U.S. DEPARTMENT OF' HEALTH
AND HUMAN SERVICES

Drawing data from the expanded birth certificate first used in 1989, the National Center for Health Statistics today reported that pregnant women who smoked cigarettes were nearly twice as likely to have infants of low birth weight -- the single most important predictor of infant deaths.

In 1989, 20 percent of mothers smoked during pregnancy, according to the NCHS report, the first to analyze data from the new certificates. Most at risk were older mothers and those who smoked the most: Women who smoked 1.5 to two packs of cigarettes per day were about one-third more likely to have a low-birthweight infant than those who smoked half a pack -- and 2.5 times as likely as nonsmokers.

In releasing the report today, HHS Secretary Louis W. Sullivan, M.D., said, "Our efforts to improve the health of mothers and babies just took a big leap forward. For the first time, we have information on maternal medical and life-style risk factors for the more than 4 million births annually in the United States. We can identify mothers at risk and practices that put them in harm's way."

Also at risk to have low-birth-weight infants were the more than one in five mothers who gained less than 22 to 27 pounds, the weight gain recommendation in effect in 1989. Their infants were two to four times as likely to be low birth weight.

Low birth weight was also associated with complications during labor and delivery and abnormal conditions in the newborn such as respiratory distress syndrome, a leading cause of infant deaths.

James Mason, M.D., assistant secretary for health and head of the Public Health Service, said, "This analysis of the smoking risk, as well as other facts and figures still to come, will help as we carry out our Healthy Start programs in high-infant mortality areas-" Mason has been visiting communities to work with them as they develop new efforts to combat infant mortality.

"The findings show conclusively that teen-age parenting can be a hazard to the mother and to her child," according to William Roper, M.D., director of the Centers for Disease Control. "Teenage mothers are more likely to have such conditions as anemia and hypertension during their pregnancies, less likely to receive prenatal care and less likely to gain the recommended weight during their pregnancies.

"And most importantly," he said, "teen-age mothers 18 and 19 years of age have the highest smoking rates of any age group -almost one-fourth are smokers." Young teens -- those under 15 -however, had the lowest rate of cigarette smoking.

overall, black mothers were less likely to smoke than their white counterparts (17 percent compared to 20 percent), and those who did smoke, smoked fewer cigarettes. The rate of cigarette smoking was also relatively low, at 8 percent, among Hispanic mothers.

Education affects tobacco use. The proportion of smokers generally declined with advanced educational attainment: The highest rate was 35 percent for women with less than high school education, and the lowest was for college graduates, 5 percent.

Eighteen percent of women whose pregnancies lasted 40 weeks or longer gained less than 21 pounds, according to Stephanie Ventura, a senior natality analyst at NCHS who wrote the report. Black mothers were almost 60 percent more likely than white mothers to gain less than 21 pounds and were 86 percent more likely to gain less than 16 pounds. Even after controlling for age, marital status or educational attainment, which also affect weight gain, large racial differences still persist, she reported.

The new certificate has expanded reporting of risk factors, and also of obstetric procedures performed, methods of delivery, abnormal conditions and congenital anomalies of the infant. Electronic fetal monitoring to record the infant's heart beat and the mother's uterine contraction was reported for more than two-thirds of all births -- more than any other procedure. ' Ultrasound had been performed for almost half of the births in 1989.

Cesarean section was the method of delivery for 22.8 percent of all births in 1989. The primary cesarean rate was 16.1 percent for births to women with no previous cesarean delivery. More than one-third of the 1989 cesarean deliveries were repeat procedures. Among women giving birth who had a previous cesarean delivery, 19 percent had a vaginal delivery in the 1989 pregnancy.

Cesarean delivery rates increased directly as mothers get older, rising from 17 percent for teen-age mothers to nearly one-third of deliveries for women in their forties. certain medical conditions -- diabetes, genital herpes, hypertension and uterine bleeding -- made a cesarean more likely.

Data in this report are based on 100 percent of the birth certificates in all states and the District of Columbia. The vast majority of states report on all items on the birth record. Data are provided to the National Center for Health Statistics through the Vital Statistics Cooperative Program. NCHS is part of the Centers for Disease Control, one of the eight Public Health service agencies within the Department of Health and Human Services.

Copies of "Advance Report of New Data from the 1989 Birth Certificate" are available from NCHS, Room 1064, 6525 Belcrest Road, Hyattsville, Md. 20782.

FOR RELEASE UPON DELIVERY
TUESDAY, APRIL 21, 1992

*REMARKS BY LOUIS W. SULLIVAN, M.D.

SECRETARY OF HEALTH AND HUMAN SERVICES

PRESS CONFERENCE

ON NEW DATA ON MATERNAL AND INFANT HEALTH

WASHINGTON, D.C.

*TEXT IS THE BASIS OF SECRETARY SULLIVAN's ORAL REMARKS. IT SHOULD BE USED WITH THE UNDERSTANDING THAT SOME MATERIAL MAY BE ADDED OR OMITTED DURING PRESENTATION.

Today, I am pleased to release two new reports on infant mortality from the National Center for Health Statistics.

For the first time, data are available on maternal medical and life-style risk factors for the more than 4 million births annually in the United States. Using data from a new, expanded birth certificate which became effective in 1989, we can now conclusively identify the factors which pose the greatest risk to mothers and to their infants.

Today, we are also releasing the latest infant mortality rate for the United States. The estimated provisional rate for 1991 shows progress and promise, but more about that later.

First, the major findings from the report on maternal and infant health based on the birth certificates of children barn in 1989. We have new information on the single most important predictor of infant mortality -- low birth weight -- and on two important causes of low birth weight: mothers who smoke and inadequate weight gain during pregnancy.

In 1989, 20 percent of mothers smoked. Most likely to smoke were teenage mothers IS and 19 years of age, of whom one-quarter were smokers. Least likely to smoke were young mothers under age 15 and women 35 and older.

However, the patterns differ significantly for white, black and Hispanic mothers. Black mothers were less likely to smoke than their white counterparts. Hispanic mothers, with only 8 percent being smokers, had by far the lowest rate.

Among black mothers, older women were more likely to be smokers; among white mothers, the pattern was reversed with teens most at risk. Hispanic women maintained the low rate of smoking across all ages.

Smoking varies greatly by education. With more education, smoking declines. one third of women with less than a high school education smoked, whereas only 5 percent of women who are college graduates smoke. Again, there are substantial racial differences. White women at the lowest educational level are twice as likely as black women to smoke.

This is very important because women who smoke are twice as likely to have a low-birth-weight infant.

The message to all women who are pregnant or planning a family is quite clear: Don't smoke. The best thing you can do to help your baby is to forego cigarettes.

Also at risk to have low-birth-weight infants were the more than one in five mothers who gained less than 22 to 27 pounds, the weight gain recommendation in effect in 1989. Their infants were 2 to 4 times as likely to be low birth weight.

You can see very clearly that as mothers gained more weight during pregnancy, the likelihood of low birth weight declined.

Black mothers were significantly more likely than white mothers to gain less than 21 pounds and twice as likely to gain less than 16 pounds.

Particularly at-risk are the teenage mothers IS and 19 years old with higher rates of smoking. These young mothers are also less likely to gain the recommended weight and are also more likely to suffer higher rates of anemia and hypertension during their pregnancies. In a "which-came-first" analysis, these teenagers are also less likely to receive timely prenatal care. In fact only one-half have prenatal care in the critical first trimester of their pregnancy.

We have just begun to analyze these new findings on maternal and infant health. These data are essential to assess the progress in reaching many of the nation's goals to promote the best health for mothers and their infants and to make pregnancy as risk-free as possible.

The expanded birth certificate reflects the cooperative spirit of vital and health statisticians in federal and state programs who worked together to plan and put in place the expanded birth certificates. The results of smaller, special studies and surveys can now be corroborated with a nationwide report covering all births in America.

one of the most important programs to use this new information will be the Healthy Start program operating in 15 communities. Its mission is to demonstrate what can be achieved in improving pregnancy outcome. A major goal is to reduce infant mortality by 50 percent over the next five years in each participating community.

The latest infant mortality rate for the United States is an estimated 8.9 per 1,000 live births, released today in the Monthly Vital Statistics Report for 1991 The 1991 provisional infant mortality rate of 8.9 is down two percent from the 1990 provisional rate of 9.1 and consistent with the long downward trend we have observed.

However, the graph clearly demonstrates the great disparity that still exists in mortality rates between white infants and black infants. We must continue to focus efforts on these vulnerable populations I am pleased this morning that we have new information to share with the public health community and with the public. I can assure you that we will use this information in every way possible to improve the health and well-being of the newest citizens of this nation the 4.1 million babies born this past year. Thank you.