Characteristics of Mothers Admitted to Intensive Care Units During Hospitalization for Delivery of a Live-born Infant: United States, 2020-2022.

Although admission of a mother to an intensive care unit (ICU) during hospitalization for delivery is a relatively rare event, rates of mortality and severe morbidity are high for both mother and child when ICU care is necessary (1-4). Studies on maternal ICU admissions have generally focused on medical diagnoses related to admission, and most have been conducted using international data or data for a hospital or group of hospitals (4-10). Information on demographic characteristics of mothers admitted to ICUs is lacking at the national level. This report describes ICU admissions overall and by race and Hispanic origin, maternal age, live birth order, and plurality for mothers delivering live-born infants in the United States in 2020-2022.

Homicides Among Infants in the United States,2017-2020.

Objectives-This report describes homicide rates among infants (under age 1 year) by selected maternal, pregnancy-related, and infant characteristics. Methods-Linked birth/infant death files based on data collected on U.S. birth and death certificates were used to calculate homicide rates among infants for the period 2017-2020. Results-A total of 1,067 homicides occurred among infants in the United States from 2017 through 2020, an average of 267 per year. More than one-half of all infant homicides occurred among infants aged 3 months and under. Homicide rates were higher among infants born to mothers who were young, had multiple previous live births, were Black non-Hispanic, were born in the United States, had lower levels of education, lived in rural areas, had no prenatal care, and delivered outside of a hospital. Rates were also higher for infants who were part of a multiple-gestation pregnancy, were born preterm or low birthweight, or were admitted to a neonatal intensive care unit.

Changes in Twin Births in the United States,2019-2021.

Objectives-This report describes changes in the number and rate of twin births from 2019 to 2021 by month and year of birth and age and race and Hispanic origin of the mother.

Standard Death Certificates Versus Enhanced Surveillance to Identify Heroin Overdose-Related Deaths.

OBJECTIVES: To compare 2 approaches to identifying heroin-related deaths in cases of overdose: standard death certificates and enhanced surveillance. METHODS: We reviewed Maryland death certificates from 2012 to 2015 in cases of overdose to determine specific mentions of heroin. Counts were compared with estimates obtained through an enhanced surveillance approach that included a protocol considering cause of death, toxicology, and scene investigation findings. RESULTS: Death certificates identified 1130 heroin-related deaths. Enhanced surveillance identified 2182 cases, nearly double the number found through the standard approach. The major factors supporting enhanced surveillance in identifying cases were the presence of morphine, either alone or in combination with quinine, and scene investigation information suggesting heroin use. CONCLUSIONS: Death certificates, the primary source of state and national data on overdose deaths, may underestimate the contribution of heroin to drug-related mortality. Enhanced surveillance efforts should be considered to allow a better understanding of the contribution of heroin to the overdose crisis. Public Health Implications. If enhanced surveillance can be incorporated into the death certificate process, national data on overdoses may better reflect the contribution of heroin to the opioid crisis.

Sharing Overdose Data Across State Agencies to Inform Public Health Strategies: A Case Study.

Data sharing and analysis are important components of coordinated and cost-effective public health strategies. However, legal and policy barriers have made data from different agencies difficult to share and analyze for policy development. To address a rise in overdose deaths, Maryland used an innovative and focused approach to bring together data on overdose decedents across multiple agencies. The effort was focused on developing discrete intervention points based on information yielded on decedents' lives, such as vulnerability upon release from incarceration. Key aspects of this approach included gubernatorial leadership, a unified commitment to data sharing across agencies with memoranda of understanding, and designation of a data management team. Preliminary results have yielded valuable insights and have helped inform policy. This process of navigating legal and privacy concerns in data sharing across multiple agencies may be applied to a variety of public health problems challenging health departments across the country.

Effectiveness of pregnancy check boxes on death certificates in identifying pregnancy-associated mortality.

OBJECTIVES: Information that would allow the identification of women who were pregnant at the time of death or within the year preceding death has historically been underreported on death certificates. As a result, the magnitude of the problem of pregnancy-associated mortality is underestimated. To improve the identification of these deaths, check boxes for reporting pregnancy status have been added to death certificates in a number of states. We used multiple external data sources to determine whether check boxes have been effective in identifying pregnancy-associated deaths. METHODS: We collected data on deaths occurring among pregnant or recently pregnant women residing in Maryland during the years 2001-2008 using multiple data sources. We determined the percentage of these deaths that could be identified through check boxes placed on death certificates. RESULTS: Overall, 64.5% of pregnancy-associated deaths were identified through pregnancy check boxes on death certificates, including 98.1% of maternal deaths-defined as deaths occurring during pregnancy or within 42 days of delivery from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes-and 46.7% of deaths from nonmaternal causes, such as homicide, suicide, accidents, and substance abuse. CONCLUSIONS: Check boxes on death certificates are effective in identifying pregnancy-associated deaths resulting from maternal causes. However, they are far less effective in identifying deaths resulting from nonmaternal causes, such as homicide, accidental death, and substance abuse, which represent three of the four leading causes of pregnancy-associated death in Maryland.

Intimate-partner homicide among pregnant and postpartum women.

OBJECTIVE: To identify pregnancy-associated homicide cases and to estimate the proportion that were perpetrated by a current or former intimate partner. METHODS: This was an analysis of pregnancy-associated homicides occurring from 1993 to 2008 among Maryland residents using linked birth and death certificates, medical examiner charts, police records, and news publications. RESULTS: Homicides (n=110) were the leading cause of death during pregnancy and the first postpartum year. Women who were African American, younger than 25 years, and unmarried were at the highest risk for homicide. Firearms were the most common (61.8%) method of death. A current or former intimate partner was the perpetrator in 54.5% (n=60) of homicide deaths and a nonpartner in 31.8% (n=35). If the cases (n=15) in which the victim-offender relationship could not be identified are excluded, 63.2% of homicides were committed by an intimate partner. Compared with homicides in which the perpetrator was not an intimate partner, a significantly higher percentage (P<.05) of intimate-partner homicides occurred at home (66.7% compared with 28.6%), among women who had completed more than 12 years of education (23.3% compared with 5.7%), and who were married (28.3% compared with 8.6%). Intimate-partner homicides were most prevalent (25.0%) during the first 3 months of pregnancy and least prevalent during the first 3 months postpartum (5.0%). CONCLUSION: The majority of pregnancy-associated homicides were committed by current or former intimate partners, most commonly during the first 3 months of pregnancy. Efforts to protect women from partners optimally should begin before conception or very early in pregnancy. LEVEL OF EVIDENCE: III.

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors.

BACKGROUND: This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy. STUDY DESIGN: Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors. RESULTS: Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression. CONCLUSION: Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.

Neonatal circumcision in Maryland: a comparison of hospital discharge and maternal postpartum survey data.

OBJECTIVE: To study circumcision rates in Maryland using hospital discharge and maternal survey data in order to provide healthcare providers, parents and policy makers with more accurate and comprehensive information about this common yet controversial procedure. METHODS: Secondary data analyses were performed using Maryland hospital discharge data files containing records of 96,457 male newborns, and postpartum survey data collected from 4273 mothers through the Maryland Pregnancy Risk Assessment Monitoring System. RESULTS: Hospital discharge data showed that 75.3% of male infants were circumcised, and survey data showed that 82.3% of male infants were circumcised. The circumcision rate among infants weighing <1500 g at birth was 38.9% using hospital discharge data and 74.5% using maternal survey data. Both sources revealed lower circumcision rates among Asian and Hispanic infants than among non-Hispanic white and non-Hispanic black infants. CONCLUSIONS: Despite reports of decreasing circumcision rates nationally, rates remain high in Maryland. In addition to providing for the inclusion of circumcision procedures that may not have been coded properly in hospital discharge records and procedures that were performed after hospital discharge, maternal survey data provide more comprehensive information than hospital discharge data about parental characteristics and factors relevant to the circumcision decision-making process.

Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality.

OBJECTIVES: I studied the extent to which maternal deaths are underreported on death certificates. METHODS: We collected data on maternal deaths from death certificates, linkage of death certificates with birth and fetal death records, and review of medical examiner records. RESULTS: Thirty-eight percent of maternal deaths were unreported on death certificates. Half or more deaths were unreported for women who were undelivered at the time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder. CONCLUSIONS: The number of maternal deaths is substantially underestimated when death certificates alone are used to identify deaths, and it is unlikely that the Healthy People 2010 objective of reducing the maternal mortality rate to no more than 3.3 deaths per 100000 live births by 2010 can be achieved. Increasing numbers of births to older women and multiple-gestation pregnancies are likely to complicate efforts to reduce maternal mortality.