Births/Maternity
Improving the well-being of mothers, infants, and children is an important public health goal for the United States. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. The objective of the Maternal, Infant, and Child Health topic area is to address a wide range of conditions, health behaviors, and health systems indicators that affect the health, wellness, and quality of life of women, children, and families.
Pregnancy provides an opportunity to identify existing health risks in women and to prevent
future health problems for women and their children. These health risks may include:
The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and interconception (between pregnancies) care. Additionally, healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential.
- Hypertension and heart disease
- Diabetes
- Depression
- Genetic conditions
- Sexually transmitted infections (STIs)
- Tobacco use and alcohol abuse
- Inadequate nutrition
- Unhealthy weight
- Intimate partner violence
The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and interconception (between pregnancies) care. Additionally, healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential.
Conditions in the places where people live, learn, work, and play affect a wide range of health
risks and outcomes. Environmental and social factors influence maternal health behaviors and
health status. These factors include access to health care and subsequent developmental
screening/early intervention services, education, employment, economic opportunities, social
support, and availability of resources to meet daily needs.
The factors that influence maternal health also affect pregnancy outcomes and infant and child health. Racial and ethnic disparities exist in maternal, infant and child mortality and can be partly attributed to disparities in social determinants of health. Children's health status varies by both race and ethnicity, as well as by family income and related factors, including educational attainment among household members and health insurance coverage. Other factors related to child health status include access to high-quality health care and medical home as well as maternity care practices that promote breastfeeding and safe sleep environments.
The cognitive and physical development of infants and children are influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Consumption of recommended amounts of folic acid before and during pregnancy reduce the risk for neural tube defects. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development. Also, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other adverse childhood experiences, are more likely to have better outcomes as adults.
The factors that influence maternal health also affect pregnancy outcomes and infant and child health. Racial and ethnic disparities exist in maternal, infant and child mortality and can be partly attributed to disparities in social determinants of health. Children's health status varies by both race and ethnicity, as well as by family income and related factors, including educational attainment among household members and health insurance coverage. Other factors related to child health status include access to high-quality health care and medical home as well as maternity care practices that promote breastfeeding and safe sleep environments.
The cognitive and physical development of infants and children are influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Consumption of recommended amounts of folic acid before and during pregnancy reduce the risk for neural tube defects. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development. Also, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other adverse childhood experiences, are more likely to have better outcomes as adults.
Many factors affect pregnancy and childbirth, including:
Infant and child health are similarly influenced by sociodemographic factors, such as family income, but are also linked to the physical and mental health of parents and caregivers.
There are racial and ethnic disparities in mortality and morbidity for mothers and children. These differences are likely the result of many factors.
Social Determinants of Maternal Health
These include pre-pregnancy health behaviors and health status, which are influenced by a variety of environmental and social factors such as access to health care and chronic stress.
Physical Determinants of Maternal Health
Common barriers to a healthy pregnancy and birth include lack of access to appropriate health care before and during pregnancy. In addition, environmental factors can shape a woman's overall health status before, during, and after pregnancy by:
Social Determinants of Infant and Child Health
The social determinants that influence maternal health also affect pregnancy outcomes and infant health. Racial and ethnic disparities in infant mortality exist, particularly for African American infants. Child health status varies by both race and ethnicity, as well as by family income and related factors, including educational attainment among household members and health insurance coverage.
Physical Determinants of Infant and Child Health
The cognitive and physical development of infants and children is influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development. Also, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other social adversities, are more likely to have better outcomes as adults.
Emerging Issues in Maternal, Infant, and Child Health
Recent efforts to address persistent disparities in maternal, infant, and child health use a "life course" perspective to health promotion and disease prevention. Fewer than half of all pregnancies are planned. Unintended pregnancy is associated with a host of public health concerns. In response, preconception health initiatives focus on improving the health of a woman before she becomes pregnant through a variety of evidence-based interventions.
The life course perspective also supports the examination of quality of life, including the challenges of male and female fertility. An estimated 7.3 million American women ages 15 to 44 received infertility services (including counseling and diagnosis) in their lifetime. Infertility is an area where health disparities are large and may only continue to increase as childbearing practices change over time.
- Preconception health status
- Maternal age
- Access to appropriate preconception and interconception health care
- Poverty
Infant and child health are similarly influenced by sociodemographic factors, such as family income, but are also linked to the physical and mental health of parents and caregivers.
There are racial and ethnic disparities in mortality and morbidity for mothers and children. These differences are likely the result of many factors.
Social Determinants of Maternal Health
These include pre-pregnancy health behaviors and health status, which are influenced by a variety of environmental and social factors such as access to health care and chronic stress.
Physical Determinants of Maternal Health
Common barriers to a healthy pregnancy and birth include lack of access to appropriate health care before and during pregnancy. In addition, environmental factors can shape a woman's overall health status before, during, and after pregnancy by:
- Affecting her health directly
- Affecting her ability to engage in healthy behaviors
Social Determinants of Infant and Child Health
The social determinants that influence maternal health also affect pregnancy outcomes and infant health. Racial and ethnic disparities in infant mortality exist, particularly for African American infants. Child health status varies by both race and ethnicity, as well as by family income and related factors, including educational attainment among household members and health insurance coverage.
Physical Determinants of Infant and Child Health
The cognitive and physical development of infants and children is influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development. Also, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other social adversities, are more likely to have better outcomes as adults.
Emerging Issues in Maternal, Infant, and Child Health
Recent efforts to address persistent disparities in maternal, infant, and child health use a "life course" perspective to health promotion and disease prevention. Fewer than half of all pregnancies are planned. Unintended pregnancy is associated with a host of public health concerns. In response, preconception health initiatives focus on improving the health of a woman before she becomes pregnant through a variety of evidence-based interventions.
The life course perspective also supports the examination of quality of life, including the challenges of male and female fertility. An estimated 7.3 million American women ages 15 to 44 received infertility services (including counseling and diagnosis) in their lifetime. Infertility is an area where health disparities are large and may only continue to increase as childbearing practices change over time.
The risk of maternal and infant mortality and pregnancy-related complications can be reduced by
increasing access to quality care preconception (before pregnancy), during pregnancy, after the
baby arrives, and interconception (between pregnancies).
- Preconception health care is the medical care a woman or man receives from their doctor or other health professionals that focuses on aspects of health shown to increase the chance of having a healthy baby. Preconception health care is different for every person, depending on his or her unique needs. Based on a person's individual health, the doctor or other health care professional will suggest a course of treatment or follow-up care as needed.
- During pregnancy-women need regular prenatal care to monitor their health and the growth and development of the fetus. Health care providers can provide needed vaccinations, order blood tests, monitor blood pressure and blood sugar to check for gestational diabetes, screen for HIV and other services to assure optimal health for mother and baby. Mothers can support their pregnancies by taking folic acid, eating a healthy diet, getting enough exercise, controlling their weight gain, avoiding exposure to certain chemicals and radiation, and abstaining from tobacco, alcohol and other drugs.
- After the baby arrives-mothers and babies need continued medical care to screen for and manage postpartum conditions in both mother and child. These can include newborn screening for treatable diseases, jaundice, hearing loss, vaccinations and care for postpartum depression. Practices such as breastfeeding, sleep positioning, and use of child safety seats are just some of the important ways parents can safeguard their baby's health.
Maternal and Child Health is tracked at the national and state levels primarily through:
- National Survey of Children's Health (NSCH)
- Behavioral Risk Factor and Surveillance System (BRFSS)
- Pregnancy Risk Assessment and Monitoring System (PRAMS)
- Birth certificates
- Death certificates
Hawai'i IBIS Health Indicator Reports
Hawai'i Health Matters Indicator Dashboards
Births
Deaths
Pregnancy Risk Assessment Monitoring System (PRAMS) - Health Insurance Coverage
- Insurance prior to pregnancy (Medicaid/QUEST)
- Payment mechanism for PNC
- Payment mechanism for delivery
- Oral health - dental insurance during pregnancy
Pregnancy Risk Assessment Monitoring System (PRAMS) - Before Pregnancy
- Cigarettes - smoked 3 months before pregnancy
- Cigarettes - avg smkd per day before pregnancy
- Alcohol - drank 3 months before pregnancy
- Alcohol - binge drinking 3 months before pregnancy
- Illicit drugs - used 1 month before pregnancy
- Discussed preconception health with HCW before pregnancy
- Multivitamins/folic acid - during the month before pregnancy
- Oral health - teeth cleaned in 12 months before pregnancy
- BMI - status before pregnancy
- Chronic disease - asthma before pregnancy
- Chronic disease - depression before pregnancy
- Chronic disease - diabetes before pregnancy
- Chronic disease - high blood pressure before pregnancy
- Chronic disease - thyroid problems before pregnancy
- Number of previous live births
- Physical abuse - by husb/ptnr 12 mos before preg (2009+)
- Intention - intended pregnancy (2012+)
- Intention - pregnancy intention (2012+)
- No contraception at conception - didn't mind getting pregnant
- No contraception at conception - thought couldn't get pregnant
- No contraception at conception - side effects
- No contraception at conception - problems getting it
- No contraception at conception - thought she or partner was sterile
- No contraception at conception - husband/partner didn't want to
Pregnancy Risk Assessment Monitoring System (PRAMS) - During Pregnancy
- Cigarettes - smoked last 3 months of pregnancy
- Cigarettes - avg smkd per day last 3 months of pregnancy
- Cigarettes - advised to quit smoking by HCW during PNC, among smokers
- Cigarettes - quit smoking during pregnancy
- Alcohol - drank last 3 months of pregnancy
- Illicit drugs - used during pregnancy
- Oral health - talked with HCW about care during pregnancy
- Oral health - teeth cleaned during pregnancy
- Oral health - needed a dentist during pregnancy
- Oral health - dental visit for problem during pregnancy
- Flu shot - offered by HCW in the 12 months b/f delivery
- Flu shot - received in the 12 months b/f delivery
- HIV test during pregnancy
- BMI - gained recommended amount of weight during pregnancy
- Gestational diabetes
- Physical abuse - by husb/ptnr during pregnancy (2009+)
- Experienced 2 or more stressors during pregnancy
- WIC - participation during pregnancy
- PNC - received early and adequate prenatal care
- PNC - trimester of first visit
- PNC - received as early as wanted
- PNC - attended childbirth class
- PNC - discussed breastfeeding with HCW
- PNC - discussed effects of smoking with HCW
- PNC - discussed seat belt use with HCW
- PNC - discussed HIV testing with HCW
- PNC - discussed physical abuse with HCW
Pregnancy Risk Assessment Monitoring System (PRAMS) - After Pregnancy
- Breastfeeding - initiation
- Breastfeeding - still
- Breastfeeding - (exclusive) duration (grouped)
- Breastfeeding - (exclusive) duration 8+ weeks
- Breastfeeding - (any) duration (grouped)
- Breastfeeding - (any) duration 8+ weeks
- Breastfeeding - liquid supplement 1st week
- Post-partum - depression (2012+)
- Post-partum - health checkup
- Contraception - used after pregnancy
- Contraception after pregnancy - tubal ligation or vasectomy
- Contraception after pregnancy - used IUDs or implants
- Contraception after pregnancy - used pills, shots, rings or patches
- Contraception after pregnancy - used condoms
- Contraception after pregnancy - natural planning or withdrawal
- Contraception after pregnancy - abstinence
- Cigarettes - relapsed after pregnancy, amg quitters
- Cigarettes - smoking 3-6 months after pregnancy
- Cigarettes - avg smkd per day after pregnancy
Pregnancy Risk Assessment Monitoring System (PRAMS) - Infant
- Hawai'i Maternal and Child Health Branch
- CDC - Pregnancy webpage
- NIH - Eunice Kennedy Shriver National Institute of Child Health and Human Development
- NIH - National Child and Maternal Health Education Program
- Healthy Mothers Healthy Babies Coalition of Hawai'i
- The National Survey of Children's Health
- Maternal and Child Health Bureau
- Association of Maternal and Child Health Programs