Office of the State Registrar

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Office of the State Registrar

• Problems in Birth Registration
• Joanne M. Wesley

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Data

• Currently there are 14 data items that are a
  problem
• The National Center for Health Statistics
  requires all states to have a reporting
  percentage below a set standard.
• Minnesota has a problem and you are the solution.

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Understanding

• The importance of why certain fields of
  information are essential may help reduce the
  number of unknown as the answer.

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1. Education of Mother and Father

• Used to
• Track trends in completed family size
• Track fertility rates by age group
• Maternal child health outcomes by age

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2. Date of Last Menses

• Used to
• Track gestational age
• Accurate dating of pregnancy tracks preterm
  birth, term birth and post date birth
• Gestational age is a key factor in infant
  outcomes.

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Prenatal Care

• 3. Month prenatal care began
• Tracks when prenatal care is being is being
  accessed
• Data allows health care providers to improve
  early care

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Prenatal Care

• 4. Number of prenatal visits
• Tracks how well care is being accessed
• Tracks how well care is being delivered
• Does not address quality of care issues

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5. Tobacco Use

• Is an obvious risk factor in pregnancy
• Increased tobacco use rates are found with
  certain age groups and ethnic races of mothers

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6. Average Number of Cigarettes

• Smoking may change during pregnancy
• (2010 worksheet will capture information
  with new question format)
• Adverse effects on infant outcomes
• Low birth weight
• Intrauterine growth retardation
• Miscarriage
• Higher infant mortality
• Negative consequences on the childs long term
  health and development

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7. Alcohol Use

• Alerts Healthcare Providers to potential adverse
  outcomes at birth and beyond

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8. Average Number of Drinks

• Gives information that will allow for education
• May allow for early intervention and screening
  for the infant for fetal alcohol spectrum disorder

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9. Mothers Weight Gain

• Insufficient (40 lbs)
  weight gain can negatively affect both maternal
  and infant outcomes
• Excessive weight gain may contribute to
• Gestational diabetes - Large for gestational age
  infant
• Preeclampsia, Pregnancy Associated Hypertension
• Labor dystocia, cesarean birth
• Shortened breastfeeding duration
• Long term maternal weight retention
• Insufficient weight gain may contribute to
• Intrauterine growth retardation
• Shortened gestation low birth weight
• Preterm labor and perinatal morbidity
• 2010 worksheet will track height weight to
  calculate Body Mass Index

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10. Medical Risk Factors

• All risk factors have the potential for adverse
  outcomes for both mother
• and baby. Documenting risk factors may allow for
  public health
• intervention with education and additional care.
• Gestational diabetes
• has risen dramatically in the last 15 years
• Women with gestational diabetes are at greater
  risk for developing diabetes later in life
• Pregnancy associated or induced hypertension
• greatest in both the youngest and oldest mothers
• Chronic hypertension
• more common in older mothers

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11. Obstetric Procedures

• Rate of induction
• Has double in the last 15 years
• Can shift the timing of birth toward an earlier
  gestational age which puts babies at risk
• Cesarean Birth
• Rose to its highest ever rate in 2005
• May result from failed induction
• Decline in trial of labor for VBAC
• Increase across all age, race and ethnic groups

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12. Complication of Labor

• Precipitous Labor
• More common in older mothers
• Breech and malpresentation
• Rate increase with maternal age
• Meconium Staining
• More common in younger mothers
• More common in non-Hispanic black mothers had
  highest rate, non-Hispanic white mother had
  lowest rate

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13. Congenital Anomalies

• Remain the leading cause of infant death
• Are under reported on the birth record
• Anomalies such as cleft lip/palate and club-foot
  are associated with maternal smoking
• Data collection over many years showed a much
  higher rate of Down Syndrome with advanced
  maternal age

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14. Abnormal Conditions

• Birth injury should be reported to track
  incidence and referral for intervention
• Assisted ventilation should be reported to
  track incidence and outcome
• Seizures more common in vacuum assisted births
• Other infection neonatal sepsis tracking is
  key to identify sepsis and respond with
  appropriate treatment

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Public Health Implications

• More accurate and comprehensive reporting on the
  birth record will enhance our ability to analyze
  and track crucial indicators of maternal and
  child health, including demographic
  characteristics, health care utilization, and
  outcomes.

• Teen childbearing
• Nonmarital childbearing
• Preterm birth
• Low birthweight
• Cesarean delivery

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• Minnesota
• has a problem
• and
• You are the solution!

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• Vitality
• shows in not only
• the ability to persist, but the ability
• to start over.
• F Scott Fitzgerald