One in six births to Cuyahoga County mothers in 2006 were premature

A recent report presenting infant and maternal health indicators taken from birth certificates for 2006 showed that 17% (1 in 6) county and 20% (1 in 5) Cleveland births were premature, born less than 37 weeks of gestational age. Three tables with data on premature births, birthweight, births to teens, and maternal smoking are presented for Cleveland neighborhood and Cuyahoga County municipalities.

Image: ninr.nih.gov

Child and maternal health data from 2006 birth certificates were analyzed by the Cleveland Department of Public Health to report on the following health indicators:

 - total births

 - prenatal care started in the first trimester (as percent of total births)

 - no prenatal care (percent)

 - adequacy of prenatal care (Kotelchuck method that uses the a) month prenatal care began, b) sex-specific gestational age and c) and number of prenatal visits based on the observed and expected number based on  (a) and (b))

 - maternal smoking during pregnancy

 - births to teens age at the time of birth: 10-14, 15-17, 18-19 years

 - birth weight (very low: 500-1,499g or 17.6 oz. to 3.3 lbs.), (low: 1,500g-2,500g, or 3 lbs. 5 oz. to 5 lbs. 8 oz.), (heavy: >4,000g, or 8 lbs. 8 oz.)  

Each indicator is reported by Cleveland neighborhood (statistical planning areas) and Cuyahoga County municipality 

Access these tables by clicking this link.

Each indicator provides different insights to the general health of mothers before and during pregnancy. As more evidence shows that the health and behaviors of mothers have significant impacts on the in utero development and health of their infants, public health officials are concerned that citizens are made aware of the trends within their neighborhoods. This report responds to this need.

Note of caution

When reading these tables, please pay attention to the column with the total births per area. Making conclusions from results where there were less than 20 births is not recommended.

Results

In 2006, there were 16,409 live births in Cuyahoga County with 6,712 births to Cleveland residents.

Premature births and birth weight

A premature birth is classified as a live birth born before 37 weeks gestational age. 17%, or 1 in 6, births to Cuyahoga County mothers, and 20% (1 in 5) births to Cleveland mothers, were premature.

Prematurity is a leading cause of death among infants. Babies born premature generally are of low birth weight (<2,500g) and can have respiratory and neurological development problems at and after birth. These problems may continue through childhood, including a higher risk of asthma, learning and language difficulties. Expectant mothers are encouraged to work with their physician or midwife to complete at least 38 weeks of gestation before birth. However, premature births occur in many women for no apparent reason. The March of Dimes has more information on preconception, prenatal and pregnancy care for mothers and fathers.

Heavy birth weight babies (>4,000g, or over 8 lbs. 8 oz.) may be associated with pregnancy-related diabetes. These infants pose a risk to the mother based on their size. A large, national study of nurses from 1972 through 2002 published in the British Medical Journal showed that heavy birthweight infants have a higher risk of developing rhematoid arthritis, diabetes, coronary heart disease and high blood pressure. (Linked here.)

Prenatal care and adequacy of prenatal care

On birth certificates, mothers are asked about the month when prenatal care was started. Since the most critical periods of fetal development begin as early as five weeks after conception (i.e. development of the brain and central nervous system) to the 11th week (external sex genitalia determination and ear formation), early entry into prenatal care is critical. However, many women begin prenatal care well after the 11th week after conception.

Women who do not have prenatal care place their babies and themselves at risk of illness, disability and even death.

Local results show that  54.7% of live births for Cuyahoga County mothers (by residence) began prenatal care in the first trimester (45.1% for Cleveland mothers.) In 2006 and thereafter, the Ohio Department of Health began using a different equation to measure the month that prenatal care began. This method was more accurate than previously used, resulting in a large decrease in this measure compared to previous years. Comparisons to earlier years' levels of prenatal care should not be made.

Just more than half (56.2%) of Cleveland mothers that had live births had an adequate number of prenatal care visits compared to 64.7% of Cuyahoga County mothers. This may reflect differences in access to care and in recognition of the need for prenatal care.

Prenatal care and local mothers

Local mothers need to make a greater effort to begin prenatal care. If mothers do not have a medical home, there are womens health clinics, such as those at the J. Glen Smith Health Center (11100 St Clair Ave.) and Thomas McCafferty Health Center (4545 Lorain Ave.) where mothers can begin prenatal care at very low cost.  Newly pregnant women, and those intending to become pregnant, should contact their local clinics, including NEON, Planned Parenthood, Neighborhood Family Practice, Care Alliance or MetroHealth Medical Center to see if they qualify for care.  Contact information for each of these centers is available at this link.

Maternal smoking

Increases in cigarette taxes has made a big impact on the overall percentage of Ohioans who smoke. Smoking among mothers in the county has been decreasing steadily in the past five years, in part, due to these cost increases and to better public education on the hazards of tobacco use.

Nearly 1 in 4 Cleveland mothers and 1 in 5 Cuyahoga County mothers smoked during pregnancy. Smoking increases the risk of premature birth, low weight babies, respiratory problems at birth and though childhood including later development of asthma among children.

Births to teens

Decreasing census, the wide availability of birth control and greater awareness of the burden of an early pregnancy has helped to decrease the overall number of births to teens for Cleveland and Cuyahoga County. Nationally, birth rates to teens are decreasing.

However, there are still parts of the city and county (Glenville, S. Broadway, Mt. Pleasant, East Cleveland) where there were at least 3 births to mothers age 10 to 14 in 2006.

Access to these tables are available at this link.

Data source

Birth certificate information was provided by the Ohio Department of Health. A collaborative effort by four local academic and public health agencies was made to more accurately locate each maternal residence to the appropriate census tract, neighborhood and municipality. Greater accuracy gives each agency more confidence in using birth data, and citizens more confidence in seeing consistent data across local agencies. These collaborating agencies are Case Western Reserve University Mandel School of Social Sciences and the Department of Epidemiology and Biostatistics, Cleveland State Northern Ohio Data Information Service (NODIS), Cuyahoga County Board of Health and the Cleveland Department of Public Health. CWRU, CCBH and CDPH are partners of this website.