Last updated: 11/21/2018 PPOR Notes: Minimum 60 fetal-infant deaths. Reference group: White NH mothers ages 20-34 with 13+ years of education in Maryland. PRINCE GEORGE'S 1 ____________________________________________________________________________________ MATERNAL AND INFANT HEALTH PROFILE Background The Office of Maternal and Child Health (MCH) Epidemiology in the MCH Bureau (MCHB) at the Maryland Department of Health created these health profiles to examine local maternal and infant health outcomes and risk factors compared to state averages. Local health departments should use these data and maps to identify and target population specific interventions to reduce maternal health risks that contribute to increased fetal-infant mortality rates among minorities in Maryland. While the statewide infant mortality rate (IMR) has decreased 32% since 1990, racial IMR disparities persist. Infant mortality rates among Black non-Hispanic (NH) births are consistently more than double the rates among White NH births. To eliminate this disparity, the IMR among Black NH births would have to decreased by approximately 60%. The leading cause of infant deaths in Maryland are preterm birth/low birth weight and Sudden Infant Death Syndrome (SIDS) for both Black NH and White NH infants. Congenital anomalies were the leading cause of death for Hispanic infants. Perinatal periods of risk (PPOR) analysis is a method of examining all fetal and infant death data to identify opportunities to reduce perinatal mortality (Sappenfield, 2010). Results from Phase 1 PPOR analysis suggests that half (49%) of excess, or preventable, fetal-infant mortality rates in Maryland during 2010-2017 was due to factors related to the maternal health and prematurity (MHP) period among Black NH births. Phase 2 analyses revealed that the largest reductions in infant mortality and adverse pregnancy outcomes could be produced by improving the social and economic environment of women which predisposes them to poorer health and birth outcomes. Specifically, factors contributing most to racial disparities in adverse pregnancy outcomes (APO: fetal or neonatal death, or very PTB and very LBW births) include differences in marital status, education, insurance coverage, community socioeconomic disadvantage, hypertension, prior preterm birth or other pregnancy outcomes, pre-pregnancy body mass index (BMI), and participation in the Women, Infants and Children (WIC) program. Lack of prenatal care and tobacco use are also associated with increased risks of APO, however, these factors do not appear to explain the differences in APO rates between Black NH and White NH births in Maryland. Findings suggest that eliminating the prevalence of hypertension could reduce APO’s by nearly 12% statewide. Drastic racial differences in marital status highlight the greater need for social support and/or services for minority women to improve pregnancy outcomes (Salihu, 2014). For greater detail about preconception and prenatal risk factors, please visit the Maryland PRAMS website (PRAMS). Programs should use these findings to develop evidence-based initiatives to improve the preconception and maternal health of women, and particularly Black NH women, to produce the greatest reductions in fetal and infant mortality in Maryland. For questions or comments, please contact the Maternal and Child Health Bureau at [email protected] or (410) 767-6713. 2017 Jurisdiction Ranks Indicator Rank* Fetal-Infant Mortality Rate (FIMR) 14th Preterm Birth (PTB, <37 weeks) 17th Low Birth Weight (LBW, <2500 grams) 18th Very PTB & Very LBW 15th Unmarried, no father listed 18th Maternal Education: High School Diploma or Less 16th Maternal Hypertension (Chronic or Gestational) 9th Medicaid Coverage 14th Maternal Obesity 14th Prior Preterm Birth 13th Maternal Age Under 20 Years Old 16th Third Trimester or No Prenatal Care Initiation 24th Preconception or Prenatal Smoking 2nd Maternal Opioid Use Disorder 1st Maternal Substance Use Disorder 2nd WIC Participation 8th *Ranks are relative to the other 24 jurisdictions. Lower is better. N/a: rank not available due to insufficient data. Perinatal Period of Risk (PPOR): Excess, or preventable, fetal-infant mortality rates by population group, Prince George's County, 2010-2017 Population Group 0.6 -0.3 1.0 0.3 0.9 Health Infant 0.5 0.2 0.4 0.6 0.7 Care Infant 1.5 1.1 1.6 1.1 1.2 Care Maternal 5.4 1.4 7.5 2.6 4.9 Prematurity Health/ Maternal All White NH Black NH Hispanic Medicaid All White NH Black NH Hispanic Medicaid All White NH Black NH Hispanic Medicaid All White NH Black NH Hispanic Medicaid 0 2 4 6 8 Deaths per 1,000 pregnancies
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Transcript
Last updated: 11/21/2018
PPOR Notes: Minimum 60 fetal-infant deaths. Reference group: White NH mothers ages 20-34 with 13+ years of education in Maryland.
PRINCE GEORGE'S 1
____________________________________________________________________________________MATERNAL AND INFANT HEALTH PROFILE
BackgroundThe Office of Maternal and Child Health (MCH) Epidemiology in the MCH Bureau(MCHB) at the Maryland Department of Health created these health profiles to examinelocal maternal and infant health outcomes and risk factors compared to state averages. Localhealth departments should use these data and maps to identify and target population specificinterventions to reduce maternal health risks that contribute to increased fetal-infantmortality rates among minorities in Maryland.
While the statewide infant mortality rate (IMR) has decreased 32% since 1990, racial IMRdisparities persist. Infant mortality rates among Black non-Hispanic (NH) births areconsistently more than double the rates among White NH births. To eliminate this disparity,the IMR among Black NH births would have to decreased by approximately 60%. Theleading cause of infant deaths in Maryland are preterm birth/low birth weight and SuddenInfant Death Syndrome (SIDS) for both Black NH and White NH infants. Congenitalanomalies were the leading cause of death for Hispanic infants.
Perinatal periods of risk (PPOR) analysis is a method of examining all fetal and infant deathdata to identify opportunities to reduce perinatal mortality (Sappenfield, 2010). Results fromPhase 1 PPOR analysis suggests that half (49%) of excess, or preventable, fetal-infantmortality rates in Maryland during 2010-2017 was due to factors related to the maternalhealth and prematurity (MHP) period among Black NH births. Phase 2 analyses revealedthat the largest reductions in infant mortality and adverse pregnancy outcomes could beproduced by improving the social and economic environment of women which predisposesthem to poorer health and birth outcomes. Specifically, factors contributing most to racialdisparities in adverse pregnancy outcomes (APO: fetal or neonatal death, or very PTB andvery LBW births) include differences in marital status, education, insurance coverage,community socioeconomic disadvantage, hypertension, prior preterm birth or otherpregnancy outcomes, pre-pregnancy body mass index (BMI), and participation in theWomen, Infants and Children (WIC) program. Lack of prenatal care and tobacco use arealso associated with increased risks of APO, however, these factors do not appear to explainthe differences in APO rates between Black NH and White NH births in Maryland. Findingssuggest that eliminating the prevalence of hypertension could reduce APO’s by nearly 12%statewide. Drastic racial differences in marital status highlight the greater need for socialsupport and/or services for minority women to improve pregnancy outcomes (Salihu, 2014).For greater detail about preconception and prenatal risk factors, please visit the MarylandPRAMS website (PRAMS).
Programs should use these findings to develop evidence-based initiatives to improve the preconception and maternal health of women, and particularly Black NH women, to produce the greatest reductions in fetal and infant mortality in Maryland. For questions or comments, please contact the Maternal and Child Health Bureau at [email protected] or (410) 767-6713.
2017 Jurisdiction Ranks
Indicator Rank*Fetal-Infant Mortality Rate(FIMR)
14th
Preterm Birth (PTB, <37weeks)
17th
Low Birth Weight (LBW,<2500 grams)
18th
Very PTB & Very LBW 15th
Unmarried, no father listed 18th
Maternal Education: HighSchool Diploma or Less
16th
Maternal Hypertension(Chronic or Gestational)
9th
Medicaid Coverage 14th
Maternal Obesity 14th
Prior Preterm Birth 13th
Maternal Age Under 20Years Old
16th
Third Trimester or NoPrenatal Care Initiation
24th
Preconception or PrenatalSmoking
2nd
Maternal Opioid UseDisorder
1st
Maternal Substance UseDisorder
2nd
WIC Participation 8th
*Ranks are relative to the other 24 jurisdictions. Lower isbetter. N/a: rank not available due to insufficient data.
Perinatal Period of Risk (PPOR): Excess, or preventable, fetal-infant mortality rates bypopulation group, Prince George's County, 2010-2017
PRINCE GEORGE'SFetal-Infant Mortality RatesFetal-infant mortality rates (FIMR) represent the number of fetal (older than 20 weeks gestation) or infant deaths(younger than 365 days old) per 1,000 pregnancies in that year. NOTE: Source is linked infant birth and deathcertificate records which exclude records not linked due to certificate errors or migration and results in lowerFIMRs than those in Maryland VSA reports.
Of the 12,548 pregnancies in Prince George's in 2017 there were 15.5 fetal or infant deaths for every 1,000pregnancies.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
PRINCE GEORGE'SPreterm Birth (PTB, <37 weeks)Preterm birth describes infants born prior to 37 weeks gestation and is a leading cause of LBW and VLBW, andinfant death. Preterm-related causes of death accounted for 35% of all infant deaths in the U.S. in 2010, morethan any other single cause.
Of the 12,422 live births in Prince George's in 2017, 10.8% were born preterm (<37 weeks gestation).
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
9.1 8.7
9.0 8.7
Other NH
8.8 9.3
9.0 9.1
Hispanic
12.7 12.8
11.9 11.7
Black NH
8.9 8.8
8.9 8.3
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
1010
by Maternal Age and Year
Preterm Birth (PTB, <37 weeks)PRINCE GEORGE'S
12.4 12.1
14.3 13.3
35+
9.5 9.5
10.0 9.7
25-34
9.9 9.8
9.8 9.3
20-24
10.3 11.0
10.0 10.9
<20
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Age and Race, 2010-2017
10.6 15.6 11.2 11.2
11.2 15.1 11.9 12.0
35+ years
8.3 12.3 8.6 8.0
7.7 11.0 8.7 8.0
25-34 years
8.7 11.9 8.4 8.0
8.1 10.8 8.3 6.6
<25 years
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
George'sPrince
1111
by Insurance Coverage and Year
Preterm Birth (PTB, <37 weeks)PRINCE GEORGE'S
10.7 10.3
11.3 10.8
Other
11.3 11.3
10.5 10.4
Medicaid
9.3 9.3
10.4 10.2
Private
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Insurance Coverage and Race, 2010-2017
9.4 13.2 8.9 9.6
9.2 12.8 8.9 9.2
Other
10.2 13.2 9.2 8.3
8.8 11.7 8.8 7.4
Medicaid
8.3 12.0 8.9 9.0
8.1 11.0 10.1 9.3
Private
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
1212
by Maternal Educational Attainment and Year
Preterm Birth (PTB, <37 weeks)PRINCE GEORGE'S
9.6 9.6
10.9 10.5
College
11.1 11.4
11.1 11.0
High School Diploma
10.8 10.9
9.6 9.6
<High School
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Educational Attainment and Race, 2010-2017
8.4 12.0 9.1 8.9
8.2 11.5 9.8 8.9
College
9.9 13.4 9.1 8.8
9.5 12.2 9.0 8.7
High School Diploma
11.0 14.5 9.0 9.2
10.1 12.5 8.8 7.8
<High School
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
1313
by Pre-Pregnancy Body Mass Index (BMI) and Year
Preterm Birth (PTB, <37 weeks)PRINCE GEORGE'S
11.8 12.1
12.5 11.8
Obese
10.0 9.9
10.1 10.2
Overweight
9.0 9.0
9.8 9.5
Normal
10.9 10.5
11.7 10.1
Underweight
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Pre-Pregnancy Body Mass Index (BMI) and Race, 2010-2017
10.4 14.0 9.9 11.2
10.9 13.1 9.8 11.2
Obese
8.8 11.9 8.9 10.3
8.9 10.8 9.1 10.3
Overweight
8.1 11.7 8.4 8.1
7.2 11.0 8.5 8.0
Normal
9.9 15.0 8.6 7.0
9.6 13.7 8.1 2.8
Underweight
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
George'sPrince
1414
by Marital Status and Year
Preterm Birth (PTB, <37 weeks)PRINCE GEORGE'S
13.7 14.1
13.3 12.4
Unmarried, No FL
10.6 10.9
10.2 10.4
Unmarried, FL
9.2 9.1
10.4 9.8
Married
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
FL: father listed on the birth certificate
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Marital Status and Race, 2010-2017
13.3 14.9 10.9 10.3
12.4 13.7 10.4 7.5
Unmarried, No FL
9.5 12.6 8.8 10.0
9.5 11.5 8.4 10.1
Unmarried, FL
8.3 11.7 8.9 8.8
8.1 11.1 9.4 8.7
Married
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 15
Preterm Birth (PTB, <37 weeks) by Maternal Residence CensusTract, 2010-2017
PRINCE GEORGE'SLow Birth Weight (LBW, <2500 grams)Low birth weight describes infants weighing less than 2500 grams, or 5.5 pounds, at birth and is a leading causeof neonatal mortality. Since low birth weight is typically associated with a preterm birth, many public healthinterventions focus on ways to reduce the rates of low birth weight, very low birth weight, and preterm birth asstrategies to reduce infant mortality.
Of the 12,422 live births in Prince George's in 2017, 9.8% were low birth weight (<2500 grams).
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
PRINCE GEORGE'SVery LBW (<1500 grams) & Very PTB (<32 weeks)Approximately 1 in 4 infants born very PTB & very LBW die before their first birthday. Very PTB & very LBWinfants also have an increased risk of developmental delays.
Of the 12,422 live births in Prince George's in 2017, 2.1% were born very premature.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
1.1 1.0
1.2 0.8
Other NH
1.1 1.1
1.1 1.0
Hispanic
2.7 2.6
2.6 2.5
Black NH
0.9 0.9
1.1 0.8
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
2424
by Maternal Age and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)PRINCE GEORGE'S
1.9 1.8
2.7 2.4
35+
1.3 1.3
1.9 1.7
25-34
1.6 1.5
1.9 1.5
20-24
2.0 1.8
1.9 1.8
<20
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Age and Race, 2010-2017
1.1 3.2 1.5 1.3
1.4 3.1 1.7 1.1
35+ years
0.8 2.5 1.1 0.9
1.0 2.4 1.1 1.0
25-34 years
1.0 2.5 0.9 1.0
0.4 2.4 0.8 *
<25 years
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
George'sPrince
2525
by Insurance Coverage and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)PRINCE GEORGE'S
1.8 1.6
2.2 2.0
Other
2.0 1.7
2.0 1.6
Medicaid
1.2 1.3
1.9 1.9
Private
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Insurance Coverage and Race, 2010-2017
1.1 3.1 1.0 1.1
1.0 3.0 1.0 1.4
Other
1.1 2.6 1.2 1.1
0.8 2.4 1.0 0.5
Medicaid
0.8 2.4 1.1 1.0
1.0 2.3 1.4 1.1
Private
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
George'sPrince
2626
by Maternal Educational Attainment and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)PRINCE GEORGE'S
1.3 1.3
2.1 1.9
College
1.8 1.8
2.2 1.8
High School Diploma
1.6 1.6
1.4 1.3
<High School
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Educational Attainment and Race, 2010-2017
0.8 2.4 1.1 1.0
0.9 2.4 1.1 1.1
College
1.1 2.7 1.2 1.0
1.5 2.6 1.2 *
High School Diploma
1.2 2.9 1.0 1.2
* 2.8 1.0 *
<High School
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
2727
by Pre-Pregnancy Body Mass Index (BMI) and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)PRINCE GEORGE'S
2.0 2.0
2.7 2.5
Obese
1.4 1.4
1.9 1.7
Overweight
1.1 1.1
1.5 1.4
Normal
1.3 1.4
1.5 1.3
Underweight
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Pre-Pregnancy Body Mass Index (BMI) and Race, 2010-2017
1.2 3.0 1.4 1.5
1.6 3.1 1.4 1.1
Obese
0.8 2.4 1.0 1.2
0.8 2.3 1.0 1.5
Overweight
0.7 2.1 0.9 0.9
0.8 2.0 0.8 0.8
Normal
1.0 2.4 0.7 0.7
0.0 2.1 * 0.0
Underweight
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
George'sPrince
2828
by Marital Status and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)PRINCE GEORGE'S
2.9 2.7
2.8 2.5
Unmarried, No FL
1.7 1.7
2.0 1.8
Unmarried, FL
1.2 1.2
1.8 1.6
Married
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
George'sPrince
FL: father listed on the birth certificate
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Marital Status and Race, 2010-2017
1.9 3.4 1.7 2.4
* 3.1 1.4 *
Unmarried, No FL
0.9 2.5 1.1 1.2
1.2 2.5 1.0 1.7
Unmarried, FL
0.8 2.3 1.0 1.0
0.9 2.3 1.1 0.9
Married
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 29
Very LBW (<1500 grams) & Very PTB (<32 weeks) by MaternalResidence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Unmarried, No Father ListedBirths to unmarried women with no father listed on the birth certificate have an increased risk of adverse birthoutcomes. (Ngui, 2009; Luo, 2004; Alio, 2010). Mothers with a lack of paternal involvement are more likely toexperience greater psychosocial stress due to insufficient economic and social support which can lead to poorhealth behaviors and adverse birth outcomes.
Of the 12,422 live births in Prince George's in 2017, 37.4% were to unmarried women with no father listedon the birth certif icate.
by Year
*Rates based on less than 5 events are suppressed. FL: father listed on the birth certificate. NH: non-Hispanic.Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
7.1 7.1
11.6 11.2
Other NH
45.9 42.9
50.1 41.4
Hispanic
42.4 40.4
38.1 33.5
Black NH
20.2 19.7
15.9 14.2
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
50
60
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 31
Risk Factor: Unmarried, No Father Listed by MaternalResidence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Maternal Education: High School Diploma or LessLow educational attainment serves as a proxy for lower socioeconomic status and is associated with increasedadverse birth outcome risks.
Of the 12,422 live births in Prince George's in 2017, 41.7% were to women with a high school education orless.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
16.3 16.1
21.3 21.6
Other NH
69.9 67.1
78.8 76.7
Hispanic
41.9 37.8
32.3 28.4
Black NH
23.0 20.2
20.5 18.2
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
20
40
60
80
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 33
Risk Factor: Maternal Education: High School Diploma or Lessby Maternal Residence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Maternal Hypertension (Chronic or Gestational)Hypertension before and during pregnancy puts women at higher risk for preeclampsia, cesarean section, pretermbirth, and a low birth weight baby.
Of the 12,422 live births in Prince George's in 2017, 9.5% were to women who had chronic or pregnancy-associated hypertension.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
3.9 4.9
3.8 5.5
Other NH
4.8 6.7
4.9 6.4
Hispanic
9.0 12.3
7.8 10.5
Black NH
6.6 8.7
6.5 7.8
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 35
Risk Factor: Maternal Hypertension (Chronic or Gestational) byMaternal Residence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Medicaid CoverageMedicaid paid births serve as a proxy for lower socioeconomic status and is associated with increased adversebirth outcome risks.
Of the 12,422 live births in Prince George's in 2017, 42.7% were Medicaid paid births.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
16.3 22.9
18.7 29.4
Other NH
36.7 53.0
30.0 51.6
Hispanic
43.8 50.6
32.2 37.3
Black NH
19.5 22.1
12.6 17.8
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
50
60
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 37
Risk Factor: Medicaid Coverage by Maternal Residence CensusTract, 2010-2017
PRINCE GEORGE'SRisk Factor: Maternal ObesityObesity during pregnancy is associated with maternal risks such as gestational diabetes, preeclampsia, stillbirthand congenital anomalies (Leddy, 2008).
Of the 12,422 live births in Prince George's in 2017, 29.4% were to obese women.
by Year
*Rates based on less than 5 events are suppressed. Obesity defined as a pre-pregnancy body mass index (BMI)score of 30 or greater. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
8.8 10.7
10.2 13.7
Other NH
19.1 22.6
19.6 24.5
Hispanic
32.2 34.6
30.0 33.0
Black NH
19.5 21.1
21.5 21.8
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 39
Risk Factor: Maternal Obesity by Maternal Residence CensusTract, 2010-2017
PRINCE GEORGE'SRisk Factor: Prior Preterm BirthWomen with a prior preterm birth are more likely to have a repeat preterm birth (Adams, 2000). Repeat PTB'smay also serve as a marker for persistent physiological risks to maternal health and is associated with greaterrisks to infant survival.
Of the 12,422 live births in Prince George's in 2017, 3.6% were to women with a prior preterm birth.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
1.8 2.4
1.9 2.3
Other NH
2.2 3.5
1.7 3.3
Hispanic
3.8 5.3
3.0 4.0
Black NH
2.6 3.2
1.6 2.4
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
1
2
3
4
5
6
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 41
Risk Factor: Prior Preterm Birth by Maternal Residence CensusTract, 2010-2017
PRINCE GEORGE'SRisk Factor: Maternal Age Under 20 Years OldTeen childbearing often limits the educational and economic opportunties for young women and is associatedwith a greater risk of adverse birth outcomes. (Ventura, 2014) Approximately, 8 in 10 births to women under 20years old are unintended. (MD PRAMS, 2018)
Of the 12,422 live births in Prince George's in 2017, 4.6% were to women under 20 years old.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
1.0 0.9
1.8 1.2
Other NH
8.1 7.1
9.7 8.0
Hispanic
10.1 6.1
8.3 4.3
Black NH
4.0 2.6
2.8 2.1
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 43
Risk Factor: Maternal Age Under 20 Years Old by MaternalResidence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Third Trimester or No Prenatal Care InitiationBabies born to women who do not receive prenatal care are three times more likely to be born at a low birthweight and five times more likely to die than babies born to mothers receiving prenatal care.
Of the 12,422 live births in Prince George's in 2017, 11.1% were to women who initiated prenatal care inthe third trimester or had no prenatal care.
by Year
*Rates based on less than 5 events are suppressed. Note: percentages are calculated excluding missing or unknownvalues of PNC initiation. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
7.9 7.7
11.1 11.0
Other NH
11.6 11.2
13.0 11.7
Hispanic
12.3 12.0
14.8 12.7
Black NH
5.4 5.4
8.9 7.2
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 45
Risk Factor: Third Trimester or No Prenatal Care Initiation byMaternal Residence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Preconception or Prenatal SmokingTobacco is the most commonly used substance during pregnancy and is associated with adverse birth outcomessuch as miscarriage, placental abruption, placental insufficiency, and low birth weight.
Of the 12,422 live births in Prince George's in 2017, 3.6% were to women who reported smoking before orduring their pregnancy.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
5.0 2.6
10.4 3.5
Other NH
4.0 2.8
3.7 1.7
Hispanic
10.9 9.4
8.6 5.4
Black NH
18.0 14.4
17.8 9.1
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 47
Risk Factor: Preconception or Prenatal Smoking by MaternalResidence Census Tract, 2010-2017
PRINCE GEORGE'SRisk Factor: Maternal Opioid Use Disorder (OUD)Opioids include heroin, morphine, codeine, oxycodone, hydrocodone, etc. Maternal opioid use disorder has beenassociated with preterm labor, stillbirth, birth defects, neonatal abstinence syndrome, and maternal mortality(Patrick, 2015; Maeda, 2014). Nationally, the rate of opioid use disorder during delivery hospitalizationsincreased 67% from 2010-2014 (Haight, 2017).
Of the 9,574 maternal hospitalizations in Prince George's in 2017, there were 2.3 with an OUD diagnosisfor every 1,000 maternal hospitalizations.
by Year
*Rates based on less than 11 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal,delivery, or postpartum) hospitalizations. Please note, diagnosis coding transitioned from ICD-9 to ICD-10beginning October 2015. Note, OUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Heslin,2017).
by Maternal Race and Year
2.2 2.6
* *
Other NH
1.6 1.9
* *
Hispanic
5.6 6.7
0.5 1.1
Black NH
24.6 30.7
9.0 14.5
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
per
1,00
0 m
ater
nal h
o...
Maryland
George'sPrince
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal, delivery, or postpartum) hospitalizations. Please note, diagnosiscoding transitioned from ICD-9 to ICD-10 beginning October 2015. Note, OUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Heslin, 2017).
PRINCE GEORGE'S 49
Risk Factor: Maternal Opioid Use Disorder (OUD) by MaternalResidence Census Tract, 2013-2016
PRINCE GEORGE'SRisk Factor: Maternal Substance Use Disorder (SUD)In addition to opioid, other substances can lead to adverse birth outcomes. Cocaine use during pregnancy canlead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Alcohol use duringpregnancy can lead to spontaneous abortion, growth restriction, birth defects, and mental retardation (Keegan,2010). This indicator represents a SUD diagnosis during a maternal hospitalization for the following substances:Opioids, Cocaine, Cannabis, Alcohol, Sedatives, and Hallucinogens.
Of the 9,574 maternal hospitalizations in Prince George's in 2017, there were 16.5 with an SUD diagnosisfor every 1,000 maternal hospitalizations.
by Year
*Rates based on less than 11 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal,delivery, or postpartum) hospitalizations. Please note, diagnosis coding transitioned from ICD-9 to ICD-10beginning October 2015. Note, SUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Fingar,2015; Heslin, 2017).
by Maternal Race and Year
6.4 7.0
3.9 4.5
Other NH
4.3 6.6
3.5 4.4
Hispanic
32.7 42.2
16.5 20.1
Black NH
37.3 46.6
21.1 30.2
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
50
per
1,00
0 m
ater
nal h
o...
Maryland
George'sPrince
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal, delivery, or postpartum) hospitalizations. Please note, diagnosiscoding transitioned from ICD-9 to ICD-10 beginning October 2015. Note, SUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Fingar, 2015; Heslin,2017).
PRINCE GEORGE'S 51
Risk Factor: Maternal Substance Use Disorder (SUD) byMaternal Residence Census Tract, 2013-2016
PRINCE GEORGE'SCharacteristic: Women, Infants and Children (WIC) ProgramParticipationPrenatal WIC participation is associated with lower infant mortality rates. WIC prenatal care benefits reduce therate of LBW babies by 25% and VLBW babies by 44%. Women participating in WIC have been found to havelonger pregnancies and are more likely to receive adequate prenatal care.
Of the 12,422 live births in Prince George's in 2017, 44.5% were to women who were enrolled in WIC.
by Year
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
20.0 19.7
24.3 25.4
Other NH
68.1 63.1
71.1 67.0
Hispanic
57.1 52.6
45.6 42.2
Black NH
23.7 19.8
18.1 15.7
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
20
40
60
80
% o
f liv
e bi
rths
Maryland
George'sPrince
Source: Maryland Vital Statistics Administration
PRINCE GEORGE'S 53
Characteristic: Women, Infants and Children (WIC) ProgramParticipation by Maternal Residence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 11.1 - 28.3
28.4 - 38.9 39.0 - 51.7 51.8 - 59.6
59.7 - 83.9
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
Source: Maryland Vital Statistics Administration and Office of MCH Epidemiology. Risk represents weighted mean predicted probability of fetal deaths, neonatal deaths, orvery PTB and very LBW births (<1,500g & <32 weeks) adjusted for maternal, hospital, and community characteristics stratified by jurisdiction among singleton pregnancies.Lowest and Highest indicate areas whose estimated risk is in the lower 5th and upper 95th percentile of the jurisdiction grouping, respectively. Data based on fewer than 5pregnancies has been suppressed.
Prince George's Adverse Pregnancy Outcome Risks54
All Races
No data Suppressed Lowest
Highest
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
Black non-Hispanic
No data Suppressed Lowest
Highest
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
White non-Hispanic
No data Suppressed Lowest
Highest
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
Hispanic
No data Suppressed Lowest
Highest
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
Source: US Census American Community Survey 2016 Five-year Census Tract Estimates
Prince George's Social Determinants of Health55
Adult Poverty Rates (ages 18-59)
% of adult residents
No data 0.0 0.3 - 4.2
4.3 - 6.4 6.5 - 9.0 9.1 - 13.2
13.3 - 75.9
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
Median Household Income
Income in 2016 inflation-adjusted dollars ($)
No data 0.0 25,045 - 54,821
54,821 - 66,051 66,051 - 82,022 82,022 - 101,373
101,373 - 147,386
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
No Health Insurance Coverage
% of adult residents, ages 18-64
No data 0.0 1.7 - 6.2
6.3 - 9.3 9.4 - 13.0 13.1 - 20.4
20.5 - 76.2
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
Houses Built Before 1950
% of households
No data 0.0 0.2 - 2.0
2.1 - 4.7 4.8 - 7.3 7.4 - 15.0
15.1 - 72.6
Bowie
Fort Washington
College Park
Oxon Hill
Laurel
Hyattsville
Capitol Heights
Upper Marlboro
5656
REFERENCESr
Alio AP, Kornosky JL, Mbah AK, et al. (2010). The impact of paternal involvement on feto-infant morbidity among Whites, Blacks andHispanics. Maternal and Child Health Journal, 14(5), 735–741. doi:10.1007/s10995-009-0482-1.
Adams MM, Elam-Evans LD, Wilson HG, Gilbertz DA (2000). Rates of and factors associated with recurrence of preterm delivery. JAMA,283(12):1591-6. 10.1001/jama.283.12.1591.
Fingar KR, Stocks C, Weiss AJ, Owens PL (2015). Neonatal and Maternal Hospital Stays Related to Substance Use, 2006–2012. HCUPStatistical Brief #193. July 2015. Agency for Healthcare Research and Quality, Rockville, MD.http://www.hcup-us.ahrq.gov/reports/statbriefs/sb193-Neonatal-Maternal-Hospitalizations-SubstanceUse.pdf.
Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization - United States,1999–2014. MMWR Morb Mortal Wkly Rep 2018;67:845-849.
Heslin KC, Owens PL, Karaca Z, Barrett ML, Moore BJ, Elixhauser A (2017). Trends in Opioid-related Inpatient Stays Shifted After the USTransitioned to ICD-10-CM Diagnosis Coding in 2015. Medical Care, 55(11):918-923.
Keegan J, Parva M, Finnegan M, Gerson A, Belden M (2010). Addiction in pregnancy. Journal of Addictive Diseases, 29(2):175-191.
Leddy MA, Power ML, Schulkin J (2008). The impact of maternal obesity on maternal and fetal health. Reviews in Obstetrics & Gynecology,1:170-178.
Luo ZC, Wilkins R, Kramer MS (2004). Disparities in pregnancy outcomes according to marital and cohabitation status. Obstetrics andGynecology, 103(6), 1300–1307. doi:10.1097/01. AOG.0000128070.44805.1f.
Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetricaloutcomes. Anesthesiology 2014;121:1158–65. https://doi.org/10.1097/ALN.0000000000000472.
Maryland (MD) PRAMS Report, 2012-2015 Births. January 2018. Available at:https://phpa.health.maryland.gov/mch/Documents/2012-2015%20PRAMS%20report_rev.pdf
Ngui E, Cortright A, & Blair K (2009). An investigation of paternity status and other factors associated with racial and ethnic disparities inbirth outcomes in Milwaukee, Wisconsin. Maternal and Child Health Journal, 13(4), 467–478. doi:10.1007/s10995-008-0383-8.
Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome:United States 2009 to 2012. J Perinatol 2015;35:650–5. https://doi.org/10.1038/jp.2015.36.
Salihu HM, Salemi JL, Nash MC, et al. (2014). Assessing the Economic Impact of Paternal Involvement: A Comparison of the GeneralizedLinear Model Versus Decision Analysis Trees. Maternal Child Health Journal, 18:1380–1390.
Sappenfield WM, Peck MG, Gilbert CS, et al (2010). Perinatal Periods of Risk: Analytic Preparation and Phase 1 Analytic Methods forInvestigating Feto-Infant Mortality. Maternal and Child Health Journal, 14:838-850.
Sappenfield WM, Peck MG, Gilbert CS, et al (2010). Perinatal Periods of Risk: Phase 2 Analytic Methods for Further InvestigatingFeto-Infant Mortality. Maternal and Child Health Journal, 14:851-863.
Ventura SJ, Hamilton BE, Mathews TJ (2014). National and state patterns of teen births in the United States, 1940–2013. National vitalstatistics reports; vol 63 no 4. Hyattsville, MD: National Center for Health Statistics.
More information about maternal preconception and prenatal risk factors and trends are available in Maryland Pregnancy Risk AssessmentMonitoring System (PRAMS) Reports and Focus Briefs available here: https://phpa.health.maryland.gov/mch/Pages/prams_report.aspx