Series 20

No. 31

Medical and Life-style

Risk Factors Affecting Fetal

Mortality, 1989–90

August 1996

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright information

All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Hoyert DL. Medical and life-style risk factors affecting fetal mortality, 1989–90.

National Center for Health Statistics. Vital Health Stat 20(31). 1996.

Library of Congress Cataloging-in-Publication Data

Hoyert, Donna L.

Medical and life-style risk factors affecting fetal mortality, 1989–1990 / (by

D.L. Hoyert)

p. cm. — (Vital and health statistics. Series 20, Data from the national vital

statistics system ; no. 31) (DHHS publication ; no. (PHS) 96-1859)

Includes bibliographical references.

ISBN 0-8406-0517-X

1. Infants—United States—Mortality. 2. Infants—Health risk

assessment—United States. I. Title. II. Series. III. Series: DHHS publication ;

no. (PHS) 96-1859.

RJ60.U5H69 1996 96-30479

614.5'992—dc20 CIP

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Washington, DC 20402-9328
Medical and Life-style

Risk Factors Affecting Fetal

Mortality, 1989–90

Series 20

Data on Mortality

No. 31

This report presents data on the occurrence of medical and life-style risk

factors among fetal deaths and live births. Fetal mortality rates are also

shown for those live births and fetal deaths with specified medical and

life-style risks.

Hyattsville, Maryland

August 1996

DHHS Publication No. (PHS) 96-1859

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Jack R. Anderson, Acting Associate Director for

International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Division of Vital Statistics

Mary Anne Freedman, M.A., Director

James A. Weed, Ph.D., Deputy Director

Harry M. Rosenberg, Ph.D., Chief, Mortality Statistics

Branch

Robert Armstrong, Acting Chief, Statistical Resources

Branch

Nicholas F. Pace, Acting Chief, Systems and Programming

Branch
Abstract

Objectives—This report presents fetal mortality data by

medical and life-style risk factors of the mother and the fetus.

Methods—Deaths and fetal mortality rates are presented

in this descriptive report. Data sources used are vital statistics

data for fetal deaths and live births.

Results—The data that became available with the revision

of the U.S. Standard Report of Fetal Death in 1989 expanded

the medical and health data available on mothers and fetuses.

Reporting of medical conditions is probably incomplete for

fetal deaths as well as for live births. Therefore, caution should

be exercised in using this data. Reported occurrences of

medical and life-style risk factors of mother and fetus for fetal

deaths and live births and fetal mortality rates are presented.

Maternal medical conditions most often associated with having a fetal death were problems with amniotic fluid levels and

blood disorders. Fetal mortality was 35 percent greater when

tobacco was used during pregnancy and 77 percent higher

when alcohol was consumed during pregnancy. The complication of labor most often associated with fetal mortality was

abruptio placenta. Although a very small proportion of all

deliveries have specific congenital anomalies reported, fetal

mortality was close to 50 percent for anencephalus, about

25 percent for renal agenesis, and slightly more than 20 percent for hydrocephalus.

iii
Contents

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Introduction............................................................................................ 1

Methods............................................................................................... 2

Fetal death reporting system ............................................................................ 2

Items described in report............................................................................... 4

Geographic area ...................................................................................... 4

Results................................................................................................ 5

Medical risk factors................................................................................... 5

Tobacco use during pregnancy .......................................................................... 6

Alcohol use during pregnancy........................................................................... 7

Complications of labor and/or delivery ................................................................... 9

Congenital anomalies of the fetus........................................................................ 9

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

List of detailed tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Text tables

A. Rate and confidence intervals of medical risk occurrences by selected medical risk factors, age and race of mother,

and ratio of occurrence rates: Total of 28 States, 1989–90 ................................................. 5

B. Rate and confidence intervals of fetal mortality by selected medical risk factors, age and race of mother, and ratio

of fetal mortality rates: Total of 28 States, 1989–90 ...................................................... 6

C. Rate and confidence intervals of delivery complication occurrences by selected complications of labor and/or

delivery, age and race of mother, and ratio of occurrence rates: Total of 29 States, 1989–90 ..................... 8

D. Rate and confidence intervals of fetal mortality by complications of labor and/or delivery, age and race of mother,

and ratio of fetal mortality rates: Total of 29 States, 1989–90 .............................................. 8

E. Rate and confidence intervals of congenital anomaly occurrences by selected congenital anomalies, age and race of

mother, and ratio of occurrence rates: Total of 26 States, 1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

F. Rate and confidence intervals of fetal mortality by selected congenital anomalies, age and race of mother, and ratio

of fetal mortality rates: Total of 26 States, 1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Figures

1. U.S. Standard Report of Fetal Death form .............................................................. 3

2. Fetal mortality by selected maternal medical risks: Total of 28 States, 1989–90 ................................ 7

3. Fetal mortality by tobacco use of mother: Total of 25 States, 1989–90 ....................................... 7

4. Fetal mortality by alcohol use of mother: Total of 26 States, 1989–90 ....................................... 7

5. Fetal mortality by complications of labor and/or delivery: Total of 29 States, 1989–90 .......................... 9

6. Fetal mortality by selected fetal anomalies: Total of 26 States, 1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Appendix

Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Keywords: fetal death data file v vital statistics v complications of labor and delivery v congenital anomalies

v
Medical and life-style risk

factors affecting fetal

mortality, 1989–90

Donna L. Hoyert, Ph.D., Division of Vital Statistics

Introduction

As a result of the revision of the U.S. Standard Report of

Fetal Death, beginning with the 1989 data year, the National

Center for Health Statistics (NCHS) has compiled fetal death

data on medical and life-style risk factors of pregnancy and

delivery and on congenital anomalies of the fetus. The new

medical and health data available for mothers and fetuses

greatly expand the information available on pregnancy outcomes in the United States. Previous reports from NCHS

presented data on medical and life-style risk factors for

pregnancies that resulted in a live birth (1,2). This report

presents corresponding data on pregnancies that resulted in a

spontaneous fetal death after 20 weeks of gestation.

Because fetal deaths account for a large proportion of

pregnancy losses (3,4), health promotion and interventions

intended to improve pregnancy outcomes must consider the

problem of fetal death. There are inherent difficulties in

collecting data on fetal deaths that have contributed to less

emphasis on research, understanding, and development of

prevention efforts (4). This report adds to the literature by

providing data on a variety of medical and life-style risk

factors for fetal deaths. As noted in the literature for similar

live birth data, there are limitations in the data that should be

taken into account (5,6). Nevertheless, as with live birth data,

these data are a source of information for deriving prevalence

measures. Although they tend to be underestimates, the data

add to the body of literature, encourage comparisons between

methodologies for collecting this type of data, and provide

insight into differences within the population (5,6). In many

cases, similar data are neither widely nor routinely available

for fetal deaths.

This report was prepared in the Division of Vital Statistics under the general

direction of Harry M. Rosenberg, Ph.D., Chief of the Mortality Statistics

Branch. Staff of the Mortality Statistics Branch and the Office of Analysis and

Epidemiology provided peer review for this report. Betty L. Smith provided

content review. The Registration Methods Branch and the Technical Services

Branch provided consultation to State vital statistics offices regarding collection of the vital statistics data on which this report is based. This report was

edited by Klaudia M. Cox and typeset by Zung T. N. Le of the Publications

Branch, Division of Data Services.

1
Methods

Fetal death reporting system

NCHS adopted the World Health Organization (WHO)

definition of ‘‘fetal death’’ as the recommended standard for

use in the early 1950’s. The following inclusive definition was

developed by the WHO in 1950 to end confusion arising from

the use of such terms as stillbirth, spontaneous abortion, and

miscarriage:

Death prior to the complete expulsion or extraction from

its mother of a product of conception, irrespective of the

duration of pregnancy; the death is indicated by the fact

that after such separation, the fetus does not breathe or

show any other evidence of life such as beating of the

heart, pulsation of the umbilical cord, or definite movement of voluntary muscles (7).

The States use a consistent definition, but the registration

of a fetal death is only required for those occurring after 20

weeks of gestation in most States. National fetal-death statistics are compiled from State fetal death reports received by

NCHS every year. They are usually tabulated for deaths of 20

or more weeks of gestation. Statistics on induced terminations

of pregnancy (abortions) are excluded in national fetal-death

statistics and are not included in this report.

The fetal death reports or certificates of most States

conform closely in content and arrangement with the U.S.

Standard Report of Fetal Death (figure 1), although States may

make modifications. The number of items on medical and

life-style risk factors was increased on the 1989 revision of the

fetal death report. Because many of these items appear for the

first time on the 1989 revision, reporting completeness is still

improving and is not yet comparable, in some instances, to

items retained from previous revisions. Reporting completeness in the data is discussed in the text and shown in each

table.

In the 1989 revision of the standard fetal death report,

checkboxes replace previously used, open-ended items regarding medical and health characteristics of the mother and the

fetus. Evidence from evaluation studies of questionnaire design

indicate that the use of checkboxes improves reporting of

chronic conditions (8–10). It was anticipated that use of

checkboxes on vital statistics records would encourage better

reporting of specific risks and conditions listed. Initially,

individual States experienced resistance from their State medical community and some procedural difficulties (6,11); yet, the

levels of reporting have improved to varying degrees (12,13).

Nevertheless, research has found that medical and lifestyle risk factors continue to be underreported on the revised

live birth certificate (5,13–16). Validation studies of live birth

records find that reporting for each of the medical and

life-style risk factor sections differs from that in medical

records. The results of selected studies show that there is

underreporting on the birth certificate. For example, medical

risk factors reported on the birth certificate agree with medical

records between 86 and 93 percent of the time; obstetric

procedures between 70 and 73 percent; and complications of

labor and delivery between 66 and 81 percent (14,15). Congenital anomalies such as rectal atresia or stenosis are only

reported on birth certificates for 10 percent of cases reported

to a birth registry while anencephaly is reported 86 percent of

the time (5). The disparity largely reflects underreporting

(13,14). However, studies comparing data collected on birth

certificates with other records found both underreporting and

reports on the birth certificate that could not be validated

against other records (5,13).

Reporting of medical conditions for the fetus is probably

also incomplete, in part, because of difficulties in recognizing

the conditions (1,5,17), particularly for fetal deaths occurring

earlier in pregnancy. However, it is possible that there could

be less underreporting for fetal deaths than for live births

because the condition is more severe in the fetal death (18) or

because the person filling out the fetal death report is motivated to account for the fetal death (19). When records are

linked to reimbursement, conditions that are reimbursable are

better reported than those that are not reimbursable (16).

Consequently, if there is relatively less underreporting for fetal

deaths than live births, then the effect would be to overestimate the risk of having a fetal death given the existence of a

specific risk factor.

Estimates of the prevalence of various conditions and

medical risks published in the literature provide further data

by which to judge the quality of vital statistics estimates

(18,20–27). The estimates in the literature are based on several

sources, including hospital discharge data (20) and birth

defects registries (21–23,25–27). They are usually based on

multiple sources including vital statistics records. In general,

the prevalence of medical and life-style risk factors among

live births and fetal deaths is understated in vital statistics

records. For example, in the case of alcohol use, the special

studies found that around 20 percent of pregnant women in

1988 were estimated to drink during pregnancy (28) compared

with merely 3 percent in the vital statistics data in this report.

2
Figure 1. U.S. Standard Report of Fetal Death form

3
Tobacco use estimates of 23 percent in 1990 (29) were similar

to estimates of 20 percent in vital statistics data in this report.

Abruptio placenta is estimated to occur in 4.9–12.9 per 1,000

deliveries (30) compared with 6.8 per 1,000 in vital statistics.

This provides an example in which vital statistics data are

within the range reported in the literature.

Items described in report

This report presents data for the combined years 1989–90

on new items on the 1989 revision of the fetal death report.

Two years of data (1989 and 1990) are combined to promote

statistical reliability and stability in estimates. Four specific

items on the fetal death report that provide detailed medical

and health information on the woman and child, in the form of

checkbox entries, are examined in this report: medical risk

factors for this pregnancy, other risk factors, complications of

labor and/or delivery, and congenital anomalies of the fetus.

(For brief medical definitions, see Technical notes.)

Two types of rates are shown in the tables. The first type

shows rates of occurrence and provides a measure of the risk

of having a delivery with the specified characteristic for all

reported deliveries (i.e., pregnancies ending in a spontaneous

fetal death of 20 weeks or more gestation or a live birth). This

is expressed as the combined number of live births and fetal

deaths with the specified characteristic per 1,000 total live

births and fetal deaths of 20 or more weeks of gestation to

women in the specified age group. In the sections on tobacco

and alcohol use, the rate of occurrence is expressed per 100

total live births and fetal deaths of 20 or more weeks of

gestation. The rate of occurrence for congenital anomalies is

expressed per 100,000 total live births and fetal deaths of 20

or more weeks gestation because of the rarity of these

conditions.

The second type shows fetal mortality rates and provides

a measure of the risk of having a spontaneous fetal death

among those deliveries with specified medical risk, complication of labor, or congenital anomaly. For each section, this is

expressed as the number of fetal deaths of 20 or more weeks

gestation per 1,000 live births and fetal deaths of 20 or more

weeks of gestation in the specified group.

Both of these measures exclude pregnancies that end with

an induced abortion; the values shown in this report might

have been considerably different had induced abortions been

included (25).

Fetal deaths with unknown characteristics were subtracted

from the number of total fetal deaths used as denominators

before rates were computed, except for tables presenting data

on tobacco and alcohol use. In the tobacco and alcohol use

tables, ‘‘not stated’’ responses to tobacco and alcohol items

were distributed proportionately. An asterisk is shown in place

of any derived statistic based on fewer than 20 cases in the

numerator or denominator.

Each of the tables shows the data for all maternal races,

separately for the white and black populations and for all

maternal ages, and separately for women under 30 years of

age and 30 years of age or older. In part, these variables are

shown to provide similar information for fetal deaths as

previously shown in reports on live births (1,2). The information on age is more limited in this report because there were

not enough events to show the data by 5-year age groups. Age

was separated into two groups—under 30 years of age and

30–49 years of age. In cases in which the relationship is

positive or inverse by age, this categorization is adequate. In

more detailed studies, investigators may need to use more

years of data to analyze maternal age in smaller categories.

Differences by race are often due to socioeconomic differences, limitations in access to health care and insurance, and

other factors not shown in this report.

Geographic area

The basic group of 29 States included in this report

represents 61 percent of all fetal deaths of 20 weeks gestation

or more in the United States. The 29 States included in the

tables were selected on the basis of reporting completeness.

States were included only if reporting was at least 80 percent

complete for each of the following variables: prenatal care,

birthweight, and method of delivery. These three variables

were selected because each is a basic data item that should be

easy to complete, but for which there is a moderate degree of

incomplete reporting. Using this criterion substantially reduced

the level of incomplete reporting for each of the medical and

life-style risk factors. For further details, see the Technical

notes. Individual tables note which of the 29 States are

excluded because items are missing from State reports or

certificates.

4
Results

Medical risk factors

Occurrence of medical risk factors

Table 1 presents data on the occurrence of 16 selected

medical risk factors by race of mother for 1989 and 1990,

which were combined for 28 States. The presence or absence

of medical risk factors was not reported for 58,875 (1 percent)

of the 4,931,210 women delivering a live infant or dead fetus.

Among the selected maternal medical risk factors (table A),

pregnancy-associated hypertension was the most frequently

reported factor with a rate of 26.3 occurrences per 1,000 total

live births and fetal deaths. This was followed by diabetes

(19.2 occurrences). Hemoglobinopathy was the least frequently reported among deliveries with a rate of 0.4 percent.

By age, 11 of the 16 medical conditions occurred more

frequently for women 30–49 years than for women under 30

years of age (table A); differences were statistically significant. For chronic hypertension, the rate of occurrence for those

aged 30–49 years was 2.4 times that of women under 30 years

of age; for diabetes (2.2 times), and previous infant 4,000

grams or more (2.2 times). In contrast, rates were not as great

among older women for anemia (0.7 or 32 percent lower),

renal disease (0.7), or eclampsia (0.8).

For seven of these medical risk factors (table A), the

medical conditions occurred relatively more frequently among

black than among white women delivering a live infant or

dead fetus. In the case of hemoglobinopathy, the ratio of

black-to-white rates was 6.5 times greater for black women

than for white women delivering a live infant or dead fetus. In

contrast, six of the medical risk factors had substantially

smaller rates for black than for white women, including

previous infant 4,000 grams or more (ratio of 0.4), Rh

sensitization (0.4), and diabetes (0.8).

Fetal mortality rates for selected medical

risk factors

The risks of experiencing a fetal loss increase for women

with certain medical risks (32,34). Among these women, the

Table A. Rate and confidence intervals of medical risk occurrences by selected medical risk factors, age and race of mother, and ratio of

occurrence rates: Total of 28 States, 1989–90

[Rates are number of deliveries with specified medical risk factor per 1,000 live births and fetal deaths to mothers of specified age]

Selected medical risk factor

Maternal age Race

All ages Under 30 years 30–49 years White Black Ratio of occurrence rates

Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval

Oldertoyounger1

Blacktowhite

Anemia ................. 15.5 (15.4,15.6) 17.1 (16.9,17.2) 11.7 (11.5,11.9) 12.5 (12.4,12.6) 30.1 (29.7,30.4) 0.7 2.4

Cardiac disease . . . . . . . . . . . . 2.9 (2.8,2.9) 2.5 (2.4,2.6) 3.8 (3.7,3.9) 3.0 (3.0,3.1) 2.5 (2.4,2.6) 1.5 0.8

Acute or chronic lung disease . . . . 2.7 (2.7,2.8) 2.7 (2.6,2.7) 2.9 (2.8,3.0) 2.6 (2.5,2.6) 3.7 (3.6,3.9) 1.1 1.4

Diabetes ................. 19.2 (19.1,19.3) 14.2 (14.1,14.3) 31.5 (31.2,31.8) 19.6 (19.4,19.7) 16.0 (15.7,16.3) 2.2 0.8

Genital herpes . . . . . . . . . . . . . 7.7 (7.6,7.8) 6.9 (6.8,7.0) 9.8 (9.6,10.0) 8.0 (7.9,8.1) 7.6 (7.4,7.8) 1.4 1.0

Hydramnios/oligohydramnios . . . . . 5.6 (5.5,5.6) 5.4 (5.3,5.5) 6.0 (5.9,6.2) 5.5 (5.4,5.5) 6.3 (6.2,6.5) 1.1 1.1

Hemoglobinopathy . . . . . . . . . . . 0.4 (0.4,0.4) 0.4 (0.4,0.5) 0.4 (0.4,0.4) 0.2 (0.2,0.2) 1.3 (1.3,1.4) 1.0 6.5

Hypertension, chronic . . . . . . . . . 6.4 (6.3,6.4) 4.5 (4.4,4.6) 11.0 (10.8,11.1) 5.6 (5.5,5.6) 10.7 (10.4,10.9) 2.4 1.9

Hypertension, pregnancyassociated ............... 26.3 (26.1,26.4) 26.4 (26.2,26.6) 25.9 (25.7,26.2) 26.5 (26.3,26.7) 27.0 (26.7,27.4) 1.0 1.0

Eclampsia . . . . . . . . . . . . . . . . 4.1 (4.0,4.1) 4.3 (4.2,4.3) 3.6 (3.5,3.7) 3.7 (3.6,3.7) 6.4 (6.2,6.5) 0.8 1.7

Incompetent cervix . . . . . . . . . . . 3.4 (3.3,3.4) 2.8 (2.8,2.9) 4.7 (4.6,4.8) 3.4 (3.3,3.5) 3.4 (3.3,3.5) 1.7 1.0

Previous infant 4,000 grams or

more . . . . . . . . . . . . . . . . . . 11.3 (11.2,11.4) 8.4 (8.3,8.5) 18.4 (18.1,18.6) 12.9 (12.8,13.0) 4.6 (4.5,4.7) 2.2 0.4

Previous preterm or smallfor-gestational-age infant ...... 13.9 (13.8,14.0) 12.5 (12.4,12.7) 17.4 (17.2,17.6) 13.3 (13.2,13.4) 17.2 (17.0,17.5) 1.4 1.3

Renal disease . . . . . . . . . . . . . 2.6 (2.6,2.7) 2.9 (2.8,2.9) 2.1 (2.0,2.2) 2.7 (2.6,2.7) 2.5 (2.4,2.6) 0.7 0.9

Rh sensitization . . . . . . . . . . . . . 6.4 (6.3,6.5) 6.2 (6.1,6.2) 7.0 (6.9,7.2) 7.3 (7.3,7.4) 3.0 (2.9,3.1) 1.1 0.4

Uterine bleeding . . . . . . . . . . . . 8.4 (8.3,8.5) 7.8 (7.7,7.9) 9.9 (9.8,10.1) 8.8 (8.7,8.9) 7.2 (7.1,7.4) 1.3 0.8

1Older refers to mothers 30–49 years of age. Younger refers to mothers under 30 years.

5
risk of having a fetal death per 1,000 live births and fetal

deaths in a specified group is shown in table 2. Medical risk

factors were not stated for about 9 percent (e.g., 3,373 divided

by 36,729) of the 36,729 women delivering a dead fetus.

The variation in fetal mortality by specific medical conditions is shown in table B. Fetal mortality rates were highest for

hemoglobinopathy (48.4 per 1,000 live births and fetal deaths

in which the risk was present) and hydramnios/oligohydramnios

(48.5) (figure 2). Thus, hydramnios/oligohydramnios and hemoglobinopathy were the reported maternal conditions most

lethal to the fetus; even so, only a small proportion (less than

5 percent) of deliveries to women reported with these conditions experienced a fetal loss.

By age, the risk of the pregnancy resulting in a fetal death

was greater for older women with four specific medical

conditions (table B). The largest difference was for acute and

chronic lung disease, with a mortality rate 53 percent greater

for women aged 30–49 years than for women under 30 years

old. In contrast, fetal mortality rates were around 20 percent

lower for women aged 30–49 years who had incompetent

cervix and uterine bleeding.

For 12 of the 16 medical conditions (table B), the risk of

experiencing a fetal loss was greater for black women than for

white women. The greatest differentials included cardiac disease (2.8), incompetent cervix (2.7), previous infant 4,000

grams or more (2.6), and pregnancy-associated hypertension

(2.5). In contrast, the risk of women with hemoglobinopathy

(0.4) having a dead fetus was less for black women than for

white women.

Tobacco use during pregnancy

Table 3 presents data on smoking among women delivering a live infant or dead fetus. The rate of smokers was 20.2

per 100 deliveries, or about 20 percent. Smoking was more

common among younger women than among older women.

The percent was 21.8 for women under 30 years and 15.9 for

those 30–49, a 27 percent differential with increasing age.

Smoking was also more common among white women than

among black women. The percent was 21.3, 1.3 times higher

than for black women, who had a percent of 16.9.

Among women who smoked, smoking 11 cigarettes or

more per day was 2.2 times more common than smoking 1–5

cigarettes per day (42.5 vs. 19.4 percent). Younger smokers

consumed smaller quantities of cigarettes per day than older

smokers. Close to half of white smokers (46.3 percent among

smoking women) smoked half a pack or more of cigarettes

daily. Only about a quarter of black smokers (24.5) consumed

that large a quantity of tobacco.

Fetal mortality by tobacco use

Research on smoking indicates that smoking is associated

with both higher levels of fetal mortality (31) and increased

risk of having a small infant (32), and that the effect of

smoking is greater for older women than for younger women

(31,33). Smoking is also associated with other pregnancy

problems including complications of labor (34).

Table B. Rate and confidence intervals of fetal mortality by selected medical risk factors, age and race of mother, and ratio of fetal

mortality rates: Total of 28 States, 1989–90

[Rates are number of fetal deaths with specified medical risk factor per 1,000 live births and fetal deaths with specified medical risk factor]

Selected medical risk factor

Maternal age Race

Ratio of

All ages Under 30 years 30–49 years White Black occurrence rates

Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval

Oldertoyounger1

Blacktowhite

All fetal deaths . . . . . . . . . . . . . 7.4 (7.4,7.5) 7.3 (7.2,7.3) 7.9 (7.8,8.1) 6.3 (6.3,6.5) 13.2 (13.1,13.6) 0.9 2.1

No medical risks . . . . . . . . . . . . 5.0 (4.9,5.1) 4.9 (4.9,5.0) 5.2 (5.0,5.3) 4.3 (4.3,4.4) 8.7 (8.5,9.0) 1.1 2.0

Anemia ................. 14.8 (13.9,15.6) 14.0 (13.1,14.9) 17.6 (15.6,19.6) 10.6 (9.7,11.5) 24.0 (22.1,25.9) 1.3 2.3

Cardiac disease . . . . . . . . . . . . 8.7 (7.2,10.2) 9.2 (7.2,11.2) 7.8 (5.4,10.2) 6.8 (5.3,8.3) 18.7 (12.7,24.6) 0.8 2.8

Acute or chronic lung disease . . . 15.3 (13.2,17.4) 13.2 (10.9,15.5) 20.2 (15.9,24.5) 15.1 (12.7,17.5) 16.4 (11.8,20.9) 1.5 1.1

Diabetes . . . . . . . . . . . . . . . . . 9.9 (9.2,10.5) 9.7 (8.8,10.6) 10.0 (9.1,10.9) 8.4 (7.7,9.0) 19.6 (17.2,22.0) 1.0 2.3

Genital herpes . . . . . . . . . . . . . 5.3 (4.6,6.0) 5.5 (4.6,6.4) 5.0 (3.8,6.2) 4.4 (3.7,5.2) 9.7 (7.2,12.1) 0.9 2.2

Hydramnios/oligohydramnios .... 48.5 (45.9,51.1) 47.9 (44.8,51.0) 49.8 (45.1,54.5) 49.4 (46.4,52.4) 46.6 (40.7,52.5) 1.0 0.9

Hemoglobinopathy .......... 48.4 (39.0,57.9) 44.8 (34.2,55.4) 58.3 (38.4,78.2) 78.8 (59.8,97.8) 32.2 (21.5,42.8) 1.3 0.4

Hypertension, chronic ........ 25.6 (23.8,27.4) 22.4 (20.1,24.7) 28.9 (26.2,31.6) 19.7 (17.8,21.5) 40.5 (36.3,44.7) 1.3 2.1

Hypertension, pregnancyassociated . . . . . . . . . . . . . . . 11.2 (10.6,11.8) 10.4 (9.7,11.1) 13.3 (12.1,14.5) 8.9 (8.3,9.4) 22.0 (20.0,23.9) 1.3 2.5

Eclampsia . . . . . . . . . . . . . . . . 11.5 (10.0,13.0) 10.5 (8.9,12.1) 14.4 (11.1,17.7) 9.5 (7.9,11.0) 17.5 (13.9,21.1) 1.4 1.8

Incompetent cervix .......... 46.1 (42.8,49.3) 50.9 (46.5,55.3) 38.9 (34.2,43.6) 36.1 (32.9,39.4) 97.8 (86.2,109.5) 0.8 2.7

Previous infant 4,000 grams or

more . . . . . . . . . . . . . . . . . . 6.1 (5.5,6.8) 5.6 (4.7,6.5) 6.7 (5.7,7.7) 5.3 (4.6,5.9) 13.6 (9.8,17.3) 1.2 2.6

Previous preterm or smallfor-gestational-age infant ...... 16.4 (15.5,17.4) 16.0 (14.8,17.2) 17.2 (15.6,18.8) 13.7 (12.7,14.8) 27.1 (24.3,29.8) 1.1 2.0

Renal disease ............. 17.5 (15.2,19.7) 16.2 (13.7,18.7) 21.8 (16.5,27.1) 14.2 (11.9,16.4) 33.6 (25.6,41.5) 1.3 2.4

Rh sensitization . . . . . . . . . . . . 6.3 (5.4,7.2) 5.9 (4.9,6.9) 7.0 (5.3,8.7) 6.0 (5.1,6.9) 10.0 (6.0,13.9) 1.2 1.7

Uterine bleeding ............ 38.2 (36.3,40.1) 41.2 (38.8,43.6) 32.3 (29.3,35.3) 31.9 (30.0,33.8) 76.3 (69.3,83.3) 0.8 2.4

1Older refers to mothers 30–49 years of age. Younger refers to mothers under 30 years.

6
Data on the risk of having a fetal death among women

who smoke is shown for 25 States (table 4). For women who

smoked, the fetal mortality rate was 9.7, or 35 percent, higher

than for women who did not smoke (7.2) (figure 3). Among

smokers, rates were 29 percent greater for women aged 30–49

years than for women under age 30. The risk of having a fetal

death was greater for black than for white smokers (ratio of

rates of 2.0); the ratio of the rates, mortality race ratio, for

nonsmokers was 2.1 in these States.

Among women of all races combined who smoked, fetal

mortality rates tended to be somewhat greater for those who

smoked greater quantities of cigarettes, but differences were

not statistically significant. However, for white and black

women separately, differences were significant. For the white

population, rates for those smoking 11 cigarettes or more were

22 percent higher than for those smoking 1–5 cigarettes. For

the black population, rates were 25 percent higher for those

smoking 11 cigarettes or more than for those smoking 1–5

cigarettes. For each quantity of cigarettes, rates were greater

for black than for white women, and rates were greater for

those aged 30–49 years than for those under age 30.

Alcohol use during pregnancy

Table 5 presents data on alcohol use among women

delivering either a live birth or a fetal death in 26 States. The

reported rate of alcohol use was 3.4 per 100 deliveries, or

about 3 percent. Alcohol use was 50 percent more common

among women aged 30–49 years (4.5) than among women

under 30 years (3.0). For white women, the percent of use was

3.3 and for black women, it was 3.9. Other studies (28,35)

with higher estimates of alcohol use during pregnancy also

find that use increases with age.

Among women who drank, consuming 1 drink a week

(60.9 per 100 live births and fetal deaths to drinking women)

was more common than consuming 5 or more per week (11.4).

Anemia

Cardiac disease

Acute or chronic lung

disease

Diabetes

Genital herpes

Hydramnios/

Oligohydramnios

Hemoglobinopathy

Hypertension, chronic

Hypertension,

pregnancy associated

Eclampsia

Incompetent cervix

Previous infant 4,000

grams or more

Previous preterm, sga

infant 

Renal disease

Rh sensitization

Uterine bleeding

No medical risks

Medical risk

0 10 20 30 40

Rate per 1,000 live births and fetal deaths

50

SGA is small for gestional age infant

1

1

Figure 2. Fetal mortality by selected maternal medical risks: Total

of 28 States, 1989–90

All races White Black

Race of mother

0

5

10

15

20

Rate per 1,000 live births and fetal deaths

Smoker Nonsmoker

Figure 3. Fetal mortality by tobacco use of mother: Total of 25

States, 1989–90

All races White Black

Race of mother

0

5

10

15

20

25

30

Rate per 1,000 live births and fetal deaths

Drinker Nondrinker

Figure 4. Fetal mortality by alcohol use of mother: Total of 26

States, 1989–90

7
Younger women were more likely to consume five or more

drinks per week than older women. Somewhat less than a

tenth of white drinkers (8.4 percent among drinking women)

consumed 5 or more drinks weekly, compared with about a

fifth of black drinkers (21.2).

Fetal mortality by alcohol use

Studies have shown that alcohol use during pregnancy

appears to be associated with a number of harmful effects,

including increased risk of fetal death, reduced birthweight,

and congenital anomalies (36). Another effect is fetal alcohol

syndrome (36,37).

Data on the risk of having a fetal death among women

who drank is shown for 26 States (table 6). For women who

drank, the fetal mortality rate was 13.3, or 77 percent higher

than the rate of 7.5 for women who did not drink (figure 4).

Among women using alcohol during pregnancy, rates were

12 percent less for women aged 30–49 years than for women

Table C. Rate and confidence intervals of delivery complication occurrences by selected complications of labor and/or delivery, age and

race of mother, and ratio of occurrence rates: Total of 29 States, 1989–90

[Rates are number of deliveries with specified complication per 1,000 live births and fetal deaths to mothers of specified age]

Selected complication

Maternal age Race

Ratio of

All ages Under 30 years 30–49 years White Black occurrence rates

Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval

Oldertoyounger1

Blacktowhite

Febrile ................... 10.5 (10.5,10.6) 11.1 (11.0,11.2) 9.2 (9.1,9.4) 9.6 (9.5,9.7) 14.8 (14.5,15.0) 0.8 1.5

Meconium, moderate/heavy ...... 57.4 (57.2,57.6) 58.2 (57.9,58.4) 55.4 (55.0,55.8) 52.5 (52.2,52.7) 83.0 (82.4,83.6) 1.0 1.6

Premature rupture of membrane . . . 31.6 (31.5,31.8) 31.0 (30.8,31.2) 33.1 (32.9,33.4) 30.4 (30.2,30.6) 38.7 (38.3,39.1) 1.1 1.3

Abruptio placenta . . . . . . . . . . . . 6.8 (6.7,6.9) 6.6 (6.5,6.6) 7.4 (7.2,7.5) 6.5 (6.4,6.6) 8.7 (8.5,8.9) 1.1 1.3

Placenta previa . . . . . . . . . . . . . 3.5 (3.4,3.5) 2.6 (2.6,2.7) 5.6 (5.4,5.7) 3.4 (3.3,3.5) 3.6 (3.4,3.7) 2.2 1.1

Other excessive bleeding . . . . . . . 5.2 (5.1,5.3) 5.0 (5.0,5.1) 5.6 (5.5,5.7) 5.3 (5.2,5.4) 3.8 (3.6,3.9) 1.1 0.7

Seizures during labor . . . . . . . . . . 0.4 (0.4,0.5) 0.5 (0.5,0.5) 0.3 (0.3,0.4) 0.4 (0.4,0.4) 0.6 (0.6,0.7) 0.6 1.5

Precipitous labor ............. 18.6 (18.5,18.7) 17.4 (17.3,17.5) 21.5 (21.3,21.8) 17.7 (17.6,17.8) 22.1 (21.7,22.4) 1.2 1.2

Prolonged labor ............. 10.5 (10.4,10.6) 10.9 (10.8,11.0) 9.6 (9.4,9.8) 10.9 (10.8,11.0) 8.0 (7.8,8.2) 0.9 0.7

Dysfunctional labor ........... 23.6 (23.5,23.8) 23.7 (23.6,23.9) 23.3 (23.1,23.6) 24.5 (24.3,24.7) 20.1 (19.8,20.4) 1.0 0.8

Breech/malpresentation ........ 38.6 (38.5,38.8) 35.9 (35.7,36.0) 45.6 (45.3,46.0) 40.7 (40.5,40.9) 30.0 (29.6,30.4) 1.3 0.7

Cephalopelvic disproportion ...... 37.4 (37.3,37.6) 38.1 (37.9,38.3) 35.7 (35.4,36.0) 39.0 (38.8,39.2) 30.1 (29.7,30.4) 0.9 0.8

Cord prolapse . . . . . . . . . . . . . . 2.6 (2.6,2.7) 2.5 (2.5,2.6) 3.0 (2.9,3.1) 2.6 (2.6,2.7) 3.0 (2.8,3.1) 1.2 1.2

Anesthetic complication . . . . . . . . 0.5 (0.5,0.5) 0.5 (0.5,0.5) 0.6 (0.6,0.6) 0.5 (0.5,0.6) 0.4 (0.4,0.5) 1.2 0.8

Fetal distress ............... 43.7 (43.5,43.9) 44.1 (43.9,44.4) 42.7 (42.3,43.0) 41.8 (41.6,42.0) 54.1 (53.6,54.6) 1.0 1.3

1Older refers to mothers 30–49 years of age. Younger refers to mothers under 30 years.

Table D. Rate and confidence intervals of fetal mortality by complications of labor and/or delivery, age and race of mother, and ratio of fetal

mortality rates: Total of 29 States, 1989–90

[Rates are number of fetal deaths with specified complication per 1,000 live births and fetal deaths in specified group]

Selected complication

Maternal age Race

Ratio of fetal

All ages Under 30 years 30–49 years White Black mortality rate

Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval

Oldertoyounger1

Blacktowhite

All fetal deaths . . . . . . . . . . . . . 7.4 (7.3,7.5) 7.2 (7.1,7.3) 7.9 (7.7,8.0) 6.3 (6.0,6.1) 13.0 (8.9,9.2) 1.1 2.1

No complication . . . . . . . . . . . . 4.5 (4.4,4.5) 4.3 (4.2,4.4) 4.7 (4.6,4.9) 3.8 (3.7,3.9) 7.9 (7.7,8.2) 1.1 2.1

Febrile .................. 28.4 (26.9,29.8) 25.3 (23.1,27.5) 37.5 (37.0,37.9) 24.5 (23.0,26.1) 42.6 (39.0,46.2) 1.5 1.7

Meconium, moderate/heavy . . . . . 6.9 (6.6,7.2) 6.6 (6.0,7.1) 7.9 (7.8,8.0) 7.1 (6.7,7.4) 6.7 (6.1,7.3) 1.2 0.9

Premature rupture of membrane . . . 17.5 (16.9,18.2) 17.0 (15.9,18.1) 18.9 (18.7,19.1) 13.3 (12.7,14.0) 34.4 (32.4,36.4) 1.1 2.6

Abruptio placenta ............ 96.9 (93.6,100.2) 102.0 (95.4,108.6) 85.5 (84.5,86.5) 82.8 (79.3,86.3) 149.8 (141.0,158.6) 0.8 1.8

Placenta previa ............. 21.4 (19.2,23.5) 27.8 (22.6,33.0) 13.8 (13.6,13.9) 17.8 (15.5,20.0) 39.8 (32.7,46.9) 0.5 2.2

Other excessive bleeding ....... 23.4 (21.6,25.3) 24.5 (20.8,28.2) 21.0 (20.8,21.2) 19.7 (17.9,21.6) 56.1 (47.9,64.3) 0.9 2.8

Seizures during labor ......... 23.8 (17.4,30.2) 16.1 (9.8,22.4) 50.6 (50.1,51.1) 25.1 (17.4,32.9) 20.6 (8.4,32.8) 3.1 0.8

Precipitous labor . . . . . . . . . . . . 5.6 (5.2,6.1) 5.8 (5.0,6.7) 5.2 (5.2,5.3) 4.8 (4.3,5.3) 9.3 (7.9,10.6) 0.9 1.9

Prolonged labor . . . . . . . . . . . . . 4.4 (3.8,4.9) 3.6 (2.9,4.4) 6.5 (6.5,6.6) 4.1 (3.5,4.7) 7.5 (5.4,9.6) 1.8 1.8

Dysfunctional labor . . . . . . . . . . . 1.9 (1.6,2.1) 1.8 (1.4,2.2) 2.0 (2.0,2.1) 1.8 (1.5,2.0) 2.5 (1.8,3.3) 1.1 1.4

Breech/malpresentation ........ 21.1 (20.4,21.7) 22.2 (20.9,23.4) 18.9 (18.7,19.1) 17.2 (16.5,17.8) 46.3 (43.7,49.0) 0.9 2.7

Cephalopelvic disproportion . . . . . 1.2 (1.1,1.4) 1.0 (0.8,1.2) 1.9 (1.8,1.9) 1.2 (1.0,1.3) 1.3 (0.8,1.7) 1.9 1.1

Cord prolapse .............. 58.2 (54.0,62.3) 57.6 (50.5,64.8) 59.3 (58.7,60.0) 50.6 (46.3,55.0) 92.2 (79.9,104.5) 1.0 1.8

Anesthetic complication . . . . . . . . 9.8 (6.0,13.5) 10.0 (3.1,16.9) 9.3 (9.2,9.4) 6.8 (3.4,10.3) 25.4 (8.8,41.9) 0.9 3.7

Fetal distress . . . . . . . . . . . . . . 4.8 (4.5,5.1) 4.6 (4.1,5.1) 5.3 (5.2,5.3) 4.3 (4.0,4.7) 6.3 (5.5,7.0) 1.2 1.5

1Older refers to mothers 30–49 years of age. Younger refers to mothers under 30 years.

8
under 30 years. The risk of having a fetal death was over 3

times greater for black than for white drinkers (ratio of rates of

3.2).

Among women who consumed alcohol, fetal mortality

was greater for those drinking greater quantities of alcohol.

Rates for those drinking 5 or more drinks weekly were 4 times

those consuming 1 drink. The corresponding ratios for the

white and black population were 4.6 and 2.0, respectively. For

each category of alcohol consumption, fetal mortality rates

were higher for black than for white women.

Complications of labor and/or delivery

Occurrence of complications

Data on complications of labor and/or delivery for 29

States are shown in table 7. About 1 percent of the records had

missing information on complications (53,104 of the total

5,080,220 fetal deaths and live births).

Rates of complications of labor and/or delivery are shown

in table C. Among all deliveries of live births or fetal deaths,

the most common complications were meconium (57.4 per

1,000 live births and fetal deaths) and fetal distress (43.7). The

least common were seizures during labor (0.4) and anesthetic

complication (0.5).

Rates of selected complications varied by maternal age

(table C). Rates were higher for older women for eight complications. Placenta previa was the complication for which

older women had the highest ratio of rates relative to younger

women (2.2). However, rates were lower for older than for

younger women for four complications, most notably, seizures

during labor (40 percent).

Rates for eight selected complications of labor were

greater for black than for white women (table C). The ratio of

rates for seizures during labor and febrile was 1.5, and the

ratio for meconium was 1.6. In contrast, rates for five

complications—including prolonged labor (0.7), other excessive bleeding (0.7), and breech/malpresentation (0.7)— were

smaller for black than for white women.

Association of complications with fetal death

Studies have shown that certain complications of labor

and/or delivery, including hemorrhaging, abruptio placenta,

and placenta previa, may be associated with fetal deaths

(20,30,34). Furthermore, complications of labor are more

likely to occur among fetal deaths occurring during the labor

and delivery process than among live births (19).

Table 8 presents fetal mortality in relation to complications of labor and/or delivery for 29 States. The presence or

absence of complications was not reported for 3,681 (10 percent) of the 37,599 women delivering a fetal death.

Fetal mortality rates differ by type of complication (table D

and figure 5). The risks were greatest for the complications of

abruptio placenta, with a rate of 96.9 fetal deaths per 1,000

live births and fetal deaths (i.e., approximately a tenth of

deliveries complicated by abruptio placenta terminated in a

fetal death) and cord prolapse (58.2).

For 6 of the 15 complications of labor and/or delivery

(table D), fetal mortality rates were greater for women 30–49

than for women under age 30 years. The rates were 3 times

greater for older women for seizures during labor, and between

10–90 percent greater for five other complications. In contrast,

rates were 50 percent lower for older women for placenta

previa, and rates were lower for two other conditions.

For black women (table D), risks of a pregnancy with a

complication of labor and/or delivery resulting in a fetal loss

were greater than for white women for 10 of the complications. For example, the ratio of black-to-white rates for

breech/malpresentation was 2.7. In contrast, the risks were

lower for black than for white women for seizures during

labor (0.8).

Congenital anomalies of the fetus

Occurrence of congenital anomalies

Table 9 presents data on 21 selected congenital anomalies

in 26 States. The presence or absence of congenital anomalies

was not reported for 65,025, or 1 percent, of live births and

fetal deaths.

Among the selected congenital anomalies (table E),

other musculoskeletal/integumental anomalies were most

Febrile

Meconium, moderate/heavy

Premature rupture of

membranes

Abruptio placenta

Placenta previa

Other excessive bleeding

Seizures during labor

Precipitous labor

Prolonged labor

Dysfunctional labor

Breech/malpresentation

Cephalopelvic disproportion

Cord prolapse

Anesthetic complications

Fetal distress

No complications

Complications of labor and/or delivery

0 20 40 60 80

Rate per 1,000 live births and fetal deaths

100

Figure 5. Fetal mortality by complications of labor and/or

delivery: Total of 29 States, 1989–90

9
common, with a reported rate of occurrence of 225.7 cases

per 100,000 live births and fetal deaths. Other circulatory/

respiratory anomalies were the next most frequently reported

condition with a rate of 158.8. The lowest rate was for

microcephalus (11.5).

For several anomalies, there were distinctive patterns of

occurrence by maternal age (table E). Rates increased with age

for five congenital anomalies. In the case of Down’s syndrome, rates were 2.4 times greater for women aged 30–49

years than for women under 30 years. In contrast, omphalocele/

gastroschisis (about 50 percent), anencephalus (about 30 percent), and polydactyly/syndactyly/adactyly (about 20 percent)

were less common for women aged 30–49 years.

Rates of occurrence for the selected congenital anomalies

except for polydactyly/syndactyly/adactyly tended to be greater

for white than black women (table E). The smallest ratio of

black-to-white rates is 0.4 for cleft lip/palate while the largest

is 3.3 for polydactyly/syndactyly/adactyly.

Fetal mortality by congenital anomalies

Congenital anomalies are frequently reported as a cause

of fetal death and are the leading cause of infant death (18,38).

The following section indicates the mortality risk for having a

fetal death. Studies of specific anomalies, particularly in the

case of anencephaly, provide a more complete picture of the

risks for death when the condition is present. Increasingly,

women are electing to abort pregnancies in which the fetus is

detected as having anencephaly or other serious anomalies

(21,25). Fetal mortality remains a risk for those pregnancies

that are continued. Even for those infants born alive, risks for

death may still be high (18,21). This report does not include

data on either induced terminations of pregnancy or infant

mortality.

Table 10 shows fetal mortality rates by congenital anomalies for 26 States. Responses to the items on congenital

anomalies were missing for 4,241 (11 percent) of the 37,127

women delivering a fetal death.

Among pregnancies of fetuses with certain congenital

anomalies, the risk of fetal death was high (figure 6 and

table F). The risk was greatest for anencephalus, with a rate

of 467.5 fetal deaths per 1,000 live births and fetal deaths

with anencephalus, or almost 50 percent. The risks were

also substantial for renal agenesis (244.8) and hydrocephalus (215.9). Although a very small proportion of all

deliveries have specific congenital anomalies (table E), for

those women carrying a fetus with a congenital anomaly,

the risks of that fetus dying before birth were high. Based

on data from fetal death reports and birth certificates, the

greatest risk for fetal loss was for anencephaly for which

just under half of anencephalic fetuses terminated as fetal

deaths.

Table E. Rate and confidence intervals of congenital anomaly occurrences by selected congenital anomalies, age and race of mother,

and ratio of occurrence rates: Total of 26 States, 1989–90

[Rates are number of deliveries with specified congenital anomaly per 100,000 live births and fetal deaths to mothers of specified age]

Selected congenital anomaly

Maternal age Race

Ratio of

All ages Under 30 years 30–49 years White Black occurrence rate

Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval

Oldertoyounger1

Blacktowhite

Anencephalus .............. 23.4 (22.1,24.8) 25.7 (23.4,28.0) 17.8 (15.0,20.6) 24.5 (22.9,26.0) 18.3 (15.5,21.2) 0.7 0.7

Spina bifida/meningocele ....... 31.4 (29.9,33.0) 32.4 (30.3,34.4) 29.1 (26.0,32.1) 34.4 (32.6,36.2) 20.9 (17.9,24.0) 0.9 0.6

Hydrocephalus .............. 36.0 (34.4,37.7) 36.6 (34.4,38.8) 34.5 (30.9,38.2) 36.4 (34.5,38.3) 37.5 (33.4,41.6) 0.9 1.0

Microcephalus . . . . . . . . . . . . . . 11.5 (10.6,12.5) 11.5 (10.3,12.7) 11.6 (9.7,13.5) 11.5 (10.4,12.5) 12.0 (9.7,14.3) 1.0 1.0

Other central nervous system

anomalies ................ 33.3 (31.7,34.9) 33.2 (31.1,35.3) 33.4 (30.0,36.8) 34.2 (32.4,36.1) 29.9 (26.2,33.5) 1.0 0.9

Heart malformations .......... 130.4 (127.2,133.6) 127.4 (123.6,131.2) 137.8 (131.5,144.1) 131.8 (128.2,135.4) 129.0 (121.4,136.6) 1.1 1.0

Other circulatory/respiratory

anomalies ................ 158.8 (155.3,162.3) 155.4 (151.2,159.5) 167.4 (160.6,174.3) 167.3 (163.2,171.3) 122.1 (114.6,129.5) 1.1 0.7

Rectal atresia/stenosis ......... 12.4 (11.4,13.3) 12.4 (11.2,13.6) 12.2 (10.3,14.1) 13.0 (11.9,14.1) 9.6 (7.6,11.7) 1.0 0.7

Tracheo-esophageal fistula/

esophageal atresia .......... 16.0 (14.9,17.1) 14.8 (13.5,16.1) 18.8 (16.5,21.1) 17.4 (16.1,18.7) 9.6 (7.6,11.7) 1.3 0.6

Omphalocele/gastroschisis ...... 28.0 (26.6,29.5) 32.4 (30.4,34.4) 17.2 (14.8,19.7) 28.4 (26.7,30.0) 28.7 (25.1,32.3) 0.5 1.0

Other gastrointestinal anomalies . . . 41.0 (39.2,42.8) 42.2 (40.0,44.4) 38.0 (34.6,41.3) 41.4 (39.3,43.4) 42.1 (37.7,46.5) 0.9 1.0

Malformed genitalia ........... 86.6 (84.0,89.2) 87.0 (83.9,90.1) 85.7 (80.8,90.6) 93.5 (90.5,96.5) 62.0 (56.7,67.3) 1.0 0.7

Renal agenesis . . . . . . . . . . . . . 11.6 (10.7,12.6) 11.8 (10.5,13.1) 11.3 (9.3,13.3) 12.7 (11.6,13.8) 8.2 (6.3,10.2) 1.0 0.6

Other urogenital anomalies ...... 124.1 (121.1,127.2) 124.3 (120.6,128.0) 123.7 (117.9,129.6) 137.7 (134.0,141.3) 76.1 (70.2,81.9) 1.0 0.6

Cleft lip/palate .............. 97.5 (94.8,100.3) 96.9 (93.6,100.2) 99.1 (93.7,104.4) 107.5 (104.3,110.8) 47.3 (42.7,51.9) 1.0 0.4

Polydactyly/syndactyly/adactyly .... 97.5 (94.8,100.3) 103.3 (100.0,106.7) 83.0 (78.2,87.9) 69.8 (67.2,72.4) 232.8 (222.6,243.1) 0.8 3.3

Club foot ................. 63.9 (61.7,66.1) 65.7 (63.0,68.4) 59.5 (55.4,63.6) 70.6 (67.9,73.2) 40.5 (36.2,44.7) 0.9 0.6

Diaphragmatic hernia .......... 14.6 (13.6,15.7) 13.7 (12.5,15.0) 16.9 (14.6,19.1) 16.0 (14.7,17.2) 9.2 (7.1,11.2) 1.2 0.6

Other musculoskeletal/integumental

anomalies ................ 225.7 (221.6,229.9) 225.2 (220.2,230.2) 227.1 (219.2,235.1) 231.7 (226.9,236.4) 205.3 (195.7,214.9) 1.0 0.9

Down’s syndrome ............ 57.1 (55.0,59.2) 41.1 (38.9,43.2) 97.1 (91.7,102.5) 61.6 (59.2,64.1) 40.6 (36.3,44.8) 2.4 0.7

Other chromosomal anomalies .... 57.2 (55.1,59.3) 51.1 (48.5,53.6) 72.5 (67.6,77.4) 58.5 (56.1,60.8) 52.7 (47.8,57.6) 1.4 0.9

1Older refers to mothers 30–49 years of age. Younger refers to mothers under 30 years.

10
For women who were carrying a fetus with a congenital

anomaly (table F), the risk of having a fetal loss was greater

for those aged 30–49 years than for those under 30 years for 4

of the 21 specific anomalies. In the case of Down’s syndrome,

the mortality rate was 1.8 times greater for women aged 30–49

years than for those under 30 years. None of the other

differences by age are statistically significant. However, when

the number of cases is small, as it is with congenital anomalies, statistical tests may not be powerful enough to distinguish

true differences.

Fetal mortality rates were greater for black than for white

women for cleft lip/palate (2.0) (table F). In contrast, rates

were smaller for black women for polydactyly/syndactyly/

adactyly (0.4).

Anencephalus

Spina bifida/meningocele

Hydrocephalus

Microcephalus

Other central nervous

system anomalies

Heart malformations

Other circulatory/

respiratory anomalies

Rectal atresia/stenos

Tracheo esophageal fistula/

esophageal atresia

Omphalocele/gastroschisis

Other gastrointestional

anomalies

Malformed genitalia

Renal agenesis

Other urogenital anomal

Cleft lip/palate

Polydactyly/syndactyly/

adactyly

Club foot

Diaphragmatic hernia

Other musculoskeletal/

integumental anomalies

Down’s syndrome

Other chromosomal

anomalies

No anomalies

Congenital anomalies

0 100 200 300 400 500

Rate per 1,000 live births and fetal deaths

Figure 6. Fetal mortality by selected fetal anomalies: Total of 26

States, 1989–90

11
Table F. Rate and confidence intervals of fetal mortality by selected congenital anomalies, age and race of mother, and ratio of fetal

mortality rates: Total of 26 States, 1989–90

[Rates are number of fetal deaths with specified congenital anomaly per 1,000 live births and fetal deaths with specified congenital anomaly]

Selected congenital anomaly

Maternal age Race

Ratio of fetal

All ages Under 30 years 30–49 years White Black mortality rate

Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval Rate

95-percent

confidence

interval

Oldertoyounger1

Blacktowhite

All fetal deaths . . . . . . . . . . . . . . 7.4 (7.4,7.5) 7.2 (7.2,7.3) 7.9 (7.8,8.1) 6.3 (6.2,6.4) 13.0 (12.9,13.4) 1.1 2.1

No anomalies . . . . . . . . . . . . . . 5.0 (4.9,5.1) 4.9 (4.8,5.0) 5.2 (5.2,5.4) 4.1 (4.1,4.2) 9.8 (9.7,10.1) 1.1 2.4

Anencephalus .............. 467.5 (428.3,506.7) 484.7 (439.5,529.8) 405.5 (327.2,483.8) 480.8 (437.1,524.6) 423.1 (321.0,525.1) 0.8 0.9

Spina bifida/meningocele ....... 155.7 (136.2,175.2) 153.6 (131.0,176.3) 161.4 (122.8,200.1) 162.9 (141.4,184.3) * * 1.1 *

Hydrocephalus .............. 215.9 (194.4,237.4) 187.1 (163.6,210.6) 292.1 (244.4,339.8) 217.8 (193.7,241.9) 216.3 (165.3,267.3) 1.6 1.0

Microcephalus .............. 132.4 (102.6,162.2) 134.8 (99.2,170.4) 126.5 (72.4,180.6) 126.1 (93.4,158.8) * * 0.9 *

Other central nervous system

anomalies ................ 197.6 (176.2,219.0) 184.3 (159.8,208.7) 230.6 (187.5,273.7) 193.2 (169.8,216.6) 228.3 (169.6,287.1) 1.3 1.2

Heart malformations .......... 53.4 (47.8,59.0) 46.1 (39.8,52.3) 70.2 (58.5,81.9) 50.9 (44.8,57.1) 60.2 (45.6,74.7) 1.5 1.2

Other circulatory/respiratory

anomalies ................ 40.2 (35.7,44.6) 37.8 (32.7,42.9) 45.6 (37.0,54.2) 39.4 (34.6,44.2) 47.2 (34.0,60.4) 1.2 1.2

Rectal atresia/stenosis ......... 71.4 (50.3,92.5) 70.1 (45.4,94.8) 74.7 (34.1,115.3) 64.3 (42.4,86.3) * * 1.1 *

Tracheo-esophageal fistula/

esophageal atresia .......... 40.2 (26.3,54.1) 41.7 (24.3,59.1) 37.3 (14.2,60.4) 39.2 (24.4,54.0) * * 0.9 *

Omphalocele/gastroschisis ...... 156.7 (135.9,177.4) 142.4 (120.6,164.1) 223.6 (164.5,282.7) 151.9 (129.1,174.8) 176.2 (123.6,228.9) 1.6 1.2

Other gastrointestinal anomalies . . . 73.4 (61.6,85.1) 72.6 (58.9,86.2) 75.6 (52.5,98.8) 78.4 (64.8,92.0) * * 1.0 *

Malformed genitalia ........... 36.6 (30.9,42.3) 35.2 (28.6,41.8) 40.1 (28.8,51.3) 34.1 (28.2,40.1) 51.2 (31.9,70.6) 1.1 1.5

Renal agenesis ............. 244.8 (204.6,285.1) 243.4 (196.2,290.7) 248.4 (171.5,325.4) 250.0 (206.2,293.8) * * 1.0 *

Other urogenital anomalies ...... 32.0 (27.5,36.4) 31.9 (26.6,37.1) 32.3 (23.9,40.7) 29.4 (24.9,34.0) 49.5 (32.3,66.6) 1.0 1.7

Cleft lip/palate .............. 59.2 (52.4,66.1) 54.5 (46.7,62.3) 70.7 (56.9,84.6) 53.3 (46.3,60.2) 107.0 (75.0,138.9) 1.3 2.0

Polydactyly/syndactyly/adactyly .... 36.4 (31.0,41.8) 32.9 (27.0,38.8) 47.3 (34.9,59.6) 47.9 (39.7,56.1) 18.2 (12.2,24.1) 1.4 0.4

Club foot ................. 52.1 (44.2,60.0) 51.8 (42.5,61.0) 53.0 (37.5,68.5) 48.5 (40.3,56.7) 75.6 (46.5,104.6) 1.0 1.6

Diaphragmatic hernia .......... 65.8 (47.2,84.4) 49.1 (29.4,68.7) 99.6 (59.7,139.4) 61.8 (42.4,81.2) * * 2.0 *

Other musculoskeletal/integumental

anomalies ................ 35.8 (32.3,39.3) 35.6 (31.4,39.7) 36.4 (29.8,43.0) 33.4 (29.6,37.1) 47.0 (36.8,57.1) 1.0 1.4

Down’s syndrome ............ 72.7 (62.8,82.6) 52.0 (40.3,63.7) 94.5 (78.3,110.7) 69.9 (59.4,80.4) 95.7 (63.0,128.3) 1.8 1.4

Other chromosomal anomalies .... 165.8 (150.9,180.8) 153.5 (135.5,171.6) 187.4 (161.1,213.8) 164.3 (147.7,180.8) 162.9 (125.6,200.3) 1.2 1.0

* Figure does not meet standard of reliability or precision.

1Older refers to mothers 30–49 years of age. Younger refers to mothers under 30 years.

12
References

1. National Center for Health Statistics. Advance report of new

data from the 1989 birth certificate. Monthly vital statistics

report; vol 40 no 12, suppl. Hyattsville, Maryland: Public

Health Service. 1992.

2. National Center for Health Statistics. Advance report of maternal and infant health data from the birth certificate, 1990.

Monthly vital statistics report; vol 42 no 2, suppl. Hyattsville,

Maryland: Public Health Service. 1993.

3. Hoyert DL. Perinatal mortality in the United States, 1985–91.

National Center for Health Statistics. Vital Health Stat 20(26).

1995.

4. Gaudino JA, Hoyert DL, MacDorman MF, Gazmarian JA,

Adams MM, and Kiely JL. Fetal deaths. In: Wilcox LS and

Marks JS, eds. From Data to Action: CDC’s Public Health

Surveillance for Women, Infants, and Children. Atlanta: U.S.

Department of Health and Human Services. 163–78. 1995.

5. Watkins ML, Edmonds L, McClearn A, Mullins L, Mulinare J,

and Khoury M. The surveillance of birth defects: The usefulness of the revised U.S. Standard Birth Certificate. American

Journal of Public Health 86(5): 731–4. 1996.

6. Woolbright LA, Harshbarger DS. The revised standard certificate of live birth: Analysis of medical risk factor data from birth

certificates in Alabama, 1988–92. Public Health Reports 110:

59–63. 1995.

7. National Office of Vital Statistics. International Recommendations on Definitions of Live Birth and Fetal Death. Public

Health Service. Washington: 1950.

8. Balamuth E. Health interview responses compared with medical

records. Vital Health Stat 2(7). 1965.

9. Laurent A, Cannell CF, Marquis KH, and Survey Research

Center, Institute for Social Research, The University of Michigan. Reporting health events in household interviews: Effects of

an extensive questionnaire and a diary procedure. Vital Health

Stat 2(49). 1972.

10. National Center for Health Statistics. Reporting chronic conditions in the National Health Interview Survey: A review of

tendencies from evaluation studies and methodological test.

Vital Health Stat 2(105). 1987.

11. Holmes AE, Rutenberg GW, and Larimer GC. Quality of new

medical data from the revised Texas certificate of Live Birth.

Proceedings of the 1991 Public Health Conference on Records

and Statistics. Washington, D.C. National Center for Health

Statistics, 1991.

12. Hexter AC, Harris JA, Roeper P, Croen LA, Krueger P, Gant D.

Evaluation of the hospital discharge diagnoses index and the

birth certificate as sources of information on birth defects.

Public Health Reports 105: 296–307. 1990.

13. Piper JM, Mitchel EF Jr., Snowden M, Hall C, Adams M, and

Taylor P. Validation of 1989 Tennessee birth certificates using

maternal and newborn hospital records. American Journal of

Epidemiology 137:758–68. 1993.

14. Buescher PA, Taylor KP, Davis MH, and Bowling M. The quality

of the new birth certificate data: A validation study in North

Carolina. American Journal of Public Health 83:1163–65. 1993.

15. O’Reilly MP. A birth certificate audit program in Pennsylvania.

Proceedings of the 1991 Public Health Conference on Records

and Statistics. Washington, D.C. National Center for Health

Statistics, 1991.

16. Parrish KM, Holt VL, Connell FA, Williams B, and LoGerfo JP.

Variations in the accuracy of obstetric procedures and diagnoses

on birth records in Washington State, 1989. American Journal of

Epidemiology 138(2): 119–27. 1993.

17. Kirby RS. Cesarean section deliveries: Improved data from the

1989 national Standard Certificates of Live Birth and Fetal

Death. Proceedings of the 1991 Public Health Conference on

Records and Statistics. Washington, D.C.: National Center for

Health Statistics, 1991.

18. Kalter H. Five-decade international trends in the relation of

perinatal mortality and congenital malformations: stillbirth and

neonatal death compared. International Journal of Epidemiology 20: 173–79. 1991.

19. Alessandri LM, Stanley FJ. A case-control study of intrapartum

stillbirths. British Journal of Obstetrics and Gynaecology 99:719–

23. 1992.

20. Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW,

Atrash HK. The epidemiology of placenta previa in the United

States, 1979 through 1987. American Journal of Obstetrics and

Gynecology 168: 1424–9. 1993.

21. Limb CJ, Holmes LB. Anencephaly: Changes in prenatal detection and birth status, 1972 through 1990. American Journal of

Obstetrics and Gynecology 170: 1333–8. 1994.

22. Centers for Disease Control and Prevention. Down’s syndrome

prevalence at birth—United States, 1983–90. Morbidity and

mortality weekly report 43(33): 617–22. 1994.

23. Kalucy M, Bower C, Stanley F, and Burton P. Survival of

infants with neural tube defects in Western Australia 1966–90.

Paediatric and Perinatal Epidemiology 8: 334–51. 1994.

24. Centers for Disease Control and Prevention. Prevention program for reducing risk for neural tube defects—South Carolina,

1992–94. Morbidity and mortality weekly reports 44(8). 1995.

25. EUROCAT Working Group. Prevalence of neural tube defects

in 20 regions of Europe and the impact of prenatal diagnosis,

1980–86. Journal of Epidemiology and Community Health 45:

52–8. 1991.

26. Yen IH, Khoury MJ, Erickson D, James LM, Waters GD, and

Berry RJ. The changing epidemiology of neural tube defects:

United States, 1968–89. American Journal of Diseases of Childhood 146: 857–61. 1992.

13
27. Schulman J, Edmonds LD, McClearn AB, Jensvold N, Shaw

GM. Surveillance for and comparison of birth defect prevalences in two geographic areas—United States, 1983–88. Morbidity and mortality weekly report 42(SS-1). 1993.

28. Serdula M, Williamson DF, Kendrick JS, et al. Trends in

alcohol consumption by pregnant women: 1985 through 1988.

Journal of the American Medical Association 265(7): 876–9.

1991.

29. National Center for Health Statistics. Health, United States,

1993. Hyattsville, MD. Public Health Service, 1994.

30. Knab DR. Abruptio placentae: An assessment of the time and

method of delivery. Obstetrics and gynecology 128: 625–9.

1978.

31. Cnattingius S, Haglund B, and Meirik O. Cigarette smoking as

risk factor for late fetal and early neonatal death. BMJ 297:

258–60. 1988.

32. Barros FC, Huttly SRA, Victora CG, Kirkwood BR, and

Vaughan JP. Comparison of the causes and consequences of

prematurity and intrauterine growth retardation: A longitudinal

study in Southern Brazil. Pediatrics 90: 238–44. 1992.

33. Ferraz EM, and Gray EM. A case-control study of stillbirths in

Northeast Brazil. International Journal of Gynecological Obstetrics 34: 13–9. 1990.

34. Williams MA, Lieberman E, Mittendorf R, Monson RR, and

Schoenbaum SC. Risk factors for abruptio placentae. Am J

Epidemiol 134: 965–72. 1991.

35. Chandra A. Health aspects of pregnancy and childbirth: United

States, 1982–88. National Center for Health Statistics. Vital

Health Stat 23(18). 1995.

36. American Medical Association. Fetal effects of maternal alcohol

use. JAMA 249(18): 2517–21. 1983.

37. Centers for Disease Control. Fetal alcohol syndrome—United

States, 1979–92. Morbidity and mortality weekly report 42(17).

1993.

38. National Center for Health Statistics. Advance report of final

mortality statistics, 1991. Monthly vital statistics report; vol 42

no 2, suppl. Hyattsville, Maryland: Public Health Service. 1993.

39. National Center for Health Statistics. Model State Vital Statistics Act and Model State Vital Statistics Regulations. Washington: Public Health Service. 1978.

40. National Center for Health Statistics. Vital statistics of the

United States, 1989, vol II, mortality, part A. Washington:

Public Health Service. 1993.

41. Hoyert DL. Effect on mortality rates of the 1989 change in

tabulating race. National Center for Health Statistics. Vital

Health Stat 20(25). 1994.

42. Brockert JE, Stockbauer JW, Senner JW, et al. Recommended

standard medical definitions for the U.S. Standard Certificate of

Live Birth, 1989 revision. Paper presented at Annual Meeting of

the Association for Vital Records and Health Statistics. 1990.

43. Greb AE, Pauli RM, Kirby RS. Accuracy of fetal death reports:

Comparison with data from an independent stillbirth assessment

program. Am J Public Health 77:9, 1202–6. 1987.

14
List of detailed tables

1. Number and rate of deliveries by race of mother, selected

medical risk factors, whether risk factor was reported, and

age of mother: Total of 28 States, 1989–90 . . . . . . . . . . 16

2. Number of fetal deaths and fetal mortality rate by race of

mother, selected medical risk factors, whether medical risk

factor was reported, and age of mother: Total of 28 States,

1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3. Number and percent distribution of deliveries by race and

smoking status of mother, according to age of mother:

Total of 25 States, 1989–90 . . . . . . . . . . . . . . . . . . . . . 18

4. Number of fetal deaths and fetal mortality rate by race,

smoking status, and age of mother: Total of 25 States,

1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

5. Number and percent distribution of deliveries by race and

alcohol use of mother, according to age of mother: Total of

26 States, 1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

6. Number of fetal deaths and fetal mortality rate by race,

alcohol use, and age of mother: Total of 26 States,

1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

7. Number and rate of deliveries by race of mother,

selected medical complications, whether complications

were reported, and age of mother: Total of 29 States,

1989–90 ................................... 22

8. Number of fetal deaths and fetal mortality rate by race of

mother, selected medical complications of labor and/or

delivery, whether complication was reported, and age of

mother: Total of 29 States, 1989–90 ............... 23

9. Number and rate of deliveries by race of mother,

selected congenital anomalies of child, whether anomalies were reported, and age of mother: Total of 26

States, 1989–90 .............................. 24

10. Number of fetal deaths and fetal mortality rate by race of

mother, selected congenital anomalies of child, whether

anomalies were reported, and age of mother: Total of 26

States, 1989–90 .............................. 26

15
Table 1. Number and rate of deliveries by race of mother, selected medical risk factors, whether risk factor was reported, and age of

mother: Total of 28 States, 1989–90

Race of mother and

selected medical risk factor

All live

births

and deaths1

Risk

factor

reported

Age of mother

Risk

factor

not stated

All

ages

Under

30 years

30–49

years

All races3 Number Rate2 Number

Anemia ................................... 4,931,210 76,518 15.5 17.1 11.7 58,875

Cardiac disease .............................. 4,931,210 14,148 2.9 2.5 3.8 58,875

Acute or chronic lung disease ..................... 4,931,210 13,434 2.7 2.7 2.9 58,875

Diabetes ................................... 4,931,210 94,661 19.2 14.2 31.5 58,875

Genital herpes ............................... 4,931,210 38,054 7.7 6.9 9.8 63,872

Hydramnios/Oligohydramnios ...................... 4,931,210 27,496 5.6 5.4 6.0 60,400

Hemoglobinopathy ............................ 4,931,210 2,085 0.4 0.4 0.4 60,400

Hypertension, chronic .......................... 4,931,210 31,390 6.4 4.5 11.0 58,875

Hypertension, pregnancy-associated ................. 4,931,210 129,509 26.3 26.4 25.9 58,875

Eclampsia .................................. 4,931,210 20,053 4.1 4.3 3.6 58,875

Incompetent cervix ............................ 4,931,210 16,633 3.4 2.8 4.7 60,400

Previous infant 4,000 grams or more ................. 4,931,210 55,588 11.3 8.4 18.4 60,400

Previous preterm or small-for-gestational-age infant ........ 4,931,210 68,716 13.9 12.5 17.4 60,400

Renal disease ............................... 4,931,210 13,007 2.6 2.9 2.1 58,875

Rh sensitization .............................. 4,852,999 31,084 6.4 6.2 7.0 60,351

Uterine bleeding .............................. 4,931,210 41,440 8.4 7.8 9.9 62,347

White

Anemia ................................... 3,914,823 48,928 12.5 13.5 10.2 43,419

Cardiac disease .............................. 3,914,823 11,771 3.0 2.6 3.9 43,419

Acute or chronic lung disease ..................... 3,914,823 9,991 2.6 2.4 2.8 43,419

Diabetes ................................... 3,914,823 76,561 19.6 14.8 30.4 43,419

Genital herpes ............................... 3,914,823 31,196 8.0 6.8 10.8 47,833

Hydramnios/Oligohydramnios ...................... 3,914,823 21,368 5.5 5.3 5.9 44,900

Hemoglobinopathy ............................ 3,914,823 838 0.2 0.2 0.2 44,900

Hypertension, chronic .......................... 3,914,823 21,764 5.6 4.1 9.0 43,419

Hypertension, pregnancy-associated ................. 3,914,823 103,721 26.5 26.9 25.6 43,419

Eclampsia .................................. 3,914,823 14,382 3.7 3.8 3.3 43,419

Incompetent cervix ............................ 3,914,823 13,340 3.4 2.9 4.6 44,900

Previous infant 4,000 grams or more ................. 3,914,823 50,402 12.9 9.7 20.3 44,900

Previous preterm or small-for-gestational-age infant ........ 3,914,823 52,075 13.3 11.8 16.8 44,900

Renal disease ............................... 3,914,823 10,516 2.7 2.9 2.1 43,419

Rh sensitization .............................. 3,845,205 28,261 7.3 7.1 7.9 44,744

Uterine bleeding .............................. 3,914,823 34,354 8.8 8.1 10.3 46,352

Black

Anemia ................................... 816,370 24,551 30.1 31.5 24.0 14,049

Cardiac disease .............................. 816,370 2,033 2.5 2.3 3.4 14,049

Acute or chronic lung disease ..................... 816,370 3,052 3.7 3.7 4.0 14,049

Diabetes ................................... 816,370 13,056 16.0 11.3 36.0 14,049

Genital herpes ............................... 816,370 6,214 7.6 8.0 6.0 14,572

Hydramnios/Oligohydramnios ...................... 816,370 5,173 6.3 6.0 7.6 14,084

Hemoglobinopathy ............................ 816,370 1,088 1.3 1.3 1.3 14,084

Hypertension, chronic .......................... 816,370 8,712 10.7 6.6 28.1 14,049

Hypertension, pregnancy-associated ................. 816,370 22,077 27.0 25.8 32.2 14,049

Eclampsia .................................. 816,370 5,193 6.4 6.3 6.4 14,049

Incompetent cervix ............................ 816,370 2,760 3.4 2.8 5.8 14,084

Previous infant 4,000 grams or more ................. 816,370 3,757 4.6 3.6 8.8 14,084

Previous preterm or small-for-gestational-age infant ........ 816,370 14,080 17.2 15.8 23.5 14,084

Renal disease ............................... 816,370 2,056 2.5 2.6 2.2 14,049

Rh sensitization .............................. 809,712 2,412 3.0 3.0 3.1 14,215

Uterine bleeding .............................. 816,370 5,911 7.2 6.9 8.6 14,537

1Total number of births and fetal deaths to residents of areas that report specified medical risk factor.

2Rates are number of deliveries with specified medical risk factor per 1,000 live births and fetal deaths to mothers of specified age.

3Includes races other than white and black.

NOTE: Table excludes data for Tennessee for all items and Kansas for Rh sensitization.

16
Table 2. Number of fetal deaths and fetal mortality rate by race of mother, selected medical risk factors, whether medical risk factor was

reported, and age of mother: Total of 28 States, 1989–90

Race of mother and

selected medical risk factor

Medical

risk

reported

in delivery1

Medical risk

reported

in fetal

death

Age of mother Specific

risk

not

present

Risk

not

All ages Under 30 years 30–49 years stated

All races2 Number Rate3 Number

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 7.3 7.9 . . . . . .

No medical risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 5.0 4.9 5.2 . . . . . .

Anemia ................................... 76,518 1,130 14.8 14.0 17.6 6.7 3,372

Cardiac disease .............................. 14,148 123 8.7 9.2 7.8 6.8 3,372

Acute or chronic lung disease ..................... 13,434 206 15.3 13.2 20.2 6.8 3,372

Diabetes ................................... 94,661 935 9.9 9.7 10.0 6.8 3,372

Genital herpes ............................... 38,054 202 5.3 5.5 5.0 6.9 3,402

Hydramnios/Oligohydramnios ...................... 27,496 1,333 48.5 47.9 49.8 6.6 3,391

Hemoglobinopathy ............................ 2,085 101 48.4 44.8 58.3 6.8 3,391

Hypertension, chronic .......................... 31,390 803 25.6 22.4 28.9 6.7 3,372

Hypertension, pregnancy-associated ................. 129,509 1,450 11.2 10.4 13.3 6.7 3,372

Eclampsia .................................. 20,053 230 11.5 10.5 14.4 6.8 3,372

Incompetent cervix ............................ 16,633 766 46.1 50.9 38.9 6.7 3,391

Previous infant 4,000 grams or more ................. 55,588 340 6.1 5.6 6.7 6.9 3,391

Previous preterm or small-for-gestational-age infant ........ 68,716 1,128 16.4 16.0 17.2 6.7 3,391

Renal disease ............................... 13,007 227 17.5 16.2 21.8 6.8 3,372

Rh sensitization .............................. 31,084 195 6.3 5.9 7.0 6.9 3,278

Uterine bleeding .............................. 41,440 1,583 38.2 41.2 32.3 6.6 3,383

White

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.1 6.9 . . . . . .

No medical risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 4.3 4.2 4.6 . . . . . .

Anemia ................................... 48,928 518 10.6 10.1 12.2 5.8 2,209

Cardiac disease .............................. 11,771 80 6.8 6.9 6.7 5.8 2,209

Acute or chronic lung disease ..................... 9,991 151 15.1 12.9 19.6 5.8 2,209

Diabetes ................................... 76,561 640 8.4 8.3 8.5 5.8 2,209

Genital herpes ............................... 31,196 138 4.4 4.6 4.2 5.9 2,234

Hydramnios/Oligohydramnios ...................... 21,368 1,055 49.4 48.2 51.7 5.6 2,226

Hemoglobinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 838 66 78.8 78.0 80.1 5.8 2,226

Hypertension, chronic .......................... 21,764 428 19.7 17.7 21.8 5.8 2,209

Hypertension, pregnancy-associated ................. 103,721 920 8.9 8.3 10.2 5.8 2,209

Eclampsia .................................. 14,382 136 9.5 9.1 10.5 5.8 2,209

Incompetent cervix ............................ 13,340 482 36.1 39.1 31.9 5.7 2,226

Previous infant 4,000 grams or more ................. 50,402 266 5.3 4.8 5.8 5.8 2,226

Previous preterm or small-for-gestational-age infant ........ 52,075 716 13.7 13.2 14.7 5.7 2,226

Renal disease ............................... 10,516 149 14.2 13.5 16.5 5.8 2,209

Rh sensitization .............................. 28,261 169 6.0 5.7 6.7 5.9 2,123

Uterine bleeding .............................. 34,354 1,095 31.9 33.7 28.5 5.6 2,217

Black

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 13.2 12.4 16.6 . . . . . .

No medical risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 8.7 8.4 10.3 . . . . . .

Anemia ................................... 24,551 589 24.0 21.7 36.9 11.7 1,044

Cardiac disease .............................. 2,033 38 18.7 19.2 * 12.1 1,044

Acute or chronic lung disease ..................... 3,052 50 16.4 14.4 * 12.1 1,044

Diabetes ................................... 13,056 256 19.6 18.3 21.4 12.0 1,044

Genital herpes ............................... 6,214 60 9.7 8.9 * 12.1 1,049

Hydramnios/Oligohydramnios ...................... 5,173 241 46.6 46.9 45.5 11.9 1,046

Hemoglobinopathy ............................ 1,088 35 32.2 28.4 * 12.1 1,046

Hypertension, chronic .......................... 8,712 353 40.5 34.4 46.6 11.8 1,044

Hypertension, pregnancy-associated ................. 22,077 485 22.0 19.1 31.7 11.8 1,044

Eclampsia .................................. 5,193 91 17.5 14.6 29.9 12.1 1,044

Incompetent cervix ............................ 2,760 270 97.8 102.7 87.7 11.8 1,046

Previous infant 4,000 grams or more ................. 3,757 51 13.6 11.7 16.8 12.1 1,046

Previous preterm or small-for-gestational-age infant ........ 14,080 381 27.1 25.2 32.2 11.8 1,046

Renal disease ............................... 2,056 69 33.6 29.1 * 12.1 1,044

Rh sensitization .............................. 2,412 24 10.0 * * 12.1 1,036

Uterine bleeding .............................. 5,911 451 76.3 78.3 69.4 11.6 1,047

. . . Category not applicable. – Quantity zero. * Figure does not meet standard of reliability or precision.

1Total number of births and fetal deaths with medical risk to residents of areas reporting specified medical risk factor.

2Includes races other than white and black.

3Rates are number of fetal deaths with specified medical risk factor per 1,000 live births and fetal deaths with specified medical risk factor.

NOTE: Table excludes data for Tennessee for all items and Kansas for Rh sensitization

17
Table 3. Number and percent distribution of deliveries by race and smoking status of mother, according to age of mother: Total of 25

States, 1989–90

Race and

smoking status of mother

Age of mother

All ages Under 30 years 30–49 years

All races1 Number2

Total ..................................... 3,651,470 2,638,477 1,012,993

Smoker .................................. 735,843 574,309 161,569

Nonsmoker ............................... 2,915,627 2,064,168 851,424

White .................................... 2,841,644 1,990,111 851,533

Smoker .................................. 604,296 475,601 128,743

Nonsmoker ............................... 2,237,348 1,514,510 722,790

Black ..................................... 732,545 597,367 135,178

Smoker .................................. 123,461 92,329 31,147

Nonsmoker ............................... 609,084 505,038 104,031

All races

Smoker ................................... 735,843 574,309 161,569

1–5 cigarettes .............................. 142,994 114,028 28,970

6–10 cigarettes ............................. 279,997 225,106 54,893

11 cigarettes or more ......................... 312,852 235,175 77,706

White

Smoker ................................... 604,296 475,601 128,743

1–5 cigarettes .............................. 100,985 80,715 20,275

6–10 cigarettes ............................. 223,391 182,168 41,222

11 cigarettes or more ......................... 279,920 212,718 67,246

Black

Smoker ................................... 123,461 92,329 31,147

1–5 cigarettes .............................. 39,702 31,484 8,230

6–10 cigarettes ............................. 53,531 40,437 13,101

11 cigarettes or more ......................... 30,228 20,408 9,816

All races1 Percent distribution3

Total ..................................... 100.0 100.0 100.0

Smoker .................................. 20.2 21.8 15.9

Nonsmoker ............................... 79.8 78.2 84.1

White .................................... 100.0 100.0 100.0

Smoker .................................. 21.3 23.9 15.1

Nonsmoker ............................... 78.7 76.1 84.9

Black ..................................... 100.0 100.0 100.0

Smoker .................................. 16.9 15.5 23.0

Nonsmoker ............................... 83.1 84.5 77.0

All races

Smoker ................................... 100.0 100.0 100.0

1–5 cigarettes .............................. 19.4 19.9 17.9

6–10 cigarettes ............................. 38.1 39.2 34.0

11 cigarettes or more ......................... 42.5 40.9 48.1

White

Smoker ................................... 100.0 100.0 100.0

1–5 cigarettes .............................. 16.7 17.0 15.7

6–10 cigarettes ............................. 37.0 38.3 32.0

11 cigarettes or more ......................... 46.3 44.7 52.2

Black

Smoker ................................... 100.0 100.0 100.0

1–5 cigarettes .............................. 32.2 34.1 26.4

6–10 cigarettes ............................. 43.4 43.8 42.1

11 cigarettes or more ......................... 24.5 22.1 31.5

1Includes races other than white and black.

2Not stated tobacco use is distributed.

3Percents are number of fetal deaths and live births with specified smoking status per 100 live births and fetal deaths.

NOTE: Table excludes data for California, Indiana, South Dakota, and West Virginia.

18
Table 4. Number of fetal deaths and fetal mortality rate by race, smoking status, and age of mother: Total of 25 States,1989–90

Race and

smoking status of mother

Age of mother

All ages Under 30 years 30–49 years

All races1 Number

Total ..................................... 27,985 19,751 8,234

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,118 5,234 1,883

Nonsmoker ............................... 20,867 14,517 6,351

White .................................... 17,913 12,109 5,804

Smoker .................................. 4,979 3,736 1,239

Nonsmoker ............................... 12,934 8,373 4,565

Black ..................................... 9,599 7,335 2,264

Smoker .................................. 2,072 1,444 628

Nonsmoker ............................... 7,527 5,891 1,636

All races

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,118 5,234 1,883

1–5 cigarettes .............................. 1,347 995 352

6–10 cigarettes ............................. 2,674 2,066 604

11 cigarettes or more ......................... 3,097 2,174 926

White

Smoker ................................... 4,979 3,736 1,239

1–5 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 736 547 189

6–10 cigarettes ............................. 1,762 1,403 354

11 cigarettes or more ......................... 2,481 1,786 696

Black

Smoker ................................... 2,072 1,444 628

1–5 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605 441 163

6–10 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892 645 246

11 cigarettes or more . . . . . . . . . . . . . . . . . . . . . . . . . 576 359 218

All races1 Rate2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 7.5 8.1

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.7 9.1 11.7

Nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 7.0 7.5

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.1 6.8

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2 7.9 9.6

Nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 5.5 6.3

Black ..................................... 13.1 12.3 16.7

Smoker .................................. 16.8 15.6 20.2

Nonsmoker ............................... 12.4 11.7 15.7

All races

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.7 9.1 11.7

1–5 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.4 8.7 12.2

6–10 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 9.2 11.0

11 cigarettes or more . . . . . . . . . . . . . . . . . . . . . . . . . 9.9 9.2 11.9

White

Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2 7.9 9.6

1–5 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 6.8 9.3

6–10 cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 7.7 8.6

11 cigarettes or more . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 8.4 10.4

Black

Smoker ................................... 16.8 15.6 20.2

1–5 cigarettes .............................. 15.2 14.0 19.8

6–10 cigarettes ............................. 16.7 15.9 18.8

11 cigarettes or more ......................... 19.0 17.6 22.2

1Includes races other than white and black.

2Rates are number of fetal deaths with specified tobacco use per 1,000 live births and fetal deaths with specified tobacco use.

NOTE: Table excludes data for California, Indiana, South Dakota, and West Virginia.

19
Table 5. Number and percent distribution of deliveries by race and alcohol use of mother, according to age of mother: Total of 26

States, 1989–90

Race and

alcohol use of mother

Age of mother

All ages Under 30 years 30–49 years

All races1 Number

Total ..................................... 3,850,653 2,792,053 1,058,600

Drinker .................................. 131,716 84,428 47,287

Nondrinker ................................ 3,718,937 2,707,625 1,011,313

White .................................... 3,018,619 2,125,550 893,069

Drinker .................................. 99,947 61,751 38,194

Nondrinker ................................ 2,918,672 2,063,799 854,875

Black ..................................... 752,887 614,340 138,547

Drinker .................................. 29,738 21,229 8,517

Nondrinker ................................ 723,149 593,111 130,030

All races

Drinker .................................... 131,716 84,428 47,287

1 drink .................................. 80,192 51,204 28,973

2–4 drinks ................................ 36,511 23,392 13,119

5 or more drinks ............................ 15,012 9,832 5,196

White

Drinker .................................... 99,947 61,751 38,194

1 drink .................................. 66,687 41,426 25,281

2–4 drinks ................................ 24,910 15,056 9,824

5 or more drinks ............................ 8,349 5,268 3,089

Black

Drinker .................................... 29,738 21,229 8,517

1 drink .................................. 12,396 9,088 3,317

2–4 drinks ................................ 11,030 7,878 3,155

5 or more drinks ............................ 6,312 4,263 2,045

All races1 Percent distribution2

Total ..................................... 100.0 100.0 100.0

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 3.0 4.5

Nondrinker ................................ 96.6 97.0 95.5

White .................................... 100.0 100.0 100.0

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 2.9 4.3

Nondrinker ................................ 96.7 97.1 95.7

Black ..................................... 100.0 100.0 100.0

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 3.5 6.1

Nondrinker ................................ 96.1 96.5 93.9

All races

Drinker .................................... 100.0 100.0 100.0

1 drink .................................. 60.9 60.6 61.3

2–4 drinks ................................ 27.7 27.7 27.7

5 or more drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4 11.6 11.0

White

Drinker .................................... 100.0 100.0 100.0

1 drink .................................. 66.7 67.1 66.2

2–4 drinks ................................ 24.9 24.4 25.7

5 or more drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.4 8.5 8.1

Black

Drinker .................................... 100.0 100.0 100.0

1 drink .................................. 41.7 42.8 38.9

2–4 drinks ................................ 37.1 37.1 37.0

5 or more drinks ............................ 21.2 20.1 24.0

1Includes races other than white and black.

2Percents are number of fetal deaths and live births with specified alcohol status per 100 live births and fetal deaths.

NOTE: Table excludes data for California, South Dakota, and Vermont.

20
Table 6. Number of fetal deaths and fetal mortality rate by race, alcohol use, and age of mother: Total of 26 States, 1989–90

Race and

alcohol use of mother

Age of mother

All ages Under 30 years 30–49 years

All races1 Number

Total ..................................... 29,504 20,913 8,591

Drinker .................................. 1,754 1,175 579

Nondrinker ................................ 27,750 19,738 8,012

White .................................... 19,191 13,074 6,117

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 583 300

Nondrinker ................................ 18,308 12,491 5,817

Black ..................................... 9,835 7,531 2,304

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 847 578 269

Nondrinker ................................ 8,988 6,953 2,035

All races

Drinker .................................... 1,754 1,175 579

1 drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661 439 222

2–4 drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581 388 194

5 or more drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511 348 164

White

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883 583 300

1 drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 252 131

2–4 drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 173 107

5 or more drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 158 63

Black

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 847 578 269

1 drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 187 85

2–4 drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292 205 87

5 or more drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 187 96

All races1 Rate2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 7.5 8.1

Drinker .................................. 13.3 13.9 12.2

Nondrinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 7.3 7.9

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 6.2 6.8

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.8 9.4 7.9

Nondrinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.1 6.8

Black ..................................... 13.1 12.3 16.6

Drinker .................................. 28.5 27.2 31.6

Nondrinker ................................ 12.4 11.7 15.7

All races

Drinker .................................... 13.3 13.9 12.2

1 drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2 8.6 7.7

2–4 drinks ................................ 15.9 16.6 14.8

5 or more drinks ............................ 34.1 35.4 31.5

White

Drinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.8 9.4 7.9

1 drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 6.1 5.2

2–4 drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 11.5 10.9

5 or more drinks ............................ 26.4 30.0 20.4

Black

Drinker .................................... 28.5 27.2 31.6

1 drink .................................. 21.9 20.5 25.7

2–4 drinks ................................ 26.5 26.0 27.7

5 or more drinks ............................ 44.8 43.8 47.1

1Includes races other than white and black.

2Rates are number of fetal deaths with specified alcohol use per 1,000 live births and fetal deaths with specified alcohol use.

NOTE: Table excludes data for California, South Dakota, and Vermont.

21
Table 7. Number and rate of deliveries by race of mother, selected medical complications, whether complications were reported, and age

of mother: Total of 29 States, 1989–90

Race of mother and

selected complication

All live

births

and fetal

deaths1

Complication

reported2

Age of mother

Complication

not

All ages stated

Under

30 years

30–49

years

All races4 Number Rate3 Number

Febrile .................................... 5,080,220 53,567 10.5 11.1 9.2 53,104

Meconium, moderate/heavy ....................... 5,080,220 291,620 57.4 58.2 55.4 53,447

Premature rupture of membrane .................... 5,080,220 160,689 31.6 31.0 33.1 53,104

Abruptio placenta ............................. 5,080,220 34,528 6.8 6.6 7.4 53,104

Placenta previa .............................. 5,080,220 17,601 3.5 2.6 5.6 53,104

Other excessive bleeding ........................ 5,080,220 26,411 5.2 5.0 5.6 53,104

Seizures during labor ........................... 5,080,220 2,231 0.4 0.5 0.3 53,104

Precipitous labor .............................. 5,080,220 94,369 18.6 17.4 21.5 53,104

Prolonged labor .............................. 5,080,220 53,332 10.5 10.9 9.6 53,104

Dysfunctional labor ............................ 5,080,220 119,987 23.6 23.7 23.3 53,104

Breech/malpresentation ......................... 5,002,009 193,318 38.6 35.9 45.6 52,368

Cephalopelvic disproportion ....................... 5,080,220 190,190 37.4 38.1 35.7 58,252

Cord prolapse ............................... 4,871,814 12,908 2.6 2.5 3.0 53,972

Anesthetic complication ......................... 5,080,220 2,663 0.5 0.5 0.6 56,740

Fetal distress ................................ 5,080,220 222,095 43.7 44.1 42.7 57,083

White

Febrile .................................... 4,027,111 38,771 9.6 10.0 8.7 40,375

Meconium, moderate/heavy ....................... 4,027,111 211,262 52.5 52.8 51.8 40,677

Premature rupture of membrane .................... 4,027,111 122,377 30.4 29.6 32.1 40,375

Abruptio placenta ............................. 4,027,111 26,076 6.5 6.2 7.0 40,375

Placenta previa .............................. 4,027,111 13,678 3.4 2.6 5.3 40,375

Other excessive bleeding ........................ 4,027,111 21,422 5.3 5.3 5.5 40,375

Seizures during labor ........................... 4,027,111 1,591 0.4 0.4 0.3 40,375

Precipitous labor .............................. 4,027,111 71,328 17.7 16.2 21.2 40,375

Prolonged labor .............................. 4,027,111 44,033 10.9 11.4 9.8 40,375

Dysfunctional labor ............................ 4,027,111 98,663 24.5 24.8 23.8 40,375

Breech/malpresentation ......................... 3,957,493 161,075 40.7 38.2 46.5 39,702

Cephalopelvic disproportion ....................... 4,027,111 156,974 39.0 40.1 36.3 44,900

Cord prolapse ............................... 3,885,390 10,132 2.6 2.5 2.9 41,207

Anesthetic complication ......................... 4,027,111 2,195 0.5 0.5 0.6 43,431

Fetal distress ................................ 4,027,111 168,355 41.8 42.5 40.3 43,733

Black

Febrile .................................... 851,678 12,590 14.8 15.2 13.0 11,424

Meconium, moderate/heavy ....................... 851,678 70,657 83.0 82.0 87.2 11,438

Premature rupture of membrane .................... 851,678 32,984 38.7 37.4 44.3 11,424

Abruptio placenta ............................. 851,678 7,410 8.7 8.3 10.6 11,424

Placenta previa .............................. 851,678 3,037 3.6 2.8 6.9 11,424

Other excessive bleeding ........................ 851,678 3,210 3.8 3.5 4.7 11,424

Seizures during labor ........................... 851,678 533 0.6 0.7 0.4 11,424

Precipitous labor .............................. 851,678 18,782 22.1 21.7 23.7 11,424

Prolonged labor .............................. 851,678 6,795 8.0 8.2 7.2 11,424

Dysfunctional labor ............................ 851,678 17,108 20.1 19.9 20.8 11,424

Breech/malpresentation ......................... 845,020 25,335 30.0 27.1 42.1 11,402

Cephalopelvic disproportion ....................... 851,678 25,608 30.1 30.5 28.2 11,987

Cord prolapse ............................... 790,149 2,342 3.0 2.7 3.9 11,457

Anesthetic complication ......................... 851,678 355 0.4 0.4 0.6 11,951

Fetal distress ................................ 851,678 46,081 54.1 52.2 62.2 11,965

1Total number of deliveries to residents of areas reporting selected complications of labor and/or delivery.

2Total number of deliveries with selected complications reported for residents of areas reporting selected complications of labor and/or delivery.

3Rates are number of deliveries with specified complication per 1,000 live births and fetal deaths to mothers of specified age.

4Includes races other than white and black.

NOTE: Table excludes data for North Carolina for cord prolapse and Kansas for breech/malpresentation.

22
Table 8. Number of fetal deaths and fetal mortality rate by race of mother, selected medical complications of labor and/or delivery,

whether complication was reported, and age of mother: Total of 29 States, 1989–90

Race of mother and

selected complication

Complication

reported

in delivery

Complication

reported

in fetal

death

Age of mother

Specific

complication

not present

Complication

not stated

in fetal

All ages death

Under

30 years

30–49

years

All races2 Number Rate1 Number

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 7.2 7.9 . . . . . .

No complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 4.5 4.3 4.7 . . . . . .

Febrile .................................... 53,567 1,519 28.4 25.3 37.5 6.5 3,681

Meconium, moderate/heavy ....................... 291,620 2,020 6.9 6.6 7.9 6.7 3,681

Premature rupture of membrane .................... 160,689 2,818 17.5 17.0 18.9 6.4 3,681

Abruptio placenta ............................. 34,528 3,345 96.9 102.0 85.5 6.1 3,681

Placenta previa .............................. 17,601 376 21.4 27.8 13.8 6.7 3,681

Other excessive bleeding ........................ 26,411 619 23.4 24.5 21.0 6.7 3,681

Seizures during labor ........................... 2,231 53 23.8 16.1 50.6 6.7 3,681

Precipitous labor .............................. 94,369 532 5.6 5.8 5.2 6.8 3,681

Prolonged labor .............................. 53,332 234 4.4 3.6 6.5 6.8 3,681

Dysfunctional labor ............................ 119,987 224 1.9 1.8 2.0 6.9 3,681

Breech/malpresentation ......................... 193,318 4,074 21.1 22.2 18.9 6.2 3,574

Cephalopelvic disproportion ....................... 190,190 230 1.2 1.0 1.9 7.0 3,712

Cord prolapse ............................... 12,908 751 58.2 57.6 59.3 6.5 3,624

Anesthetic complication ......................... 2,663 26 9.8 10.0 9.3 6.7 3,697

Fetal distress ................................ 222,095 1,060 4.8 4.6 5.3 6.8 3,697

White

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.1 6.9 . . . . . .

No complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 3.8 3.6 4.2 . . . . . .

Febrile .................................... 38,771 951 24.5 22.0 31.4 5.6 2,478

Meconium, moderate/heavy . . . . . . . . . . . . . . . . . . . . . . . 211,262 1,498 7.1 6.8 7.7 5.7 2,478

Premature rupture of membrane .................... 122,377 1,632 13.3 12.7 14.7 5.5 2,478

Abruptio placenta ............................. 26,076 2,159 82.8 87.8 72.4 5.2 2,478

Placenta previa .............................. 13,678 243 17.8 22.8 11.9 5.7 2,478

Other excessive bleeding ........................ 21,422 423 19.7 19.9 19.5 5.7 2,478

Seizures during labor ........................... 1,591 40 25.1 17.4 49.7 5.7 2,478

Precipitous labor .............................. 71,328 342 4.8 5.2 4.0 5.8 2,478

Prolonged labor .............................. 44,033 179 4.1 3.3 6.1 5.8 2,478

Dysfunctional labor ............................ 98,663 173 1.8 1.8 1.6 5.9 2,478

Breech/malpresentation ......................... 161,075 2,765 17.2 17.5 16.5 5.3 2,387

Cephalopelvic disproportion ....................... 156,974 181 1.2 0.9 1.7 5.9 2,504

Cord prolapse ............................... 10,132 513 50.6 49.7 52.4 5.6 2,442

Anesthetic complication ......................... 2,195 15 6.8 7.4 5.6 5.8 2,489

Fetal distress ................................ 168,355 730 4.3 4.3 4.5 5.8 2,489

Black

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 13.0 12.2 16.4 . . . . . .

No complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 7.9 7.5 9.7 . . . . . .

Febrile .................................... 12,590 536 42.6 36.1 74.6 11.4 1,061

Meconium, moderate/heavy ....................... 70,657 471 6.7 6.0 9.3 12.4 1,061

Premature rupture of membrane .................... 32,984 1,136 34.4 31.8 43.9 11.0 1,061

Abruptio placenta ............................. 7,410 1,110 149.8 147.5 157.3 10.7 1,061

Placenta previa .............................. 3,037 121 39.8 48.9 24.2 11.8 1,061

Other excessive bleeding ........................ 3,210 180 56.1 58.9 47.1 11.7 1,061

Seizures during labor . . . . . . . . . . . . . . . . . . . . . . . . . . . 533 11 20.6 13.0 69.4 11.9 1,061

Precipitous labor .............................. 18,782 174 9.3 8.0 14.3 11.9 1,061

Prolonged labor .............................. 6,795 51 7.5 6.4 12.8 11.9 1,061

Dysfunctional labor ............................ 17,108 43 2.5 1.7 5.6 12.1 1,061

Breech/malpresentation ......................... 25,335 1,174 46.3 48.3 41.0 10.8 1,046

Cephalopelvic disproportion ....................... 25,608 33 1.3 1.0 2.6 12.2 1,066

Cord prolapse ............................... 2,342 216 92.2 91.3 95.1 11.5 1,041

Anesthetic complication . . . . . . . . . . . . . . . . . . . . . . . . . 355 9 25.4 27.1 20.6 11.9 1,066

Fetal distress ................................ 46,081 289 6.3 5.6 8.5 12.2 1,066

. . . Category not applicable.

– Quantity zero.

1Rates are number of fetal deaths with specified complication per 1,000 live births and fetal deaths with specified complication.

2Includes races other than white and black.

NOTE: Table exludes data for North Carolina for cord prolapse and data for Kansas for breech/malpresentation.

23
Table 9. Number and rate of deliveries by race of mother, selected congenital anomalies of child, whether anomalies were reported, and

age of mother: Total of 26 States, 1989–90

Race of mother and

congenital anomaly of infant

All live

births

and fetal

deaths1

Congenital

anomaly

reported

Age of mother

Not

stated

All

ages

Under

30 years

30–49

years

All races2 Number Rate3 Number

Anencephalus ............................... 4,986,141 1,168 23.4 25.7 17.8 65,025

Spina bifida/meningocele ........................ 4,986,141 1,567 31.4 32.4 29.1 65,025

Hydrocephalus ............................... 4,986,141 1,797 36.0 36.6 34.5 65,025

Microcephalus ............................... 4,986,141 574 11.5 11.5 11.6 65,025

Other central nervous system anomalies ............... 4,986,141 1,660 33.3 33.2 33.4 65,025

Heart malformations ........................... 4,986,141 6,501 130.4 127.4 137.8 65,025

Other circulatory/respiratory anomalies ................ 4,986,141 7,919 158.8 155.4 167.4 65,025

Rectal atresia/stenosis .......................... 4,986,141 616 12.4 12.4 12.2 65,025

Tracheo-esophageal fistula/esophageal atresia ........... 4,986,141 796 16.0 14.8 18.8 65,025

Omphalocele/gastroschisis ....................... 4,986,141 1,398 28.0 32.4 17.2 65,025

Other gastrointestinal anomalies .................... 4,986,141 2,044 41.0 42.2 38.0 65,025

Malformed genitalia ............................ 4,986,141 4,319 86.6 87.0 85.7 65,025

Renal agenesis .............................. 4,986,141 580 11.6 11.8 11.3 65,025

Other urogenital anomalies ....................... 4,986,141 6,190 124.1 124.3 123.7 65,025

Cleft lip/palate ............................... 4,986,141 4,863 97.5 96.9 99.1 65,025

Polydactyly/syndactyly/adactyly ..................... 4,986,141 4,863 97.5 103.3 83.0 65,025

Club foot .................................. 4,986,141 3,187 63.9 65.7 59.5 65,025

Diaphragmatic hernia ........................... 4,986,141 730 14.6 13.7 16.9 65,025

Other musculoskeletal/integumental anomalies ........... 4,986,141 11,256 225.7 225.2 227.1 65,025

Down’s syndrome ............................. 4,986,141 2,848 57.1 41.1 97.1 65,025

Other chromosomal anomalies ..................... 4,986,141 2,852 57.2 51.1 72.5 65,025

White

Anencephalus ............................... 3,946,684 965 24.5 27.1 18.3 46,781

Spina bifida/meningocele ........................ 3,946,684 1,357 34.4 35.9 30.9 46,781

Hydrocephalus ............................... 3,946,684 1,437 36.4 37.8 33.3 46,781

Microcephalus ............................... 3,946,684 452 11.5 11.1 12.4 46,781

Other central nervous system anomalies ............... 3,946,684 1,351 34.2 34.2 34.4 46,781

Heart malformations ........................... 3,946,684 5,203 131.8 128.6 139.3 46,781

Other circulatory/respiratory anomalies ................ 3,946,684 6,602 167.3 165.7 170.9 46,781

Rectal atresia/stenosis .......................... 3,946,684 513 13.0 13.4 12.0 46,781

Tracheo-esophageal fistula/esophageal atresia ........... 3,946,684 688 17.4 16.3 20.1 46,781

Omphalocele/gastroschisis ....................... 3,946,684 1,119 28.4 33.3 16.9 46,781

Other gastrointestinal anomalies .................... 3,946,684 1,632 41.4 42.8 38.0 46,781

Malformed genitalia ............................ 3,946,684 3,691 93.5 94.5 91.3 46,781

Renal agenesis .............................. 3,946,684 500 12.7 13.2 11.5 46,781

Other urogenital anomalies ....................... 3,946,684 5,433 137.7 138.8 135.0 46,781

Cleft lip/palate ............................... 3,946,684 4,244 107.5 108.8 104.7 46,781

Polydactyly/syndactyly/adactyly ..................... 3,946,684 2,755 69.8 72.1 64.5 46,781

Club foot .................................. 3,946,684 2,785 70.6 73.1 64.6 46,781

Diaphragmatic hernia ........................... 3,946,684 631 16.0 15.3 17.5 46,781

Other musculoskeletal/Integumental anomalies ........... 3,946,684 9,143 231.7 231.1 232.9 46,781

Down’s syndrome ............................. 3,946,684 2,432 61.6 44.3 101.9 46,781

Other chromosomal anomalies ..................... 3,946,684 2,307 58.5 52.5 72.2 46,781

Black

Anencephalus ............................... 850,411 156 18.3 18.7 16.7 16,607

Spina bifida/meningocele ........................ 850,411 178 20.9 20.6 22.2 16,607

Hydrocephalus ............................... 850,411 319 37.5 34.6 50.1 16,607

Microcephalus ............................... 850,411 102 12.0 13.2 6.8 16,607

Other central nervous system anomalies ............... 850,411 254 29.9 30.1 29.0 16,607

Heart malformations ........................... 850,411 1,097 129.0 126.3 140.3 16,607

Other circulatory/respiratory anomalies ................ 850,411 1,038 122.1 115.5 150.2 16,607

Rectal atresia/stenosis .......................... 850,411 82 9.6 9.1 11.7 16,607

Tracheo-esophageal fistula/esophageal atresia ........... 850,411 82 9.6 8.9 13.0 16,607

Omphalocele/Gastroschisis ....................... 850,411 244 28.7 30.5 21.0 16,607

Other gastrointestinal anomalies .................... 850,411 358 42.1 42.0 42.6 16,607

Malformed genitalia ............................ 850,411 527 62.0 63.3 56.2 16,607

Renal agenesis .............................. 850,411 70 8.2 7.8 9.9 16,607

See footnotes at end of table.

24
Table 9. Number and rate of deliveries by race of mother, selected congenital anomalies of child, whether anomalies were reported, and

age of mother: Total of 26 States, 1989–90—Con.

Race of mother and

congenital anomaly of infant

All live

births

and fetal

deaths1

Congenital

anomaly

reported

Age of mother

Not

stated

All

ages

Under

30 years

30–49

years

Black—Con. Number Rate3 Number

Other urogenital anomalies ....................... 850,411 647 76.1 76.5 74.2 16,607

Cleft lip/palate ............................... 850,411 402 47.3 46.8 49.4 16,607

Polydactyly/syndactyly/adactyly ..................... 850,411 1,980 232.8 233.8 228.7 16,607

Club foot .................................. 850,411 344 40.5 40.8 38.9 16,607

Diaphragmatic hernia ........................... 850,411 78 9.2 7.7 15.5 16,607

Other musculoskeletal/Integumental anomalies ........... 850,411 1,746 205.3 205.3 205.2 16,607

Down’s syndrome ............................. 850,411 345 40.6 30.5 83.4 16,607

Other chromosomal anomalies ..................... 850,411 448 52.7 47.6 74.2 16,607

1Total number of births and fetal deaths to residents of areas reporting selected congenital anomalies.

2Includes races other than white and black.

3Rates are number of deliveries with specified congenital anomaly per 100,000 live births and fetal deaths to mothers of specified age.

NOTE: Table excludes data for New Mexico, South Dakota, and Vermont.

25
Table 10. Number of fetal deaths and fetal mortality rate by race of mother, selected congenital anomalies of child, whether anomalies

were reported, and age of mother: Total of 26 States, 1989–90

Race of mother and

congenital anomaly of infant

Congenital

anomaly

reported

in delivery1

Congenital

anomaly

reported

in fetal

death

Age of mother Specific

anomaly

not

present

Congenital

anomaly

not

stated

All

ages

Under

30 years

30–49

years

All races2 Number Rate3 Number

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 7.2 7.9 . . . . . .

No anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 5.0 4.9 5.2 . . . . . .

Anencephalus ............................... 1,168 546 467.5 484.7 405.5 6.6 4,241

Spina bifida/meningocele ........................ 1,567 244 155.7 153.6 161.4 6.6 4,241

Hydrocephalus ............................... 1,797 388 215.9 187.1 292.1 6.6 4,241

Microcephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 76 132.4 134.8 126.5 6.7 4,241

Other central nervous system anomalies ............... 1,660 328 197.6 184.3 230.6 6.6 4,241

Heart malformations ........................... 6,501 347 53.4 46.1 70.2 6.6 4,241

Other circulatory/respiratory anomalies ................ 7,919 318 40.2 37.8 45.6 6.6 4,241

Rectal atresia/stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . 616 44 71.4 70.1 74.7 6.7 4,241

Tracheo-esophageal fistula/esophageal atresia . . . . . . . . . . . 796 32 40.2 41.7 37.3 6.7 4,241

Omphalocele/gastroschisis ....................... 1,398 219 156.7 142.4 223.6 6.6 4,241

Other gastrointestinal anomalies .................... 2,044 150 73.4 72.6 75.6 6.7 4,241

Malformed genitalia ............................ 4,319 158 36.6 35.2 40.1 6.7 4,241

Renal agenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 580 142 244.8 243.4 248.4 6.7 4,241

Other urogenital anomalies ....................... 6,190 198 32.0 31.9 32.3 6.7 4,241

Cleft lip/palate ............................... 4,863 288 59.2 54.5 70.7 6.6 4,241

Polydactyly/syndactyly/adactyly ..................... 4,863 177 36.4 32.9 47.3 6.7 4,241

Club foot .................................. 3,187 166 52.1 51.8 53.0 6.7 4,241

Diaphragmatic hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . 730 48 65.8 49.1 99.6 6.7 4,241

Other musculoskeletal/integumental anomalies ........... 11,256 403 35.8 35.6 36.4 6.6 4,241

Down’s syndrome ............................. 2,848 207 72.7 52.0 94.5 6.6 4,241

Other chromosomal anomalies ..................... 2,852 473 165.8 153.5 187.4 6.6 4,241

White

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.1 6.9 . . . . . .

No anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 4.1 4.0 4.5 . . . . . .

Anencephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 965 464 480.8 501.3 410.1 5.6 2,669

Spina bifida/meningocele ........................ 1,357 221 162.9 163.6 160.8 5.7 2,669

Hydrocephalus ............................... 1,437 313 217.8 191.0 288.6 5.7 2,669

Microcephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452 57 126.1 124.6 129.3 5.7 2,669

Other central nervous system anomalies ............... 1,351 261 193.2 180.3 223.0 5.7 2,669

Heart malformations ........................... 5,203 265 50.9 45.4 62.9 5.7 2,669

Other circulatory/respiratory anomalies ................ 6,602 260 39.4 37.6 43.4 5.7 2,669

Rectal atresia/stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . 513 33 64.3 56.8 83.9 5.7 2,669

Tracheo-esophageal fistula/esophageal atresia . . . . . . . . . . . 688 27 39.2 42.3 33.5 5.7 2,669

Omphalocele/gastroschisis . . . . . . . . . . . . . . . . . . . . . . . 1,119 170 151.9 135.1 228.9 5.7 2,669

Other gastrointestinal anomalies .................... 1,632 128 78.4 77.9 79.8 5.7 2,669

Malformed genitalia ............................ 3,691 126 34.1 31.5 40.6 5.7 2,669

Renal agenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 125 250.0 247.9 255.5 5.7 2,669

Other urogenital anomalies ....................... 5,433 160 29.4 29.0 30.6 5.7 2,669

Cleft lip/palate ............................... 4,244 226 53.3 48.3 65.2 5.7 2,669

Polydactyly/syndactyly/adactyly ..................... 2,755 132 47.9 41.7 64.0 5.7 2,669

Club foot .................................. 2,785 135 48.5 48.6 48.2 5.7 2,669

Diaphragmatic hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . 631 39 61.8 47.3 91.3 5.7 2,669

Other musculoskeletal/integumental anomalies ........... 9,143 305 33.4 34.0 31.8 5.7 2,669

Down’s syndrome ............................. 2,432 170 69.9 51.6 88.4 5.7 2,669

Other chromosomal anomalies ..................... 2,307 379 164.3 153.1 183.2 5.6 2,669

Black

All fetal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 13.0 12.2 16.4 . . . . . .

No anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – – 9.8 9.2 12.1 . . . . . .

Anencephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 66 423.1 418.6 444.4 11.4 1,476

Spina bifida/meningocele . . . . . . . . . . . . . . . . . . . . . . . . 178 19 * * * 11.4 1,476

Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 69 216.3 184.9 308.6 11.4 1,476

Microcephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 16 * * * 1,476

Other central nervous system anomalies . . . . . . . . . . . . . . . 254 58 228.3 202.9 340.4 11.4 1,476

Heart malformations ........................... 1,097 66 60.2 49.4 101.3 11.4 1,476

Other circulatory/respiratory anomalies ................ 1,038 49 47.2 45.3 53.5 11.4 1,476

See footnotes at end of table.

26
Table 10. Number of fetal deaths and fetal mortality rate by race of mother, selected congenital anomalies of child, whether anomalies

were reported, and age of mother: Total of 26 States, 1989–90—Con.

Race of mother and

congenital anomaly of infant

Congenital

anomaly

reported

in delivery1

Congenital

anomaly

reported

in fetal

death

Age of mother Specific

anomaly

not

present

Congenital

anomaly

not

stated

All

ages

Under

30 years

30–49

years

Black—Con. Number Rate3 Number

Rectal atresia/stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . 82 11 * * * 11.4 1,476

Tracheo-esophageal fistula/esophageal atresia . . . . . . . . . . . 82 4 * * * 11.5 1,476

Omphalocele/gastroschisis . . . . . . . . . . . . . . . . . . . . . . . 244 43 176.2 166.7 235.3 11.4 1,476

Other gastrointestinal anomalies . . . . . . . . . . . . . . . . . . . . 358 19 * * * 11.4 1,476

Malformed genitalia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527 27 51.2 52.8 44.0 11.4 1,476

Renal agenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 15 * * * 11.4 1,476

Other urogenital anomalies . . . . . . . . . . . . . . . . . . . . . . . 647 32 49.5 51.2 41.7 11.4 1,476

Cleft lip/palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402 43 107.0 102.5 125.0 11.4 1,476

Polydactyly/syndactyly/adactyly ..................... 1,980 36 18.2 19.3 13.5 11.4 1,476

Club foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344 26 75.6 74.7 79.4 11.4 1,476

Diaphragmatic hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6 * * * 11.5 1,476

Other musculoskeletal/integumental anomalies ........... 1,746 82 47.0 43.1 63.3 11.4 1,476

Down’s syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 33 95.7 61.9 148.1 11.4 1,476

Other chromosomal anomalies . . . . . . . . . . . . . . . . . . . . . 448 73 162.9 155.5 183.3 11.4 1,476

. . . Category not applicable.

– Quantity zero.

* Figure does not meet standard of reliability or precision.

1Total number of births and fetal deaths to residents of areas reporting specified congenital anomaly.

2Includes races other than white and black.

3Rates are number of fetal deaths with specified congenital anomaly per 1,000 live births and fetal deaths with specified congenital anomaly.

NOTE: Table excludes data for New Mexico, South Dakota, and Vermont.

27
Appendix

Contents

Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Source of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Collection of data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Classification of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Definitions of medical terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Quality of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Random variation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Appendix table

I. Number of fetal deaths and percent distribution of fetal deaths by selected characteristics: Selected States and the

United States, 1989–90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

28
Technical notes

Source of data

The fetal-death reporting system of the United States

encompasses the 50 States, the District of Columbia, Puerto

Rico, the Virgin Islands, and Guam. Fetal-death statistics for

every year are based on all reports of fetal death received by

the National Center for Health Statistics (NCHS). However, a

reporting criterion was used to limit the number of States

included in the tables of this report to a basic group of States.

The 29 States included in this report are Alabama, Arkansas,

California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Mississippi, Missouri, New

Hampshire, New Mexico, North Carolina, North Dakota,

Ohio, Oregon, Pennsylvania, South Carolina, South Dakota,

Tennessee, Utah, Vermont, West Virginia, Wisconsin, and

Wyoming.

Results for a subset of States are believed to be reasonably representative of all States based on comparison of

characteristics for the subset of States to all States (see

table I). The largest differences are that the selected States

have 12 percent more nonmetropolitan residents than the total

United States and less unknown or not stated total birth order

and period of gestation.

Tabulations of fetal deaths were based solely on information obtained by NCHS from copies of original reports of fetal

deaths from State registration offices. The exception is registration offices in New York State (excluding New York City),

which only submitted State-coded data in 1989 and 1990. The

information from these copies was edited, coded, and tabulated. All mortality information taken from these records was

transferred by NCHS to magnetic tape for computer processing.

Collection of data

The 1977 revision of the Model State Vital Statistics Act

and Model State Vital Statistics Regulations (39) recommended that spontaneous fetal deaths at a gestation of 20

weeks or more or a weight of 350 grams or more and all

induced terminations of pregnancy regardless of gestational

age be reported. It was also recommended that they be

reported on separate forms. These forms are to be considered

legally required statistical reports rather than legal documents.

Beginning with 1970 fetal deaths, procedures were implemented to separate reports of spontaneous fetal deaths from

those of induced terminations of pregnancy. These procedures

are still in use.

For many years, the U.S. Standard Report of Fetal Death,

issued by the Public Health Service, has been used as a model

to attain uniformity in the contents of documents used to

collect fetal mortality information (40). The standard report is

revised periodically by the national vital statistics agency

through consultation with State health officers and registrars;

Federal agencies concerned with vital statistics; national,

State, and county medical societies; and others working in

such fields as public health, social welfare, demography, and

insurance. This revision procedure has ensured careful evaluation of each item in terms of its current and future usefulness

for legal, medical and health, demographic, and research

purposes. New items have been added when necessary, and

old items have been modified to ensure better reporting or

have been dropped when their usefulness appeared to be

limited.

Revised Report of Fetal Death

Beginning with data for 1989, new items were added to

the U.S. Standard Report of Fetal Death. This includes information on Hispanic origin of the mother and father, method of

delivery, and other variables discussed in this report. In

addition, questions on complications of labor and delivery and

congenital anomalies of fetus(es) were changed from an

open-ended to a checkbox format to ensure more complete

reporting of information. However, because of differences in

implementation dates of the new fetal death report among

States, and because of inexperience in reporting and processing the new items, reporting of the new items in individual

States may not be complete for 1989. Moreover, not all States

revised their report in 1989 or added each specific checkbox.

Classification of data

The principal value of vital statistics data is realized

through the presentation of rates. Fetal mortality rates are

computed by relating the fetal deaths of a class to the live

births and fetal deaths of a similarly defined class. Vital

statistics of fetal deaths and live births must, therefore, be

classified according to similarly defined systems and tabulated

in comparable groups. Even when the variables common to

both, such as age and race, have been similarly classified and

tabulated, inconsistencies in reporting between the fetal death

report and birth certificate may result in significant discrepancies. If fetal death data are not as complete as live birth data,

29
this would tend to underestimate rates. Alternatively, the rates

could be overestimated if reporting of risk factors or anomalies is more complete for fetal deaths than for live births. This

could be due to the person filling out the form being motivated

to explain the poor outcome or having better information on

the presence of risk factors.

Race

For vital statistics in the United States for 1989 and 1990,

fetal deaths are classified by race—white, black, American

Indian, Chinese, Hawaiian, Japanese, Filipino, Other Asian or

Pacific Islander, and Other.

The white category includes, in addition to persons reported

as white, those reported as Mexican, Puerto Rican, Cuban, and

all other Caucasians. The American Indian category includes

American, Alaskan, Canadian, Eskimo, and Aleut.

Beginning with the 1989 data year, NCHS changed the

method of tabulating live birth and fetal death data by race

from race of child to race of mother (40,41).

When the race of the mother is unknown, the mother is

assigned to the father’s race. When information for both

parents is missing, the race of the mother is assigned to the

specific race of the mother of the preceding record with known

race.

Period of gestation

The period of gestation is the number of completed weeks

elapsed between the first day of the last normal menstrual

period (LMP) and the date of delivery (see Technical appendix, VSUS (40) for further details).

Age of mother

Age of mother is computed from the mother’s date of

birth and the date of the termination of the pregnancy. For

States whose reports do not contain an item on the mother’s

date of birth, reported age of the mother (in years) is used. The

age of the mother is edited in NCHS for upper and lower

limits. When mothers are reported to be under 10 years of age

or 50 years of age and over, the age of the mother is

considered not stated and is assigned as follows: Age on all

fetal-death records with age of mother not stated is assigned

according to the age appearing on the record previously

processed for a mother of identical race and having the same

total-birth order (total of live births and other terminations).

This is also applicable for live births.

Definitions of medical terms

The following definitions are adapted and abbreviated

from a set of definitions compiled by a committee of Federal

and State health statistics officials for the Association for Vital

Records and Health Statistics (42).

Medical risk factors for this pregnancy

Anemia—Hemoglobin level of less than 10.0 g/dL during

pregnancy, or a hematocrit of less than 30 percent during

pregnancy.

Cardiac disease—Disease of the heart.

Acute or chronic lung disease—Disease of the lungs

during pregnancy.

Diabetes—Metabolic disorder characterized by excessive

discharge of urine and persistent thirst; includes juvenile

onset, adult onset, and gestational diabetes during pregnancy.

Genital herpes—Infection of the skin of the genital area

by herpes simplex virus.

Hydramnios/oligohydramnios—Any noticeable excess

(hydramnios) or lack (oligohydramnios) of amniotic fluid.

Hemoglobinopathy—A blood disorder caused by alteration in the genetically determined molecular structure of

hemoglobin (for example, sickle-cell anemia).

Table I. Number of fetal deaths and percent distribution of fetal

deaths by selected characteristics: Total of 29 States and the

United States, 1989–90

Selected characteristic Selected States United States

Number

Total ....................... 37,599.0 61,855.0

Percent distribution

Total ....................... 100.0 100.0

Maternal age

Under 20 years ................ 16.0 15.1

20–29 years .................. 53.5 53.2

30 years and over ............... 30.5 31.7

Maternal race

White ...................... 67.6 67.3

Black ....................... 29.4 29.3

Other . . . . . . . . . . . . . . . . . . . . . . . 3.1 3.4

Total birth order

1 ......................... 31.1 30.1

2 ......................... 24.0 23.4

3 ......................... 16.8 16.7

4 ......................... 10.2 10.2

5 or more .................... 13.0 13.3

Not stated . . . . . . . . . . . . . . . . . . . . 4.8 6.4

Metropolitan residence

Metropolitan .................. 76.2 78.8

Nonmetropolitan ................ 23.8 21.2

Period of gestation

20–23 weeks .................. 23.1 23.8

24–27 weeks .................. 15.2 15.0

28 weeks and over .............. 56.6 54.2

Unknown . . . . . . . . . . . . . . . . . . . . 5.1 7.0

Fetal birthweight

1,499 grams or less .............. 53.2 51.4

1,500–2,499 grams .............. 17.4 16.5

2,500 grams or more ............. 21.90 20.7

Not stated . . . . . . . . . . . . . . . . . . . . 7.5 11.5

Fetal sex

Male ....................... 52.90 53.3

Female ..................... 47.1 46.7

NOTE: Percents may not add to 100.0 because of rounding.

30
Hypertension, chronic—Blood pressure persistently greater

than 140/90, diagnosed prior to onset of pregnancy or before

the 20th week of gestation.

Hypertension, pregnancy-associated—An increase in blood

pressure of at least 30 mm hg systolic or 15 mm hg diastolic

on two measurements taken 6 hours apart after the 20th week

of gestation.

Eclampsia—The occurrence of convulsions and/or coma

unrelated to other cerebral conditions in women with signs and

symptoms of pre-eclampsia.

Incompetent cervix—Characterized by painless dilation of

the cervix in the second trimester or early in the third trimester

of pregnancy, with premature expulsion of membranes through

the cervix and ballooning of the membranes into the vagina,

followed by rupture of the membranes and subsequent expulsion of the fetus.

Previous preterm or small-for-gestational-age infant—

Previous birth of an infant prior to term (before 37 completed

weeks of gestation), or of an infant weighing less than the 10th

percentile for gestational age, using a standard weight for age

chart.

Renal disease—Kidney disease.

Rh sensitization—The process or state of becoming sensitized to the Rh factor as when an Rh-negative woman is

pregnant with an Rh-positive fetus.

Uterine bleeding—Any clinically significant bleeding during the pregnancy, taking into consideration the state of

pregnancy; any second or third trimester bleeding of the uterus

prior to the onset of labor.

Complications of labor and/or delivery

Febrile—A fever greater than 100 degrees F. or 38 C.

occurring during labor and/or delivery.

Meconium, moderate/heavy—Meconium consists of undigested debris from swallowed amniotic fluid, various products

of secretion, and excretion and shedding by the gastrointestinal tract; moderate to heavy amounts of meconium in the

amniotic fluid noted during labor and/or delivery.

Premature rupture of membranes (more than 12 hours)—

Rupture of the membranes at any time during pregnancy and

more than 12 hours before the onset of labor.

Abruptio placenta—Premature separation of a normally

implanted placenta from the uterus.

Placenta previa—Implantation of the placenta over or

near the internal opening of the cervix.

Other excessive bleeding—The loss of a significant amount

of blood from conditions other than abruptio placenta or

placenta previa.

Seizures during labor—Maternal seizures occurring during labor from any cause.

Precipitous labor (less than 3 hours)—Extremely rapid

labor and delivery lasting less than 3 hours.

Prolonged labor (more than 20 hours)—Abnormally slow

progress of labor lasting more than 20 hours.

Dysfunctional labor—Failure to progress in a normal

pattern of labor.

Breech/malpresentation—At birth, the presentation of the

fetal buttocks rather than the head, or other malpresentation.

Cephalopelvic disproportion—The relationship of the size,

presentation, and position of the fetal head to the maternal

pelvis, which prevents dilation of the cervix and/or descent of

the fetal head.

Cord prolapse—Premature expulsion of the umbilical

cord in labor before the fetus is delivered.

Anesthetic complications—Any complication during labor

and/or delivery brought on by an anesthetic agent or agents.

Fetal distress—Signs indicating fetal hypoxia (deficiency

in amount of oxygen reaching fetal tissues).

Congenital anomalies

Anencephalus—Absence of the cerebral hemispheres.

Spina bifida/meningocele—Developmental anomaly characterized by defective closure of the bony encasement of the

spinal cord, through which the cord and meninges may or may

not protrude.

Hydrocephalus—Excessive accumulation of cerebrospinal fluid within the ventricles of the brain with consequent

enlargement of the cranium.

Microcephalus—A significantly small head.

Other central nervous system anomalies—Other specified

anomalies of the brain, spinal cord, and nervous system.

Heart malformations—Congenital anomalies of the heart.

Other circulatory/respiratory anomalies—Other specified

anomalies of the circulatory and respiratory systems.

Rectal atresia/stenosis—Congenital absence, closure, or

narrowing of the rectum.

Tracheo-esophageal fistula/esophageal atresia—An abnormal passage between the trachea and the esophagus; esophageal atresia is the congenital absence or closure of the

esophagus.

Omphalocele/gastroschisis—An omphalocele is a protrusion of variable amounts of abdominal viscera from a midline

defect at the base of the umbilicus. In gastroschisis, the

abdominal viscera protrude through an abdominal wall defect,

usually on the right side of the umbilical cord insertion.

Other gastrointestinal anomalies—Other specified congenital anomalies of the gastrointestinal system.

Malformed genitalia—Congenital anomalies of the reproductive organs.

Renal agenesis—One or both kidneys are completely

absent.

Other urogenital anomalies—Other specified congenital

anomalies of the organs concerned in the production and

excretion of urine, together with organs of reproduction.

Cleft lip/palate—Cleft lip is a fissure or elongated opening of the lip; cleft palate is a fissure in the roof of the mouth.

These are failures of embryonic development.

Polydactyly/syndactyly, adactyly—Polydactyly is the presence of more than five digits on either hands and/or feet;

syndactyly is having fused or webbed fingers and/or toes;

adactyly is the absence of fingers and/or toes.

Club foot—Deformities of the foot, which is twisted out

of shape or position.

31
Diaphragmatic hernia—Herniation of the abdominal contents through the diaphragm into the thoracic cavity, usually

resulting in respiratory distress.

Other musculoskeletal/integumental anomalies—Other

specified congenital anomalies of the muscles, skeleton, or

skin.

Down’s syndrome—The most common chromosomal defect

with most cases resulting from an extra chromosome (trisomy

21).

Other chromosomal anomalies—All other chromosomal

aberrations.

Quality of Data

Completeness of registration

All States have adopted laws requiring the registration of

live births and the reporting of fetal deaths. It is believed that

more than 99 percent of the live births occurring in this

country are registered.

Reporting requirements for fetal deaths vary somewhat

from State to State. Most of these areas require reporting of

fetal deaths at gestations of 20 weeks or more (see Technical

Appendix, VSUS (40) for further information). There is substantial evidence that not all fetal deaths for which reporting is

required are reported (43). While overall reporting is not as

complete for fetal deaths as for births and deaths, it is believed

to be relatively complete for fetal deaths at a gestation of 28

weeks or more.

The tables in this report are based on fetal deaths occurring at gestations of 20 weeks or more. These tables also

include fetal deaths for which gestation is not stated for those

States requiring reporting at 20 weeks or more gestation only.

Fetal deaths of ‘‘not stated’’ gestation were excluded for

Georgia except for those with a stated birth weight of 500

grams or more. Georgia requires the reporting of all products

of conception.

Random variation

Although the fetal death data in this report are not

subject to sampling error, they may be affected by random

variation in the number of fetal deaths involved. In general,

vital events may be assumed to follow the binomial distribution. However, many of the checkbox items refer to extremely

rare events. Rare events may be assumed to follow a Poisson

probability distribution. Additional information on random

variation and the calculation of confidence intervals are available in the Technical appendix, VSUS (40).

32
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436–8500

E-mail: nchsquery@nch10a.em.cdc.gov

Internet: http://www.cdc.gov/nchswww/nchshome.htm
DHHS Publication No. (PHS) 96-1859, Series 20, No. 31

6-0485 (8/96)

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