Charlan Kroelinger - Academia.edu (original) (raw)

Papers by Charlan Kroelinger

Research paper thumbnail of Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement

Journal of Womens Health, Jan 17, 2022

Background: Provider challenges to accessing long-acting reversible contraception (LARC) include ... more Background: Provider challenges to accessing long-acting reversible contraception (LARC) include level of reimbursement for LARC device acquisition and cost to stock. State-level LARC device reimbursement policies that cover a greater proportion of the cost of the LARC device and enable providers to purchase LARC upfront may improve contraceptive access. Materials and Methods: To summarize state-level policies that include language on LARC device reimbursement in the outpatient setting, we conducted a systematic, web-based review among all 50 states of publicly available LARC device reimbursement policies that include coverage of LARC devices as a medical or pharmacy benefit, the use of the 340B Drug Pricing Program to purchase LARC devices, and separate payment for LARC devices outside of the Medicaid Prospective Payment System (PPS) payment rate for Federally Qualified Health Centers or Rural Health Clinics. Results: Forty-two percent (21/50) of states with publicly available state-level policies included language on LARC device reimbursement. Among the states, 24% (5/21) had coverage policies as a medical benefit, 33% (7/21) as a pharmacy benefit, and 19% (4/21) as both a medical benefit and pharmacy benefit; 38% (8/21) used the 340B Program to purchase LARC devices; and 62% (13/21) indicated separate payment for LARC devices outside of the Medicaid PPS payment rate. Conclusion: State-level policies for LARC device reimbursement vary, highlighting differences in reimbursement strategies across the U.S. Future research could explore how the implementation of these payment methods may impact LARC device reimbursement and whether increased reimbursement may improve access to the full range of contraceptive methods.

Research paper thumbnail of Neonatal intensive-care unit admission of infants with very low birth weight--19 states, 2006

PsycEXTRA Dataset

Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (... more Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (<1,500 g [3.3 lbs]). In 2006, the mortality rate among infants with VLBW was 240.4 per 1,000 live births. Because neonatal intensive care has been shown to reduce mortality among infants with VLBW, current standards call for neonatal intensive-care for all infants with VLBW; however, the proportion of infants with VLBW who are admitted to a neonatal intensive care unit (NICU) is not known, nor are the predictors for NICU admission. To estimate the prevalence of admission to NICUs among infants with VLBW and assess factors predicting admission, CDC analyzed birth data from 2006 for 19 states. This report summarizes the results of that analysis, which found that overall, 77.3% of infants with VLBW were admitted to NICUs (range: 63.7% in California to 93.4% in North Dakota). Among infants with VLBW born to Hispanic mothers, 71.8% were admitted to NICUs, compared with 79.5% of those with non-Hispanic black mothers and 80.5% of those with non-Hispanic white mothers. Multivariate analysis of the data indicated that preterm delivery, multiple births, and cesarean delivery all were independently associated with greater prevalence of NICU admission among infants with VLBW. Wide variation was observed among states in the prevalence of NICU admission of infants with VLBW; these state data should be assessed further, and barriers to NICU admission should be identified and addressed.

Research paper thumbnail of Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The 2011 MCH Epidemiology Awards

Maternal and Child Health Journal, Apr 19, 2012

The Coalition for Excellence, formed of 16 organizations, sponsors the Maternal and Child Health ... more The Coalition for Excellence, formed of 16 organizations, sponsors the Maternal and Child Health (MCH) Epidemiology Awards to provide national recognition for individuals, teams, institutions, and leaders who make significant contributions to improve the health of women, infants, children, and families by advancing public health knowledge, practice, research, and use of data (Table 1). Multiple awards are presented each year in different categories, including advancing knowledge, effective practice, outstanding leadership, excellence in teaching, young professional achievement, and lifetime achievement in MCH epidemiology. In 2011, three deserving public health researchers, one administrator, and one clinic were recognized for noteworthy contributions to MCH epidemiology.

Research paper thumbnail of Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The 2014 National MCH Epidemiology Awards

Maternal and Child Health Journal, Jan 2, 2016

Purpose-The impact of programs, policies, and practices developed by professionals in the field o... more Purpose-The impact of programs, policies, and practices developed by professionals in the field of maternal and child health (MCH) epidemiology is highlighted biennially by 16 national MCH agencies and organizations, or the Coalition for Excellence in MCH Epidemiology. Description-In September 2014, multiple leading agencies in the field of MCH partnered to host the national CityMatCH Leadership and MCH Epidemiology Conference in Phoenix, Arizona. The conference offered opportunities for peer exchange; presentation of new scientific methodologies, programs, and policies; dialogue on changes in the MCH field; and discussion of emerging MCH issues relevant to the work of local, state, and national MCH professionals. During the conference, the National MCH Epidemiology Awards were presented to individuals, teams, institutions, and leaders for significantly contributing to the improved health of women, children, and families. Assessment-During the conference, the Coalition presented seven deserving health researchers and research groups with national awards in the areas of advancing knowledge, effective practice, outstanding leadership, young professional achievement, and lifetime achievement. The article highlights the accomplishments of these national-level awardees. Conclusion-Recognition of deserving professionals strengthens the field of MCH epidemiology, and sets the standard for exceptional research, mentoring, and practice.

Research paper thumbnail of A population study of the contribution of medical comorbidity to the risk of prematurity in blacks

American Journal of Obstetrics and Gynecology, Oct 1, 2007

The purpose of this study was to test the hypothesis that the higher prevalence of medical comorb... more The purpose of this study was to test the hypothesis that the higher prevalence of medical comorbidities among black women accounts for their increased risk of prematurity. A population-based regional cohort of women receiving obstetric care for singleton pregnancies at a large community hospital between 2003 and 2006 were analyzed using univariate and multivariable logistic regression. Data for 18,624 consecutive births found increased odds of adverse outcomes for black compared to white women: prematurity OR = 1.6 (1.4-1.8), extreme prematurity OR = 2.5 (2.0-3.2). Logistic regression modeling identified black race, age < 20, preconception diabetes and hypertension, smoking, underweight, and gestational hypertension as the greatest risks for adverse outcomes. Controlling for these risks did not attenuate the higher risk for prematurity among blacks. Though there is a greater burden of health risk among black women, this did not account for the higher rates of low birthweight and prematurity.

Research paper thumbnail of Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015–2018

Womens Health Issues, Mar 1, 2023

Research paper thumbnail of Updated interim Zika clinical guidance for pregnant women and data on contraceptive use to decrease Zika-affected pregnancies

Accreditation Statements CME: The Centers for Disease Control and Prevention is accredited by the... more Accreditation Statements CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME®) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.0 contact hours. IACET CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.1 CEU's for this program. CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.0 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 0. CDC provider number 98614. CPE: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 0.1 CEUs in pharmacy education. The Universal Activity Number is 0387-0000-16-102-L04-P and enduring 0387-0000-16-102-H04-P. This activity is knowledge based. AAVSB/RACE: This program was reviewed and approved by the AAVSB RACE program for 1.0 hours of continuing education in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program's validity or relevancy to the veterinary profession. CPH: The Centers for Disease Control and Prevention is a pre-approved provider of Certified in Public Health (CPH) recertification credits and is authorized to offer 1 CPH recertification credit for this program. Continuing Education Disclaimer CDC, our planners, presenters, and their spouses/partners wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Planners have reviewed content to ensure there is no bias. This presentation will not include any discussion of the unlabeled use of a product or products under investigational use.

Research paper thumbnail of Increased cesarean section rate over time (1994-2006) in Delaware is not associated with improved outcomes in very low birth weight infants

PubMed, May 1, 2010

Cesarean deliveries (C-section) have been increasing over time. The objectives of this study were... more Cesarean deliveries (C-section) have been increasing over time. The objectives of this study were to analyze cesarean section delivery rates over time, and determine whether there is an association between C-section, mortality, and severe intraventricular hemorrhage (IVH) in VLBW infants. We performed a retrospective cohort study of babies with birth weight < 1,500 grams, between 1994 and 2006, at Christiana Hospital (n = 2,040). Severe IVH was considered grade 3 to 4. Data were analyzed by three-year cohorts. Statistics included unadjusted and multivariable analyses. Cesarean delivery increased 22 percent from 1994 to 2006. When controlling for potential confounding variables including gestational age and presentation at birth, odds of C-section delivery remained elevated in Cohort 4 (2003-2006) compared with Cohort 1 (1994-1997; OR = 1.12, 95% CI 1.01-1.24). The rate of infant death and severe IVH did not change over time. After multivariable analysis, C-section was not associated with a decrease in death, severe IVH, or death and/or IVH. In our population of VLBW infants, the rate of C-section delivery increased over time. This increased rate was not associated with any change in the odds of death and/or severe IVH.

Research paper thumbnail of Summary of neonatal and maternal transport and reimbursement policies—a 5-year update

Journal of Perinatology, Apr 12, 2022

To examine the number of states with neonatal and maternal transport and reimbursement policies i... more To examine the number of states with neonatal and maternal transport and reimbursement policies in 2019, compared with 2014. We conducted a systematic review of web-based, publicly available information on neonatal and maternal transport policies for each state in 2019. Information was abstracted from rules, codes, licensure regulations, and planning and program documents, then summarized within two categories: transport and reimbursement policies. In 2019, 42 states had a policy for neonatal transport and 37 states had a policy for maternal transport, increasing by 8 and 7 states respectively. Further, 31 states had a reimbursement policy for neonatal transport and 11 states for maternal transport, increases of 1 state per category. Overall, the number of states with policies increased from 2014 to 2019. The number of state neonatal and maternal transport policies increased; these policies may support provision of care at the most risk-appropriate facilities.

Research paper thumbnail of Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies

Womens Health Issues, Nov 1, 2021

Background:Previous assessment of statewide policies on long-acting reversible contraception (LAR... more Background:Previous assessment of statewide policies on long-acting reversible contraception (LARC) indicate that an increasing number of states are implementing policies specifically for provision immediately postpartum, supported by current clinical guidelines. Less is known about how state policies describe payment methodologies for the insertion procedure and device costs.Methods:We conducted a systematic, web-based review of publicly available statewide policy language on immediate postpartum LARC among all 50 states. We examined the payor/s identified in the policy and policy type, if the policy included language on the global obstetric fee, whether providers and/or facilities were authorized to bill for procedure or device costs, and if the billing mechanism was identified as inpatient and/or outpatient services.Results:Three-fourths of states (76%; n = 38) had statewide policies on immediate postpartum LARC. All policies identified Medicaid as the payor, although two also included non-Medicaid plans. Language allowing for reimbursement separate from the global obstetric fee for insertion procedures was present in 76% of states; 23 states permit it and 6 do not. Device cost reimbursement separate from the fee was identified in more state policies (92%); 31 states allow it and 4 do not. More policies included inpatient or outpatient billing mechanisms for device costs (82%; n = 31) than insertion procedures (50%; n = 19).Conclusions:Medicaid reimbursement policies for immediate postpartum LARC services vary by state reimbursement process, type, and mechanism. Observed differences indicate payment methodologies more often include the cost of the device than provider reimbursement (31 states vs. 23 states). Fewer than one-half of states offer reimbursement for provider insertion fees, a significant systems barrier to contraceptive access for women who choose LARC immediately postpartum.

Research paper thumbnail of Seven years later: state neonatal risk-appropriate care policy consistency with the 2012 American Academy of Pediatrics Policy

Journal of Perinatology, Jul 12, 2021

To assess consistency of state neonatal risk-appropriate care policies with the 2012 AAP policy s... more To assess consistency of state neonatal risk-appropriate care policies with the 2012 AAP policy seven years post-publication. Systematic, web-based review of all publicly available 2019 state neonatal levels of care policies. Information on infant risk (gestational age, birth weight), technology and equipment capabilities, and availability of specialty staffing used to define neonatal levels of care was extracted for review. Half of states (50%) had a neonatal risk-appropriate care policy. Of those states, 88% had language consistent with AAP-defined Level I criteria, 80% with Level II, 56% with Level III, and 55% with Level IV. Comparing policies (2014–2019), consistency increased in state policies among all levels of care with the greatest increase among level IV criteria. States improved consistency of policy language by each level of care, though half of states still lack policy to provide minimum standards of care to the most vulnerable infants.

Research paper thumbnail of Translating Policy to Practice and Back Again

Womens Health Issues, Nov 1, 2008

The state of Delaware is in the unique position of implementing legislatively supported policy on... more The state of Delaware is in the unique position of implementing legislatively supported policy on preconception health. The state has allocated funding to translate preconception care policy to practice through a statewide program. The Delaware Division of Public Health has been given the responsibility of defining and implementing the preconception care program targeting a high-risk population. The state partnered with Medicaid, private practitioners, local hospitals, state service centers, and Federally Qualified Health Centers to develop a scope of program services that supplement the current clinical care provided at annual visits for women of childbearing age. Because the program has been in operation for 9 months, the Division of Public Health utilized feedback from the providing agencies to begin efforts for program sustainability and to modify the existing policy. Current efforts include developing outcome measures for the program, measuring program effectiveness through evaluation, and working with Medicaid and Managed Care Organizations to develop a reimbursement system for services.

Research paper thumbnail of Biological and Psychosocial Determinants of Problematic Birth Outcomes

The current research, analysis, and dissertation are dedicated to my daughter, Ember Kimmerbryce ... more The current research, analysis, and dissertation are dedicated to my daughter, Ember Kimmerbryce Crutchfield. She had no choice in supporting me throughout the doctoral process, and means more to me than any other person I have known. When she reads this dedication one day, I hope she will be proud. Secondly, I would like to thank Kathryn S. Oths, PhD, for her invaluable input throughout my graduate career, and Kevin Kip, PhD, for his support during the proposal phase of this dissertation. Thirdly, I would like to thank my family and friends for their support over the past five years. Specifically, Charles and Lu Kroelinger; Keara, Cory, and

Research paper thumbnail of Overview of 2018 U.S. Assisted Reproductive Technology (Art) Treatment Outcomes and Contribution of Art to Multiple Births and Preterm Births in the United States

Fertility and Sterility, Sep 1, 2020

These results suggest that not all 1PN-ICSI zygotes are abnormal, and these can result in a viabl... more These results suggest that not all 1PN-ICSI zygotes are abnormal, and these can result in a viable pregnancy and healthy live birth. Continued culture to blastocyst of 1PN-ICSI zygotes should be carried out in order to further assess their potential for transfer. SUPPORT: None.

Research paper thumbnail of Collaboration at the Federal, State, and Local Levels to Build Capacity in Maternal and Child Health: The Impact of the Maternal and Child Health Epidemiology Program

Journal of Womens Health, May 1, 2012

This article provides a description of the Maternal and Child Health Epidemiology Program housed ... more This article provides a description of the Maternal and Child Health Epidemiology Program housed in the Division of Reproductive Health at the Centers for Disease Control and Prevention. The article highlights programmatic efforts to build capacity and increase infrastructure within states, localities, and among tribes in the field of maternal and child health by leveraging partnerships with other federal, nonprofit, private, and academic agencies.

Research paper thumbnail of Rising Infant Mortality in Delaware: An Examination of Racial Differences in Secular Trends

Maternal and Child Health Journal, Mar 6, 2007

Recent increases in the Delaware Infant Mortality Rate (IMR) have been attributed to a rise in th... more Recent increases in the Delaware Infant Mortality Rate (IMR) have been attributed to a rise in the mortality of very low birth weight (VLBW, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1500 g) infants born to mothers of higher socioeconomic status. This study examines whether the determinants of infant mortality trends in Delaware vary by race. Linked birth/infant death cohort files for the two periods 1993-1997 and 1998-2002 were used to evaluate the determinants of infant mortality trends separately for White and Black racial groups. Kitagawa analyses determined the components of race-specific infant mortality trends attributable to changes in both the birthweight distribution and birthweight-specific mortality rates. Maternal characteristics were examined to identify factors associated with IMR changes. Between the two time periods, infant mortality increased 23% among White infants and 17% among Black infants. For both races, the infant mortality increase was explained by increases in the incidence and mortality of VLBW infants, specifically below &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;500 grams for Blacks and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1,000 grams for Whites. The increased incidence of VLBW deliveries was statistically significant only among Whites, almost 40% of which was explained by an increase in multiple births. For both Whites and Blacks, the increase in VLBW mortality occurred mainly among births to more traditionally advantaged women who were twenty or older, at least high school educated, married, privately insured, had received first trimester prenatal care, and those who delivered multiple births. These findings suggest that conventional strategies of increasing access to prenatal care among disadvantaged women may be insufficient to reverse recent IMR increases in Delaware, irrespective of race. Future efforts should focus on understanding the causes of the increased infant mortality associated with higher socioeconomic status, including changes in assisted reproductive technology utilization, maternal health status, and obstetric practice.

Research paper thumbnail of Assisted Reproductive Technology Surveillance — United States, 2018

Morbidity and mortality weekly report, Feb 18, 2022

Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (A... more Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to have multiple births because multiple embryos might be transferred. Multiple births can pose substantial risks for both mothers and infants, including obstetric complications, preterm birth (<37 weeks), and low birthweight (<2,500 g). This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2018 and compares birth outcomes that occurred in 2018 (resulting from ART procedures performed in 2017 and 2018) with outcomes for all infants born in the United States in 2018.

Research paper thumbnail of Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015

Morbidity and Mortality Weekly Report, Jan 12, 2018

Introduction: There have been dramatic improvements in reducing infant sleep-related deaths since... more Introduction: There have been dramatic improvements in reducing infant sleep-related deaths since the 1990s, when recommendations were introduced to place infants on their backs for sleep. However, there are still approximately 3,500 sleep-related deaths among infants each year in the United States, including those from sudden infant death syndrome, accidental suffocation and strangulation in bed, and unknown causes. Unsafe sleep practices, including placing infants in a nonsupine (on side or on stomach) sleep position, bed sharing, and using soft bedding in the sleep environment (e.g., blankets, pillows, and soft objects) are modifiable risk factors for sleep-related infant deaths. Methods: CDC analyzed 2009-2015 Pregnancy Risk Assessment Monitoring System (PRAMS) data to describe infant sleep practices. PRAMS, a state-specific and population-based surveillance system, monitors self-reported behaviors and experiences before, during, and shortly after pregnancy among women with a recent live birth. CDC examined 2015 data on nonsupine sleep positioning, bed sharing, and soft bedding use by state and selected maternal characteristics, as well as linear trends in nonsupine sleep positioning from 2009 to 2015. Results: In 2015, 21.6% of respondents from 32 states and New York City reported placing their infant in a nonsupine sleep position; this proportion ranged from 12.2% in Wisconsin to 33.8% in Louisiana. Infant nonsupine sleep positioning was highest among respondents who were non-Hispanic blacks. Nonsupine sleep positioning prevalence was higher among respondents aged <25 years compared with ≥25 years, those who had completed ≤12 years compared with >12 years of education, and those who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children during pregnancy. Based on trend data from 15 states, placement of infants in a nonsupine sleep position decreased significantly from 27.2% in 2009 to 19.4% in 2015. In 2015, over half of respondents (61.4%) from 14 states reported bed sharing with their infant, and 38.5% from 13 states and New York City reported using any soft bedding, most commonly bumper pads and thick blankets. Conclusions and Implications for Public Health Practice: Improved implementation of the safe sleep practices recommended by the American Academy of Pediatrics could help reduce sleep-related infant mortality. Evidence-based interventions could increase use of safe sleep practices, particularly within populations whose infants might be at higher risk for sleep-related deaths. * A small percentage of respondents (<4%) selected more than one sleep position. Respondents selecting multiple positions were classified as placing their infant in a nonsupine sleep position. Denominator includes supine, on stomach, on side only, and combinations of any of the three positions. † The 32 states include Alabama,

Research paper thumbnail of Assisted Reproductive Technology Surveillance — United States, 2017

Morbidity and mortality weekly report, Dec 18, 2020

Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (A... more Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to have multiple-birth infants because multiple embryos may be transferred. Multiple births can pose substantial risks for both mothers and infants, including obstetric complications, preterm birth (<37 weeks), and low birthweight (<2,500 g). This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2017 and compares birth outcomes that occurred in 2017 (resulting from ART procedures performed in 2016 and 2017) with outcomes for all infants born in the United States in 2017.

Research paper thumbnail of Trends in Repeat Births and Use of Postpartum Contraception Among Teens — United States, 2004–2015

Morbidity and Mortality Weekly Report, Apr 28, 2017

Teen* childbearing (one or more live births before age 20 years) can have negative health, social... more Teen* childbearing (one or more live births before age 20 years) can have negative health, social, and economic consequences for mothers and their children (1). Repeat teen births (two or more live births before age 20 years) can constrain the mother's ability to take advantage of educational and workforce opportunities (2), and are more likely to be preterm or of low birthweight than first teen births (3). Despite the historic decline in the U.S. teen birth rate during 1991-2015, from 61.8 to 22.3 births per 1,000 females aged 15-19 years (4), many teens continue to have repeat births (3). The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recommend that clinicians counsel women (including teens) during prenatal care about birth spacing and postpartum contraceptive use (5), including the safety and effectiveness of long-acting reversible methods that can be initiated immediately postpartum. To expand upon prior research assessing patterns and trends in repeat childbearing and postpartum contraceptive use among teens with a recent live birth (i.e., 2-6 months after delivery) (3), CDC analyzed data from the National Vital Statistics System natality files (2004 and 2015) and the Pregnancy Risk Assessment Monitoring System (PRAMS; 2004-2013). The number and proportion of teen births that were repeat births decreased from 2004 (82,997; 20.1%) to 2015 (38,324; 16.7%); in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among sexually active teens with a recent live birth, postpartum use of the most effective contraceptive methods (intrauterine devices and contraceptive implants) increased from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three reported using either a least effective method (15.7%) or no method (17.2%). Strategies that comprehensively address the social and health care needs of teen parents can facilitate access to and use of effective methods of contraception and help prevent repeat teen births. National Vital Statistics System natality files, compiled annually by CDC's National Center for Health Statistics, include demographic information such as maternal age, race, and Hispanic ethnicity for all births in the 50 states and the District of Columbia. † CDC analyzed national and state-specific * For this report, the term "teen" refers to a person aged <20 years.

Research paper thumbnail of Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement

Journal of Womens Health, Jan 17, 2022

Background: Provider challenges to accessing long-acting reversible contraception (LARC) include ... more Background: Provider challenges to accessing long-acting reversible contraception (LARC) include level of reimbursement for LARC device acquisition and cost to stock. State-level LARC device reimbursement policies that cover a greater proportion of the cost of the LARC device and enable providers to purchase LARC upfront may improve contraceptive access. Materials and Methods: To summarize state-level policies that include language on LARC device reimbursement in the outpatient setting, we conducted a systematic, web-based review among all 50 states of publicly available LARC device reimbursement policies that include coverage of LARC devices as a medical or pharmacy benefit, the use of the 340B Drug Pricing Program to purchase LARC devices, and separate payment for LARC devices outside of the Medicaid Prospective Payment System (PPS) payment rate for Federally Qualified Health Centers or Rural Health Clinics. Results: Forty-two percent (21/50) of states with publicly available state-level policies included language on LARC device reimbursement. Among the states, 24% (5/21) had coverage policies as a medical benefit, 33% (7/21) as a pharmacy benefit, and 19% (4/21) as both a medical benefit and pharmacy benefit; 38% (8/21) used the 340B Program to purchase LARC devices; and 62% (13/21) indicated separate payment for LARC devices outside of the Medicaid PPS payment rate. Conclusion: State-level policies for LARC device reimbursement vary, highlighting differences in reimbursement strategies across the U.S. Future research could explore how the implementation of these payment methods may impact LARC device reimbursement and whether increased reimbursement may improve access to the full range of contraceptive methods.

Research paper thumbnail of Neonatal intensive-care unit admission of infants with very low birth weight--19 states, 2006

PsycEXTRA Dataset

Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (... more Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (&lt;1,500 g [3.3 lbs]). In 2006, the mortality rate among infants with VLBW was 240.4 per 1,000 live births. Because neonatal intensive care has been shown to reduce mortality among infants with VLBW, current standards call for neonatal intensive-care for all infants with VLBW; however, the proportion of infants with VLBW who are admitted to a neonatal intensive care unit (NICU) is not known, nor are the predictors for NICU admission. To estimate the prevalence of admission to NICUs among infants with VLBW and assess factors predicting admission, CDC analyzed birth data from 2006 for 19 states. This report summarizes the results of that analysis, which found that overall, 77.3% of infants with VLBW were admitted to NICUs (range: 63.7% in California to 93.4% in North Dakota). Among infants with VLBW born to Hispanic mothers, 71.8% were admitted to NICUs, compared with 79.5% of those with non-Hispanic black mothers and 80.5% of those with non-Hispanic white mothers. Multivariate analysis of the data indicated that preterm delivery, multiple births, and cesarean delivery all were independently associated with greater prevalence of NICU admission among infants with VLBW. Wide variation was observed among states in the prevalence of NICU admission of infants with VLBW; these state data should be assessed further, and barriers to NICU admission should be identified and addressed.

Research paper thumbnail of Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The 2011 MCH Epidemiology Awards

Maternal and Child Health Journal, Apr 19, 2012

The Coalition for Excellence, formed of 16 organizations, sponsors the Maternal and Child Health ... more The Coalition for Excellence, formed of 16 organizations, sponsors the Maternal and Child Health (MCH) Epidemiology Awards to provide national recognition for individuals, teams, institutions, and leaders who make significant contributions to improve the health of women, infants, children, and families by advancing public health knowledge, practice, research, and use of data (Table 1). Multiple awards are presented each year in different categories, including advancing knowledge, effective practice, outstanding leadership, excellence in teaching, young professional achievement, and lifetime achievement in MCH epidemiology. In 2011, three deserving public health researchers, one administrator, and one clinic were recognized for noteworthy contributions to MCH epidemiology.

Research paper thumbnail of Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The 2014 National MCH Epidemiology Awards

Maternal and Child Health Journal, Jan 2, 2016

Purpose-The impact of programs, policies, and practices developed by professionals in the field o... more Purpose-The impact of programs, policies, and practices developed by professionals in the field of maternal and child health (MCH) epidemiology is highlighted biennially by 16 national MCH agencies and organizations, or the Coalition for Excellence in MCH Epidemiology. Description-In September 2014, multiple leading agencies in the field of MCH partnered to host the national CityMatCH Leadership and MCH Epidemiology Conference in Phoenix, Arizona. The conference offered opportunities for peer exchange; presentation of new scientific methodologies, programs, and policies; dialogue on changes in the MCH field; and discussion of emerging MCH issues relevant to the work of local, state, and national MCH professionals. During the conference, the National MCH Epidemiology Awards were presented to individuals, teams, institutions, and leaders for significantly contributing to the improved health of women, children, and families. Assessment-During the conference, the Coalition presented seven deserving health researchers and research groups with national awards in the areas of advancing knowledge, effective practice, outstanding leadership, young professional achievement, and lifetime achievement. The article highlights the accomplishments of these national-level awardees. Conclusion-Recognition of deserving professionals strengthens the field of MCH epidemiology, and sets the standard for exceptional research, mentoring, and practice.

Research paper thumbnail of A population study of the contribution of medical comorbidity to the risk of prematurity in blacks

American Journal of Obstetrics and Gynecology, Oct 1, 2007

The purpose of this study was to test the hypothesis that the higher prevalence of medical comorb... more The purpose of this study was to test the hypothesis that the higher prevalence of medical comorbidities among black women accounts for their increased risk of prematurity. A population-based regional cohort of women receiving obstetric care for singleton pregnancies at a large community hospital between 2003 and 2006 were analyzed using univariate and multivariable logistic regression. Data for 18,624 consecutive births found increased odds of adverse outcomes for black compared to white women: prematurity OR = 1.6 (1.4-1.8), extreme prematurity OR = 2.5 (2.0-3.2). Logistic regression modeling identified black race, age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20, preconception diabetes and hypertension, smoking, underweight, and gestational hypertension as the greatest risks for adverse outcomes. Controlling for these risks did not attenuate the higher risk for prematurity among blacks. Though there is a greater burden of health risk among black women, this did not account for the higher rates of low birthweight and prematurity.

Research paper thumbnail of Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015–2018

Womens Health Issues, Mar 1, 2023

Research paper thumbnail of Updated interim Zika clinical guidance for pregnant women and data on contraceptive use to decrease Zika-affected pregnancies

Accreditation Statements CME: The Centers for Disease Control and Prevention is accredited by the... more Accreditation Statements CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME®) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.0 contact hours. IACET CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.1 CEU's for this program. CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.0 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 0. CDC provider number 98614. CPE: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 0.1 CEUs in pharmacy education. The Universal Activity Number is 0387-0000-16-102-L04-P and enduring 0387-0000-16-102-H04-P. This activity is knowledge based. AAVSB/RACE: This program was reviewed and approved by the AAVSB RACE program for 1.0 hours of continuing education in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program's validity or relevancy to the veterinary profession. CPH: The Centers for Disease Control and Prevention is a pre-approved provider of Certified in Public Health (CPH) recertification credits and is authorized to offer 1 CPH recertification credit for this program. Continuing Education Disclaimer CDC, our planners, presenters, and their spouses/partners wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Planners have reviewed content to ensure there is no bias. This presentation will not include any discussion of the unlabeled use of a product or products under investigational use.

Research paper thumbnail of Increased cesarean section rate over time (1994-2006) in Delaware is not associated with improved outcomes in very low birth weight infants

PubMed, May 1, 2010

Cesarean deliveries (C-section) have been increasing over time. The objectives of this study were... more Cesarean deliveries (C-section) have been increasing over time. The objectives of this study were to analyze cesarean section delivery rates over time, and determine whether there is an association between C-section, mortality, and severe intraventricular hemorrhage (IVH) in VLBW infants. We performed a retrospective cohort study of babies with birth weight < 1,500 grams, between 1994 and 2006, at Christiana Hospital (n = 2,040). Severe IVH was considered grade 3 to 4. Data were analyzed by three-year cohorts. Statistics included unadjusted and multivariable analyses. Cesarean delivery increased 22 percent from 1994 to 2006. When controlling for potential confounding variables including gestational age and presentation at birth, odds of C-section delivery remained elevated in Cohort 4 (2003-2006) compared with Cohort 1 (1994-1997; OR = 1.12, 95% CI 1.01-1.24). The rate of infant death and severe IVH did not change over time. After multivariable analysis, C-section was not associated with a decrease in death, severe IVH, or death and/or IVH. In our population of VLBW infants, the rate of C-section delivery increased over time. This increased rate was not associated with any change in the odds of death and/or severe IVH.

Research paper thumbnail of Summary of neonatal and maternal transport and reimbursement policies—a 5-year update

Journal of Perinatology, Apr 12, 2022

To examine the number of states with neonatal and maternal transport and reimbursement policies i... more To examine the number of states with neonatal and maternal transport and reimbursement policies in 2019, compared with 2014. We conducted a systematic review of web-based, publicly available information on neonatal and maternal transport policies for each state in 2019. Information was abstracted from rules, codes, licensure regulations, and planning and program documents, then summarized within two categories: transport and reimbursement policies. In 2019, 42 states had a policy for neonatal transport and 37 states had a policy for maternal transport, increasing by 8 and 7 states respectively. Further, 31 states had a reimbursement policy for neonatal transport and 11 states for maternal transport, increases of 1 state per category. Overall, the number of states with policies increased from 2014 to 2019. The number of state neonatal and maternal transport policies increased; these policies may support provision of care at the most risk-appropriate facilities.

Research paper thumbnail of Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies

Womens Health Issues, Nov 1, 2021

Background:Previous assessment of statewide policies on long-acting reversible contraception (LAR... more Background:Previous assessment of statewide policies on long-acting reversible contraception (LARC) indicate that an increasing number of states are implementing policies specifically for provision immediately postpartum, supported by current clinical guidelines. Less is known about how state policies describe payment methodologies for the insertion procedure and device costs.Methods:We conducted a systematic, web-based review of publicly available statewide policy language on immediate postpartum LARC among all 50 states. We examined the payor/s identified in the policy and policy type, if the policy included language on the global obstetric fee, whether providers and/or facilities were authorized to bill for procedure or device costs, and if the billing mechanism was identified as inpatient and/or outpatient services.Results:Three-fourths of states (76%; n = 38) had statewide policies on immediate postpartum LARC. All policies identified Medicaid as the payor, although two also included non-Medicaid plans. Language allowing for reimbursement separate from the global obstetric fee for insertion procedures was present in 76% of states; 23 states permit it and 6 do not. Device cost reimbursement separate from the fee was identified in more state policies (92%); 31 states allow it and 4 do not. More policies included inpatient or outpatient billing mechanisms for device costs (82%; n = 31) than insertion procedures (50%; n = 19).Conclusions:Medicaid reimbursement policies for immediate postpartum LARC services vary by state reimbursement process, type, and mechanism. Observed differences indicate payment methodologies more often include the cost of the device than provider reimbursement (31 states vs. 23 states). Fewer than one-half of states offer reimbursement for provider insertion fees, a significant systems barrier to contraceptive access for women who choose LARC immediately postpartum.

Research paper thumbnail of Seven years later: state neonatal risk-appropriate care policy consistency with the 2012 American Academy of Pediatrics Policy

Journal of Perinatology, Jul 12, 2021

To assess consistency of state neonatal risk-appropriate care policies with the 2012 AAP policy s... more To assess consistency of state neonatal risk-appropriate care policies with the 2012 AAP policy seven years post-publication. Systematic, web-based review of all publicly available 2019 state neonatal levels of care policies. Information on infant risk (gestational age, birth weight), technology and equipment capabilities, and availability of specialty staffing used to define neonatal levels of care was extracted for review. Half of states (50%) had a neonatal risk-appropriate care policy. Of those states, 88% had language consistent with AAP-defined Level I criteria, 80% with Level II, 56% with Level III, and 55% with Level IV. Comparing policies (2014–2019), consistency increased in state policies among all levels of care with the greatest increase among level IV criteria. States improved consistency of policy language by each level of care, though half of states still lack policy to provide minimum standards of care to the most vulnerable infants.

Research paper thumbnail of Translating Policy to Practice and Back Again

Womens Health Issues, Nov 1, 2008

The state of Delaware is in the unique position of implementing legislatively supported policy on... more The state of Delaware is in the unique position of implementing legislatively supported policy on preconception health. The state has allocated funding to translate preconception care policy to practice through a statewide program. The Delaware Division of Public Health has been given the responsibility of defining and implementing the preconception care program targeting a high-risk population. The state partnered with Medicaid, private practitioners, local hospitals, state service centers, and Federally Qualified Health Centers to develop a scope of program services that supplement the current clinical care provided at annual visits for women of childbearing age. Because the program has been in operation for 9 months, the Division of Public Health utilized feedback from the providing agencies to begin efforts for program sustainability and to modify the existing policy. Current efforts include developing outcome measures for the program, measuring program effectiveness through evaluation, and working with Medicaid and Managed Care Organizations to develop a reimbursement system for services.

Research paper thumbnail of Biological and Psychosocial Determinants of Problematic Birth Outcomes

The current research, analysis, and dissertation are dedicated to my daughter, Ember Kimmerbryce ... more The current research, analysis, and dissertation are dedicated to my daughter, Ember Kimmerbryce Crutchfield. She had no choice in supporting me throughout the doctoral process, and means more to me than any other person I have known. When she reads this dedication one day, I hope she will be proud. Secondly, I would like to thank Kathryn S. Oths, PhD, for her invaluable input throughout my graduate career, and Kevin Kip, PhD, for his support during the proposal phase of this dissertation. Thirdly, I would like to thank my family and friends for their support over the past five years. Specifically, Charles and Lu Kroelinger; Keara, Cory, and

Research paper thumbnail of Overview of 2018 U.S. Assisted Reproductive Technology (Art) Treatment Outcomes and Contribution of Art to Multiple Births and Preterm Births in the United States

Fertility and Sterility, Sep 1, 2020

These results suggest that not all 1PN-ICSI zygotes are abnormal, and these can result in a viabl... more These results suggest that not all 1PN-ICSI zygotes are abnormal, and these can result in a viable pregnancy and healthy live birth. Continued culture to blastocyst of 1PN-ICSI zygotes should be carried out in order to further assess their potential for transfer. SUPPORT: None.

Research paper thumbnail of Collaboration at the Federal, State, and Local Levels to Build Capacity in Maternal and Child Health: The Impact of the Maternal and Child Health Epidemiology Program

Journal of Womens Health, May 1, 2012

This article provides a description of the Maternal and Child Health Epidemiology Program housed ... more This article provides a description of the Maternal and Child Health Epidemiology Program housed in the Division of Reproductive Health at the Centers for Disease Control and Prevention. The article highlights programmatic efforts to build capacity and increase infrastructure within states, localities, and among tribes in the field of maternal and child health by leveraging partnerships with other federal, nonprofit, private, and academic agencies.

Research paper thumbnail of Rising Infant Mortality in Delaware: An Examination of Racial Differences in Secular Trends

Maternal and Child Health Journal, Mar 6, 2007

Recent increases in the Delaware Infant Mortality Rate (IMR) have been attributed to a rise in th... more Recent increases in the Delaware Infant Mortality Rate (IMR) have been attributed to a rise in the mortality of very low birth weight (VLBW, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1500 g) infants born to mothers of higher socioeconomic status. This study examines whether the determinants of infant mortality trends in Delaware vary by race. Linked birth/infant death cohort files for the two periods 1993-1997 and 1998-2002 were used to evaluate the determinants of infant mortality trends separately for White and Black racial groups. Kitagawa analyses determined the components of race-specific infant mortality trends attributable to changes in both the birthweight distribution and birthweight-specific mortality rates. Maternal characteristics were examined to identify factors associated with IMR changes. Between the two time periods, infant mortality increased 23% among White infants and 17% among Black infants. For both races, the infant mortality increase was explained by increases in the incidence and mortality of VLBW infants, specifically below &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;500 grams for Blacks and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1,000 grams for Whites. The increased incidence of VLBW deliveries was statistically significant only among Whites, almost 40% of which was explained by an increase in multiple births. For both Whites and Blacks, the increase in VLBW mortality occurred mainly among births to more traditionally advantaged women who were twenty or older, at least high school educated, married, privately insured, had received first trimester prenatal care, and those who delivered multiple births. These findings suggest that conventional strategies of increasing access to prenatal care among disadvantaged women may be insufficient to reverse recent IMR increases in Delaware, irrespective of race. Future efforts should focus on understanding the causes of the increased infant mortality associated with higher socioeconomic status, including changes in assisted reproductive technology utilization, maternal health status, and obstetric practice.

Research paper thumbnail of Assisted Reproductive Technology Surveillance — United States, 2018

Morbidity and mortality weekly report, Feb 18, 2022

Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (A... more Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to have multiple births because multiple embryos might be transferred. Multiple births can pose substantial risks for both mothers and infants, including obstetric complications, preterm birth (<37 weeks), and low birthweight (<2,500 g). This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2018 and compares birth outcomes that occurred in 2018 (resulting from ART procedures performed in 2017 and 2018) with outcomes for all infants born in the United States in 2018.

Research paper thumbnail of Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015

Morbidity and Mortality Weekly Report, Jan 12, 2018

Introduction: There have been dramatic improvements in reducing infant sleep-related deaths since... more Introduction: There have been dramatic improvements in reducing infant sleep-related deaths since the 1990s, when recommendations were introduced to place infants on their backs for sleep. However, there are still approximately 3,500 sleep-related deaths among infants each year in the United States, including those from sudden infant death syndrome, accidental suffocation and strangulation in bed, and unknown causes. Unsafe sleep practices, including placing infants in a nonsupine (on side or on stomach) sleep position, bed sharing, and using soft bedding in the sleep environment (e.g., blankets, pillows, and soft objects) are modifiable risk factors for sleep-related infant deaths. Methods: CDC analyzed 2009-2015 Pregnancy Risk Assessment Monitoring System (PRAMS) data to describe infant sleep practices. PRAMS, a state-specific and population-based surveillance system, monitors self-reported behaviors and experiences before, during, and shortly after pregnancy among women with a recent live birth. CDC examined 2015 data on nonsupine sleep positioning, bed sharing, and soft bedding use by state and selected maternal characteristics, as well as linear trends in nonsupine sleep positioning from 2009 to 2015. Results: In 2015, 21.6% of respondents from 32 states and New York City reported placing their infant in a nonsupine sleep position; this proportion ranged from 12.2% in Wisconsin to 33.8% in Louisiana. Infant nonsupine sleep positioning was highest among respondents who were non-Hispanic blacks. Nonsupine sleep positioning prevalence was higher among respondents aged <25 years compared with ≥25 years, those who had completed ≤12 years compared with >12 years of education, and those who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children during pregnancy. Based on trend data from 15 states, placement of infants in a nonsupine sleep position decreased significantly from 27.2% in 2009 to 19.4% in 2015. In 2015, over half of respondents (61.4%) from 14 states reported bed sharing with their infant, and 38.5% from 13 states and New York City reported using any soft bedding, most commonly bumper pads and thick blankets. Conclusions and Implications for Public Health Practice: Improved implementation of the safe sleep practices recommended by the American Academy of Pediatrics could help reduce sleep-related infant mortality. Evidence-based interventions could increase use of safe sleep practices, particularly within populations whose infants might be at higher risk for sleep-related deaths. * A small percentage of respondents (<4%) selected more than one sleep position. Respondents selecting multiple positions were classified as placing their infant in a nonsupine sleep position. Denominator includes supine, on stomach, on side only, and combinations of any of the three positions. † The 32 states include Alabama,

Research paper thumbnail of Assisted Reproductive Technology Surveillance — United States, 2017

Morbidity and mortality weekly report, Dec 18, 2020

Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (A... more Problem/Condition: Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to have multiple-birth infants because multiple embryos may be transferred. Multiple births can pose substantial risks for both mothers and infants, including obstetric complications, preterm birth (<37 weeks), and low birthweight (<2,500 g). This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2017 and compares birth outcomes that occurred in 2017 (resulting from ART procedures performed in 2016 and 2017) with outcomes for all infants born in the United States in 2017.

Research paper thumbnail of Trends in Repeat Births and Use of Postpartum Contraception Among Teens — United States, 2004–2015

Morbidity and Mortality Weekly Report, Apr 28, 2017

Teen* childbearing (one or more live births before age 20 years) can have negative health, social... more Teen* childbearing (one or more live births before age 20 years) can have negative health, social, and economic consequences for mothers and their children (1). Repeat teen births (two or more live births before age 20 years) can constrain the mother's ability to take advantage of educational and workforce opportunities (2), and are more likely to be preterm or of low birthweight than first teen births (3). Despite the historic decline in the U.S. teen birth rate during 1991-2015, from 61.8 to 22.3 births per 1,000 females aged 15-19 years (4), many teens continue to have repeat births (3). The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recommend that clinicians counsel women (including teens) during prenatal care about birth spacing and postpartum contraceptive use (5), including the safety and effectiveness of long-acting reversible methods that can be initiated immediately postpartum. To expand upon prior research assessing patterns and trends in repeat childbearing and postpartum contraceptive use among teens with a recent live birth (i.e., 2-6 months after delivery) (3), CDC analyzed data from the National Vital Statistics System natality files (2004 and 2015) and the Pregnancy Risk Assessment Monitoring System (PRAMS; 2004-2013). The number and proportion of teen births that were repeat births decreased from 2004 (82,997; 20.1%) to 2015 (38,324; 16.7%); in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among sexually active teens with a recent live birth, postpartum use of the most effective contraceptive methods (intrauterine devices and contraceptive implants) increased from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three reported using either a least effective method (15.7%) or no method (17.2%). Strategies that comprehensively address the social and health care needs of teen parents can facilitate access to and use of effective methods of contraception and help prevent repeat teen births. National Vital Statistics System natality files, compiled annually by CDC's National Center for Health Statistics, include demographic information such as maternal age, race, and Hispanic ethnicity for all births in the 50 states and the District of Columbia. † CDC analyzed national and state-specific * For this report, the term "teen" refers to a person aged <20 years.