Maternal, Infant, and Child Health

Fetal, Infant, Child, and Adolescent Deaths


16-1		Fetal and infant deaths


16-1a		At 20 or more weeks of gestation


16-1b		Perinatal deaths


16-1c		Infant deaths


16-1d		Neonatal deaths


16-1e		Postneonatal deaths


16-1f		All birth defects


16-1g		Congenital heart defects


16-1h		SIDS deaths


16-2		Child deaths


16-2a		Children aged 1 to 4 years


16-2b		Children aged 5 to 9 years


16-3		Adolescent and young adult deaths


16-3a		Adolescents aged 10 to 14 years


16-3b		Adolescents aged 15 to 19 years


16-3c		Young adults aged 20 to 24 years

Maternal Deaths and Illnesses


16-4		Maternal deaths


16-5		Maternal illness and complications due to pregnancy


16-5a		During labor and delivery


16-5b		Ectopic pregnancies


16-5c		Postpartum complications

Prenatal Care


16-6		Prenatal care


16-6a		First trimester


16-6b		Early and adequate


16-7		Childbirth classes

Obstetrical Care


16-8		Very low birth weight infants born at level III hospitals


16-9		Cesarean births


16-9a		First-time births


16-9b		Prior cesarean deliveries

Risk Factors


16-10		Low birth weight and very low birth weight


16-10a		Low birth weight


16-10b		Very low birth weight


16-11		Preterm births


16-11a		Total preterm


16-11b		32 to 36 weeks of gestation


16-11c		Less than 32 weeks of gestation


16-12		Weight gain during pregnancy


16-13		Infants put to sleep on their backs

Developmental Disabilities and Neural Tube Defects


16-14		Developmental disabilities


16-14a		Mental retardation


16-14b		Cerebral palsy


16-14c		Autism


16-14d		Epilepsy


16-15		Spina bifida and other neural tube defects


16-16		Optimum folic acid levels


16-16a		Folic acid consumption


16-16b		Median RBC folate levels

Prenatal Substance Exposure


16-17		Prenatal substance exposure


16-17a		Alcohol


16-17b		Binge drinking


16-17c		Cigarette smoking


16-17d		Illicit drugs


16-18		Fetal alcohol syndrome

Breastfeeding, Newborn Screening, and Service Systems


16-19		Breastfeeding


16-19a		Early postpartum


16-19b		At 6 months


16-19c		At 1 year


16-20		Newborn bloodspot screening


16-20a		Screening at birth


16-20b		Followup diagnostic testing


16-20c		Appropriate service interventions


16-21		Sepsis among children with sickle cell disease


16-22		Medical homes for children with special health care needs


16-23		Service systems for children with special health care needs

	States are required to report fetal deaths if they occur in the 20th week of pregnancy or later, or if they weigh at least 350 grams.3 The number of fetal deaths may be underreported in part because of variations in reporting requirements by States.
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-1b. Fetal and infant deaths during perinatal period (28 weeks of gestation to 7 days or more after birth).
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 1,000 live births plus fetal deaths.
Baseline	7.5 (1997).
Numerator	Number of fetal and infant deaths (from 28 weeks gestation to 7 days after birth).
Denominator	Number of live births plus fetal deaths (of at least 28 weeks gestation).
Targeted Population	U.S. resident live births plus fetal deaths (20 or more weeks gestation).
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	The number of fetal deaths may be underreported in part because of variations in reporting requirements by States.
	A description of the primary measurement used to determine the infant’s gestational age—the interval between the first day of the last normal menstrual period (LMP) and the birth—has been published by NCHS.1
	A description of the perinatal death measurement has been published by NCHS.3
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-1c. All infant deaths (within 1 year).
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	14.1 (Maternal and Infant Health).
Measure	Rate per 1,000 live births.
Baseline	7.2 (1998).
Numerator	Number of deaths to infants under age 1 year.
Denominator	Number of live births.
Targeted Population	U.S. resident live births.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	This objective uses a similar measurement protocol as the comparable Healthy People 2000 objective; however, all of the baseline data for this objective come from the period-linked birth and infant death data set (linked file).4 In the linked file, the information from the death certificate is linked to information on the birth certificate for each infant under 1 year who died during the calendar year. The purpose of linkage is to use the many variables and improve racial/ethnic reporting available from the birth certificate. The comparable Healthy People 2000 objective was tracked using the annual “unlinked” file5 for the total and black population, and the cohort (used from 1983–91) or period-(used since 1995) linked file for the American Indian/Alaska Native and Puerto Rican populations.2
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-1d. Neonatal deaths (within the first 28 days of life).
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	14.1d (Maternal and Infant Health).
Measure	Rate per 1,000 live births.
Baseline	4.8 (1998).
Numerator	Number of deaths infants aged under 28 days.
Denominator	Number of live births.
Targeted Population	U.S. resident live births.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 16-1c for more information.
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-1e. Postneonatal deaths (between 28 days and 1 year).
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	14.1g (Maternal and Infant Health).
Measure	Rate per 1,000 live births.
Baseline	2.4 (1998).
Numerator	Number of deaths to infants aged 28 days to 11 months.
Denominator	Number of live births.
Targeted Population	U.S. resident live births.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 16-1c for more information.
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-1f. All birth defects.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 1,000 live births.
Baseline	1.6 (1998).
Numerator	Number of infant (under age 1 year) deaths due to birth defects (ICD-9 codes 740-759).
Denominator	Number of live births.
Targeted Population	U.S. resident live births.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	All of the baseline data for this objective come from the period-linked birth and infant death data set (linked file).4 In the linked file, the information from the death certificate is linked to information on the birth certificate for each infant under 1 year who died during the calendar year. The purpose of linkage is to the use the many variables and improve racial/ethnic reporting available from the birth certificate.
	See Part C for a description of the NVSS and Appendix A for focus area contact information.

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16-1g. Congenital heart defects.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 1,000 live births.
Baseline	0.53 (1998).
Numerator	Number of infant (under age 1 year) deaths from congenital heart and vascular defects (ICD-9 codes 745-747).
Denominator	Number of live births.
Targeted Population	U.S. resident live births.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 16-1f for more information.
	ICD-9 codes 745-746 refer to congenital anomalies of the heart, and code 747 refers to other congenital anomalies of the circulatory system.
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-1h. Reduce deaths from sudden infant death syndrome (SIDS).
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 1,000 live births.
Baseline	0.72 (1998).
Numerator	Number of infant (under age 1 year) deaths from SIDS (ICD-9 code 798.0).
Denominator	Number of live births.
Targeted Population	U.S. resident live births.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 16-1f for more information.
	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-2.		Reduce the rate of child death.

16-2a. Children aged 1 to 4 years.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 100,000 population.
Baseline	34.6 (1998).
Numerator	Number of deaths among children aged 1 to 4 years.
Denominator	Number of children aged 1 to 4 years.
Targeted Population	U.S. resident population.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-2b. Children aged 5 to 9 years.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 100,000 population.
Baseline	17.7 (1998).
Numerator	Number of deaths among children aged 5 to 9 years.
Denominator	Number of children aged 5 to 9 years.
Targeted Population	U.S. resident population.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-3.		Reduce deaths of adolescents and young adults.

16-3a. Adolescents aged 10 to 14 years.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 100,000 population.
Baseline	22.1 (1998).
Numerator	Number of deaths among adolescents aged 10 to 14 years.
Denominator	Number of adolescents aged 10 to 14 years.
Targeted Population	U.S. resident population.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-3b. Adolescents aged 15 to 19 years.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 100,000 population.
Baseline	70.6 (1998).
Numerator	Number of deaths among adolescents aged 15 to 19 years.
Denominator	Number of adolescents aged 15 to 19 years.
Targeted Population	U.S. resident population.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-3c. Young adults aged 20 to 24 years.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	Not applicable.
Measure	Rate per 100,000 population.
Baseline	95.3 (1998).
Numerator	Number of deaths among young adults aged 20 to 24 years.
Denominator	Number of young adults aged 20 to 24 years.
Targeted Population	U.S. resident population.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Part C for a description of NVSS and Appendix A for focus area contact information.

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Maternal Deaths and Illnesses


16-4.		Reduce maternal deaths.

National Data Source

National Vital Statistics System (NVSS), CDC, NCHS.

State Data Source

National Vital Statistics System (NVSS), CDC, NCHS.

Healthy People 2000 Objective

14.3 (Maternal and Infant Health).

Measure

Ratio per 100,000 live births.

Baseline

7.1 (1998).

Numerator

Number of female deaths due to obstetric causes (ICD-9 codes 630 to 676) within 42 days of a pregnancy.

Denominator

Number of live births.

Targeted Population

U.S. resident population.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Annual.

Comments

Caution should be used when comparing these data with pregnancy-related mortality rates from other reports. NCHS uses the definition of maternal mortality and related coding conventions recommended in the ICD-9 by the World Health Organization. Other definitions may use different time intervals from pregnancy to death and may be more inclusive with regard to cause of death.

A description of the maternal mortality measurement has been published by NCHS.2

See Part C for a description of NVSS and Appendix A for focus area contact information.

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16-5.		Reduce maternal illness and complications due to pregnancy.

16-5a. Maternal complications during hospitalized labor and delivery.

16-1a. Fetal deaths at 20 or more weeks of gestation.
National Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
State Data Source	National Vital Statistics System (NVSS), CDC, NCHS.
Healthy People 2000 Objective	14.2 (Maternal and Infant Health).
Measure	Rate per 1,000 live births plus fetal deaths.
Baseline	6.8 (1997).
Numerator	Number of fetal deaths (20 or more weeks of gestation).
Denominator	Number of live births plus fetal deaths (20 or more weeks gestation).
Targeted Population	U.S. resident live births plus fetal deaths (20 or more weeks gestation).
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	A description of the primary measurement used to determine the infant’s gestational age—the interval between the first day of the last normal menstrual period (LMP) and the birth—has been published by NCHS.1
	This objective uses the same measurement protocol as the comparable Healthy People 2000 objective 14.2. A description of the fetal death measurement has been published by NCHS.2