabetes during pregnancy, and controlling
diabetes for women's health.
Diethylstilbestrol (DES) Update
Diethylstilbestrol (DES) is a drug once prescribed during pregnancy to
prevent miscarriages or premature deliveries. In the U.S. an estimated
5 to 10 million persons were exposed to DES from 1938 to 1971, including
pregnant women prescribed DES and their children. In 1971, the Food and
Drug Administration (FDA) advised physicians to stop prescribing DES because
it was linked to a rare vaginal cancer. After more than 30 years of research,
there are more confirmed health risks associated with DES exposure. However,
not all exposed individuals will experience DES-related health problems.
Whether you know for sure or suspect you were exposed to DES, you can use
CDC's DES Update to learn more about DES exposure and what you can do about
it.
Fact Sheets: Birth
Defects and Developmental Disabilities
Learn more about a variety of issues related to birth defects and developmental
disabilities.
Fact
Sheet: Tobacco Use and Reproductive Outcomes
Learn more about how tobacco use affects reproductive health.
Fast Stats A-Z: Births/Natality
View data and statistics on births/natality.
Fast Stats A-Z:
Reproductive Health Statistics
View data and statistics on reproductive health.
Fetal Alcohol Syndrome
Fetal alcohol syndrome is 100% preventable if a woman does not drink alcohol
while she is pregnant. Learn more.
Folic Acid
Folic acid is a B vitamin. It is used in our bodies to make new cells.
If a woman has enough folic acid in her body before she is pregnant, it
can help prevent major birth defects of her baby's brain and spine. These
birth defects are called neural tube defects or NTDs. Women need to take
folic acid every day starting before they are pregnant to help prevent
NTDs. The CDC and the U.S. Public Health Service urge every woman who could
become pregnant to get 400 micrograms (400 mcg) of synthetic folic acid
every day. Learn more.
Folic
Acid Publications in English and Spanish
Order a variety of folic acid materials, including PSAs, booklets, brochures,
and more.
Frequently Asked Questions: West Nile Virus, Pregnancy, and Breastfeeding Learn answers to questions about West Nile Virus, pregnancy, and breastfeeding.
Guidelines for
Vaccinating Pregnant Women
Risk to a developing fetus from vaccination of the mother during pregnancy
is primarily theoretical. No evidence exists of risk from vaccinating pregnant
women with inactivated virus or bacterial vaccines or toxoids. Benefits
of vaccinating pregnant women usually outweigh potential risks when the
likelihood of disease exposure is high, when infection would pose a risk
to the mother or fetus, and when the vaccine is unlikely to cause harm.
Learn more.
Health Topics:
Pregnancy
View a list of links to information related to pregnancy.
Hepatitis
B and You
A computerized PowerPoint health education program, this program was designed
for women who test positive for the hepatitis B virus (HBV) during pregnancy.
The program was developed with input from HBV-infected women as to information
they wanted regarding the cause, transmission, and prevention of perinatal
hepatitis B. Feedback was obtained as to women's knowledge level before
and after viewing the information. Hepatitis B and You presents information
at a sixth grade reading level, and uses strategies that are known to work
with people who have low literacy skills. The use of this specialized program
with a large group of women from a county health department has improved
the rate of completion for both the hepatitis B vaccination series and
serologic follow-up by 50 percent.
HIV, STD, and TB Prevention
Learn more about HIV, sexually transmitted diseases, and tuberculosis.
Infant
Health
Learn more about infant health.
Listeriosis:
Frequently Asked Questions
Learn answers to frequently asked questions about listeriosis.
Medication
Use during Pregnancy and Breastfeeding
Many pregnant women or mothers who are breastfeeding worry about whether
to take medications - including prescription and over-the-counter drugs,
vitamins, and dietary or herbal supplements. They are afraid these could
harm their child. However, sometimes taking medication can't be avoided.
Learn more.
Occupational Safety and
Health: Reproductive Health
Learn more about reproductive health and the workplace.
Pregnancy Nutrition
Surveillance System
The Pediatric Nutrition Surveillance System (PedNSS) and the Pregnancy
Surveillance System (PNSS) are program-based surveillance systems that
monitor the nutritional status of low-income infants, children, and women
in federally funded maternal and child health programs. Learn more.
Pregnancy Planning Education
Program
Learn what you need to know now to have a safe pregnancy and healthy baby
with this online education program available for women who are planning
to get pregnant.
Preventing
Emerging Infectious Diseases: Addressing the Problem of Diseases of Pregnant
Women and Newborns
Each year, 6 million pregnancies and 4 million live births occur in the
United States. Infectious diseases pose a silent yet serious health threat
to many of these women and their babies. Infection acquired during pregnancy,
while sometimes inapparent and asymptomatic in the mother, can be devastating
to the health of the infant. CDC, in collaboration with other government
agencies, industry, academia, and other health partners, has developed
a plan with four goals specifically designed to limit the harm caused by
infectious agents acquired during pregnancy and early infancy.
Reproductive Health
Learn more about reproductive health.
STDs
and Pregnancy
Learn answers to frequently asked questions related to sexually transmitted
diseases (STDs) and pregnancy.
Toxoplasmosis
and Pregnant Women
Toxoplasmosis is an infection caused by a parasite called Toxoplasma gondii.
This parasite is carried by cats and is passed in their feces (stool).
Pregnant women need to be aware that toxoplasmosis can cause problems with
pregnancy, including abortion. However, people are more likely to get toxoplasmosis
from eating undercooked meat or gardening than from contact with pet cats.
By following simple safety tips, pregnant women can reduce the risk of
getting toxoplasmosis from cats.
Toxoplasmosis:
An Important Message for Women
Learn more about toxoplasmosis.
Pregnancy:
Unintended and Teen Pregnancy
Learn more about unintended and teen pregnancy.
Vaccinations
and Pregnancy
Find out what vaccinations pregnant women should get and other information.
What
You Can Do to Keep Germs from Harming Your Baby
Germs are everywhere in the world: on us, in us, and around us. Some of
them can harm your baby before and after birth. This booklet has important
information about some diseases caused by germs and the screening tests
and vaccinations that can help prevent them.
Women and Smoking:
A Report of the Surgeon General
Learn more about the harmful effects smoking has on women.
This site contains documents in PDF format. You will need Adobe Acrobat Reader
to access the file. If you do not have the Acrobat Reader, you may download a
free copy from the Adobe Web site.
Page last modified: October 16, 2008
Page last reviewed: March 3, 2008