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More Women Receiving Prenatal Care

But premature births, caesarean deliveries also up, U.S. report finds

WEDNESDAY, Dec. 18, 2002 (HealthDayNews) -- The share of American women who received prenatal care in the first three months of pregnancy rose 7 percent between 1991 and 2001, to 83 percent, according to new government figures released today.

But premature births were also up, dramatically, to their highest level in 20 years. And Caesarean deliveries reached an all-time high last year, the Centers for Disease Control and Prevention (CDC) report on maternal and infant health found.

On the plus side, the report also found that only 1 percent of American mothers-to-be last year reported getting no prenatal care at all during pregnancy -- half as many as in 1990. Blacks and Hispanics, who historically haven't received prenatal care as frequently as whites, showed particularly strong gains, the report found.

Still, about a quarter of minority women aren't getting timely prenatal checkups, said Joyce Martin, a statistician with the National Center for Health Statistics, a division of the CDC and lead author of the report. Prenatal care is important for monitoring the health of both mother and fetus, and can catch conditions like diabetes or high blood pressure that might threaten the lives of both.

"It's very important that all women have timely, competent care," Martin said. "You don't want a woman starting prenatal care in her seventh or eighth month of pregnancy, when it's too late to control problems like diabetes or hypertension."

Health officials were enthusiastic about the prenatal findings in the report, which was based on birth certificates filed in state vital statistics offices and reported to CDC.

"We're continuing to make excellent progress in our efforts to have more women, particularly minority women, receive early prenatal care," Secretary of Health and Human Services Tommy Thompson said in a statement today. "Timely prenatal care is one of the best ways to ensure the health of mothers and their infants, and we will continue working to expand access to this essential care for all Americans."

Another encouraging sign: The number of women who smoked during pregnancy fell to 12 percent in 2001, a drop of 38 percent from 1989. Exposure to tobacco in the womb significantly raises a baby's chances of being born underweight. Slight infants face higher risks of developmental delays.

But not all the news in the report was good. Premature births have hit their highest level in two decades, making up roughly 12 percent of the 4,025,933 newborns in 2001. Premature babies -- those born earlier than 37 weeks of gestation -- are often underweight. Not surprisingly, the incidence of low birth weight infants -- defined as weighing less than about 5.5 pounds -- rose to 7.7 percent of deliveries, up more than 13 percent since the mid-1980s.

Experts attributed some of the rise in prematurity and low birth weight to an increase in induced labor, which is now twice as common as it was in 1989 and makes up a fifth of all deliveries. Some probably is also due to a surge in multiple pregnancies, like twins and triplets, that has accompanied greater use of fertility-enhancing therapies and assisted reproduction.

The nation's twin birth rate topped 3 percent of all deliveries in 2001 for the first time, and the number of triplets and "higher-order multiples" climbed 3 percent between 2000 and 2001.

Caesarean section surgery accounted for about 24 percent of deliveries last year, up 5 percent from the year before and an all-time high, officials said. Similarly, the rate of vaginal delivery after a previous C-section plummeted 20 percent during the period. Caesarean section procedures aren't risky for infants, but like any operation, they can pose a threat to the health of the mother.

The reasons for the recent surge in C-section deliveries aren't fully understood, Martin said. Some of the increase probably reflects factors like maternal choice and physician habits.

The country's birth rate fell slightly between 2000 and 2001, from 14.7 per 1,000 people to 14.5 per 1,000. Births to single women constituted roughly a third of all deliveries last year, or 1.3 million children, the report found. Although that was a record high, the rate of births to unwed mothers fell fractionally.

Teen births fell to an all-time low of 45.8 per 1,000 girls age 15 to 19 in 2001, off 26 percent since 1991, officials said. Among black girls, the decline has been even sharper, with births tumbling 46 percent during the period.

What To Do

For more on the report, try the CDC's National Center for Health Statistics. To learn more about child health, go to the National Institute of Child Health and Human Development.

SOURCES: Joyce Martin, M.P.H., statistician, National Center for Health Statistics, Hyattsville, Md.; Dec. 18, 2002, Health and Human Services report, "Births: Final Data for 2001"; Dec. 18, 2002, statement, HHS Secretary Tommy Thompson
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