Objectives. We compared data on race as reported by the mother on North Carolina birth certificates with data on race in officially reported statistics. We also determined to what extent differences in the classification of race affect measures of racial disparity in maternal and child health indicators. Methods. We examined how data on race are collected, coded, and tabulated in North Carolina via live birth certificates, death certificates, the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey, and the Central Cancer Registry case records. We showed how the data on race collected through North Carolina birth and death certificates are translated into 10 fixed racial categories designated by the National Center for Health Statistics (NCHS) for use in official vital statistics. We compared race as reported by the mother on birth certificates to racial tabulations used in the official published birth statistics. We also examined to what extent differences in the determination of race affect measures of racial disparity in maternal and child health indicators. Results. Out of nearly 118,000 live births in North Carolina in 2002, mothers reported more than 600 different versions of race on birth certificates. These entries were collapsed into the 10 standard racial categories outlined in federal coding rules. Approximately two-thirds of mothers of Hispanic ethnicity report their race with a label that can be categorized as “Other” race, but nearly all of these births are re-coded to “white” for the official birth statistics. Measures of racial disparity vary depending on whether self-reported or officially coded race is used. Conclusions. This study shows that, given the opportunity to report their own race, North Carolinians describe their race using a wide variety of terms and concepts. In contrast, health statistics are usually reported using a few standardized racial categories defined by federal policy. The NCHS rules for coding race should be reexamined. As the ethnic and racial diversity of the United States continues to increase, these rules will become increasingly antiquated.

Background: The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain. Sample: The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women ( ‡18 years) who delivered singleton full-term infants in 2011 and 2012. Methods: A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight. Results: A total of 197,354 women ( ‡18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91). Conclusions: Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.

Background: Pregnant women with influenza are more likely to have complications, but information on infant outcomes is limited. Methods: Five state/local health departments collected data on outcomes of infants born to pregnant women with 2009 H1N1 influenza reported to the Centers for Disease Control and Prevention from April to December 2009. Collaborating sites linked information on pregnant women with confirmed 2009 H1N1 influenza, many who were severely ill, to their infants’ birth certificates. Collaborators also collected birth certificate data from two comparison groups that were matched with H1N1-affected pregnancies on month of conception, sex, and county of residence. Results: 490 pregnant women with influenza, 1,451 women without reported influenza with pregnancies in the same year, and 1,446 pregnant women without reported influenza with prior year pregnancies were included. Women with 2009 H1N1 influenza admitted to an intensive care unit (ICU; n = 64) were more likely to deliver preterm infants (<37 weeks), low birth weight infants, and infants with Apgar scores <=6 at 5 min than women in comparison groups (adjusted relative risk, aRR = 3.9 [2.7, 5.6], aRR = 4.6 [2.9, 7.5], and aRR = 8.7 [3.6, 21.2], for same year comparisons, respectively). Women with influenza who were not hospitalized and hospitalized women not admitted to the ICU did not have significantly elevated risks for adverse infant outcomes. Conclusions: Severely ill women with 2009 H1N1 influenza during pregnancy were more likely to have adverse birth outcomes than women without influenza, providing more support for influenza vaccination during pregnancy.

Linking traditional maternal mortality files to NC-VDRS provided a notable improvement in ascertainment of pregnancy-associated violent deaths.

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