MICH-10.1 Increase the proportion of pregnant women who receive prenatal care beginning in the first trimester
About the Data
Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.
Number of births to females receiving prenatal care in the first trimester (three months) of pregnancy
Number of live births
The National Center for Health Statistics transitioned to a new birth certificate in 2003 that was not completely implemented until 2016. The old certificates collected information on the numerical month of pregnancy that care began the new certificates collect the exact date of the first prenatal visit. This resulted in a discontinuity in information on prenatal care. Also, the method of calculating the length of pregnancy has changed from the date of the last normal menses to the obstetric estimate of gestation at delivery (OE).
Information on prenatal care (PNC) has been included on the U.S. Standard Certificate of Live Birth since the 1968 revision to help explore the relationship between PNC and pregnancy outcomes. The items “Month of pregnancy prenatal care began” and “Total number of prenatal visits” were included until the most recent 2003 revision. For the 2003 revision, the month PNC began item was replaced with the “Date of first prenatal care visit (month, day, year).” The change from the numerical month of pregnancy that care began to the exact date of the first prenatal visit resulted in a discontinuity in information on PNC (i.e., PNC timing based on the date of the first prenatal visit was not comparable with timing based on the month care began. Further, implementation of the 2003 revision was delayed across the country, resulting in a lack of national data on PNC until all vital statistics jurisdictions implemented the new standard in 2016.
The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) has measured vital statistics gestational age data based primarily on the difference between the date of the last normal menses (LMP) and the date of infant’s birth since national LMP data first became available in 1981. However, the quality of LMP-based data has long been of concern. Imperfect maternal recall, misinterpretation of bleeding early in pregnancy, irregular menstrual cycles, and data entry errors have been shown to result in the misclassification of gestational age, particularly at preterm (under 37 completed weeks) and postterm (42 weeks and over).
An alternative measure of gestational age, the clinical estimate (CE), was added to the 1989 U.S. Standard Certificate of Live Birth. Detailed definitions and instructions for the new measure were not developed or released, however. Concerns with data quality and the lack of national reporting (California did not report the CE) precluded the estimate from being used as a national measure of gestational age. The CE was replaced with the similar item, the ‘‘obstetric estimate of gestation at delivery’’ (OE) with the 2003 birth certificate revision. More detailed definitions and instructions were developed and distributed for the OE, which in brief is defined as ‘‘the best estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’. Despite differences in definitions and instructions, data for the CE and OE appear comparable and are combined in natality public-use files. National data for a combined OE-CE item did not become available until the 2007 data year, however.
Compared with LMP-based estimates, recent studies suggest higher consistency between OE-CE-based estimates and birthweight and better agreement between the OE-CE-based estimates and estimates of gestational age based on an early ultrasound (considered the gold standard). Agreement was also closer between the OE-CE estimates and gestational ages for births conceived using assisted reproductive technology, for which dates of conception were well documented. Studies also indicate high to moderate agreement between OE reporting on the birth certificate and information on best estimates of gestational age and estimated delivery dates on hospital medical records.
Increasing evidence of the greater validity of OE-based data compared with LMP-based data, and the national availability of OE data, have prompted NCHS to transition to the use of the OE as its standard, primary measure of gestational age.
Data for the obstetric estimate measure are based primarily on the 2003 U.S. Standard Certificate of Live Birth item ‘‘Obstetric estimate of gestation.’’ The obstetric estimate of gestation is defined as ‘‘the best obstetric estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’.
Data for the remaining states are based on the 1989 revision of the U.S. Standard Certificate of Live Birth item ‘‘Clinical estimate of gestation.’’ The instructions to hospitals for the 1989 revision simply state that the birth attendant should provide a clinical estimate of gestation not based on the date of LMP and the date of birth. Despite differences in terminology and instructions, studies and NCHS’ own internal review of CE and OE data for the study period (available upon request; e-mail email@example.com) suggest that estimates based on the obstetric estimate and the clinical estimate of gestation are comparable. Accordingly, data for these two measures are combined for and are referred to as the OE.
The following report outlines how gestational age is measured in vital statistics data using LMP and the transition to the OE.
Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.
Additional resources about the objective
- Osterman MJK, Martin JA, Menacker F. Expanded health data from the new birth certificate, 2006. National vital statistics reports; vol 58 no 5. Hyattsville, MD: National Center for Health Statistics. 2009.