Annual Summary of Vital Statistics: 2008

T. J. Mathews, Arialdi M. Miniño, Michelle J. K. Osterman, Donna M. Strobino and

Bernard Guyer
Pediatrics 2011;127;146-157; originally published online Dec 20, 2010;
DOI: 10.1542/peds.2010-3175

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://www.pediatrics.org/cgi/content/full/127/1/146

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Annual Summary of Vital Statistics: 2008
AUTHORS: T. J. Mathews, MS,a Arialdi M. Miniño, MPH,a
abstract Michelle J. K. Osterman, MHS,a Donna M. Strobino, PhD,b
and Bernard Guyer, MD, MPHb
The number of births in the United States decreased between 2007 and
aDivision of Vital Statistics, National Center for Health Statistics,
2008 (preliminary estimate: 4 251 095). Birth rates declined among all Centers for Disease Control and Prevention, Hyattsville,
women aged 15 to 39 years; the decrease among teenagers reverses Maryland; and bDepartment of Population and Family Health
the increases seen in the previous 2 years. The total fertility rate de- Sciences, Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland
creased 2% in 2008 to 2085.5 births per 1000 women. The proportion of
all births to unmarried women increased to 40.6% in 2008, up from KEY WORDS
birth, death, teenaged fertility, infant mortality, low birth weight,
39.7% in 2007. The 2008 preterm birth rate was 12.3%, a decline of 3% mortality, multiple births, cesarean rate, vital statistics, ICD-10,
from 2007. In 2008, 32.3% of all births occurred by cesarean delivery, up revised certificates
nearly 2% from 2007. Twin and triplet birth rates were unchanged. The ABBREVIATIONS
infant mortality rate was 6.59 infant deaths per 1000 live births in 2008 NCHS—National Center for Health Statistics
IMR—infant mortality rate
(significantly lower than the rate of 6.75 in 2007). Life expectancy at
NMR—neonatal mortality rate
birth was 77.8 years in 2008. Crude death rates for children aged 1 to 19 PNMR—postneonatal mortality rate
years decreased by 5.5% between 2007 and 2008. Unintentional injuries OMB—Office of Management and Budget
and homicide were, respectively, the first and second leading causes of LBW—low birth weight

death in this age group. These 2 causes of death jointly accounted for
51.2% of all deaths of children and adolescents in 2008. This annual
article is a long-standing feature in Pediatrics and provides a summary
of the most current vital statistics data for the United States. We also
include a special feature this year on the differences in cesarean-
delivery rates according to race and Hispanic origin. Pediatrics 2011;
127:146–157
METHODS
www.pediatrics.org/cgi/doi/10.1542/peds.2010-3175
doi:10.1542/peds.2010-3175
Accepted for publication Oct 25, 2010
Address correspondence to T. J. Mathews, MS, Centers for
Disease Control and Prevention, National Center for Health
Statistics, 3311 Toledo Rd, Room 7318, Hyattsville, MD 20782.
E-mail: tjm4@cdc.gov
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2011 by the American Academy of Pediatrics

The data presented in this report were obtained from vital statistics FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
records: birth certificates and death certificates for residents in all US
states and the District of Columbia. Birth data for 2008 are preliminary
and based on ⬎99% of records. Mortality data for 2008 are preliminary
and based on ⬎99% of records. Birth and death data for 2007 and
earlier years are final and include all records. More complete descrip-
tions of vital statistics data systems are available elsewhere.1– 6
Current vital statistics patterns and recent trends through 2007 and
2008 are presented according to age, race, and Hispanic origin as well
as other birth and death characteristics. More detailed data are avail-
able for final 2007 births than for preliminary 2008 births; therefore,
some of the detailed analyses of birth patterns are based on 2007 data.
Hispanic origin and race are collected as separate items in vital
records. Persons of Hispanic origin may be of any race. A number of
reporting areas allow for multiple-race categories on birth and death
certificates. However, until all areas revise their certificates to reflect
updated reporting standards for race,7 multiple-race data are
“bridged” back to single-race categories.3,4,8,9 For birth data, mothers’
marital status was reported directly in all reporting areas but New
York in 2007 and 2008. Details about the reporting of marital status in
New York and editing methods and imputations as applied to other
items on the birth certificate are presented in publications of the Na-

146 MATHEWS et al
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tional Center for Health Statistics
(NCHS).1,3,5
Cause-of-death statistics in this report
are based solely on the underlying
cause of death compiled in accor-
dance with the International Classifi-
cation of Diseases, 10th Revision (ICD-
10).10 The underlying cause of death is
defined as “(a) the disease or injury
which initiated the train of morbid
events leading directly to death, or (b)
the circumstances of the accident or
violence which produced the fatal inju-
ry.”10 For certain causes of death such
as unintentional injuries, homicide,
suicide, drug-induced death, and sud-
den infant death syndrome, prelimi-
nary data may show lower numbers of
death relative to final data for the
same year. This is a function of the
truncated nature of the preliminary
file, primarily because cause-of-death
information may not be available or
may be incomplete when preliminary
data are sent to NCHS but is available
later for final data processing.
Ranking for leading causes of death is
based on number of deaths.11 Infant
mortality refers to the death of an in-
fant younger than 1 year. Infant mor-
tality rates (IMRs) were computed by
dividing the total number of infant
deaths in each calendar year by the
total number of live births in the same
year. Neonatal mortality rates (NMRs)
are shown for infant deaths that oc-
curred at less than 28 days, and post-
neonatal mortality rates (PNMRs) are
shown for infant deaths that occurred
between 28 days to less than 1 year of
age. The denominator for both rates is
the number of live births.
The latest infant mortality statistics ac-
cording to race and Hispanic origin
are from the 2006 period linked birth/
infant death data set.12 In this data set,
the death certificate was linked with
the corresponding birth certificate for
each infant who died in the United
States in 2006. The purpose of this link-
PEDIATRICS Volume 127, Number 1, January 2011
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age was to use additional variables
available from the birth certificate,
such as birth weight, to better inter-
pret infant mortality patterns.
Birth data for 2008 are for selected items
that were collected by using both the
1989 (unrevised) and the 2003 (revised)
US standard certificates of live birth. The
2003 revision is described in detail else-
where.3,5,13,14 Twenty-seven states (Cali-
fornia, Colorado, Delaware, Florida,
Georgia, Idaho, Indiana, Iowa, Kansas,
Kentucky, Michigan, Montana, Nebraska,
New Hampshire, New Mexico, New York,
North Dakota, Ohio, Oregon, Pennsylva-
nia, South Carolina, South Dakota, Ten-
nessee, Texas, Vermont, Washington,
and Wyoming) had implemented the re-
vised birth certificates as of January 1,
2008 (accounting for 65% of 2008
births).1 Information on prenatal care
and smoking during pregnancy are not
comparable between the 2 versions of
the birth certificate,3,13,14 and data on
these topics are not combined. Prenatal
care data in this report are based on 22
reporting areas (accounting for 53% of
2007 births) that implemented the re-
vised birth certificate as of January 1,
2007.3 Information on smoking during
pregnancy is based on the same report-
ing area with the exclusion of Florida (ac-
counting for 48% of 2007 births).3 Trend
analysis of prenatal care and smoking
during pregnancy was compromised by
the yearly change in the composition of
revised and unrevised reporting areas.
Information on prenatal care and smok-
ing during pregnancy, based on limited
geographic coverage, is not generaliz-
able to the entire United States.
Mortality data for 2008 were collected
by using both the 1989 (unrevised) and
2003 (current or “revised”) versions of
the US standard certificate of death.
The 2003 revision is described in detail
elsewhere.2,4 A list of the 31 reporting
areas with revised death certificates
as of January 1, 2008, is available else-
where.2 The remaining 20 areas re-
SPECIAL ARTICLES
ported data in 2008 on the basis of the
1989 “unrevised” version of the death
certificate. All mortality data items
presented in this report are consid-
ered comparable between revisions;
accordingly, revised and unrevised
data are combined.
Population denominators for the cal-
culation of birth, death, and fertility
rates are estimates based on the pop-
ulation enumerated by the US Census
Bureau as of April 1, 2000. Estimates
for 2000 –2008 and revised estimates
for the intercensal period 1991–1999
were produced under a collaborative
arrangement between the US Census
Bureau and the NCHS. To calculate
birth and death rates for these time
periods, reported population data for
multiple-race persons were bridged
back to single-race categories.8,9 In ad-
dition, the 2000 census counts were
modified to be consistent with the 1977
Office of Management and Budget
(OMB) race categories.15
Data for the international compari-
sons of births and IMRs were obtained
from the 2008 United Nations Demo-
graphic Yearbook.16
NATURAL INCREASE
Nearly 1.8 million persons were added
to the US population in 2008 as a result
of natural increase (the excess of
births over deaths) (Table 1).1,2 The
rate of natural increase was 5.8 per-
sons per 1000 population in 2008.
BIRTHS
In 2008, there were 4 251 095 births,
⬃2% fewer than in 2007 (4 316 233),
which was the highest number ever reg-
istered for the United States (Table 1).1
The crude birth rate decreased by 2%
in 2008 to 14.0 births per 1000 total
population from 14.3 in 2007. The gen-
eral fertility rate (the number of births
per 1000 women aged 15– 44 years)
declined 1% in 2008 to 68.7. Birth rates
declined among everyone in the 15- to
147
TABLE 1 Vital Statistics of the United States, Selected Years: 1915–2007 (Final) and 2008 (Preliminary)
Number Ratea
2008 2007 2000 2008 2007 2000 1990 1980 1950 1915b
Live births 4 251 095 4 316 233 4 058 814 14.0 14.3 14.4 16.7 15.9 24.1 29.5
Fertility rate NA NA NA 68.7 69.5 65.9 70.9 68.4 106.2 125.0
Deaths 2 473 018 2 423 712 2 403 351 8.1 8.0 8.5 8.6 8.8 9.6 13.2
Age-adjusted rate NA NA NA 7.6 7.6 8.7 9.4 10.4 14.5 21.7
Natural increase 1 778 077 1 892 521 1 655 463 5.8 6.3 5.9 8.1 7.1 14.5 16.3
Infant mortality 28 033 29 138 28 035 6.59 6.75 6.89 9.2 12.6 29.2 99.9
Population base, thousands NA NA NA 304 060 301 621 281 422 248 710 226 546 150 697 100 546
Data for 2008 are preliminary. Data for 2007 and all earlier years are final. Populations are as of July 1 for 2007 and 2008 and as of April 1 in 1950, 1980, 1990, and 2000. Population for 1915
is the midyear estimate based on the April 15, 1910, census. NA indicates not applicable.
a Rates per 1000 population except for fertility, which is per 1000 women aged 15 to 44 years, and infant mortality, which is per 1000 live births.

b Birth rate was adjusted to include states not in the registration area (10 states and the District of Columbia when started in 1915). Death rate is for death registration area. The IMR is for

birth registration area.

Data sources: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System, and the US Census Bureau.

39-year age group; rates increased for Rates for Asian or Pacific Islander and 3; Fig 1).1 The birth rate for teenagers
women aged 40 years and older (Fig Native American women were essen- aged 15 to 17 years decreased 2% to
1).1 The total fertility rate in 2008 was tially unchanged. Fertility rates for 21.7 per 1000 in 2008, and the birth
2085.5 births per 1000 women, a 2% these groups in 2008 ranged from a rate for older teenagers aged 18 to 19
decrease compared with the rate in low of 59.6 births per 1000 women years decreased 4% to 70.7 per 1000
2007 (2122.5). The total fertility rate es- aged 15 to 44 for non-Hispanic white (Table 3).
timates the number of births that a hy- women to a high of 98.6 for Hispanic
pothetical group of 1000 women would women (Table 2). Childbearing for Women in their 20s
have if they experienced, throughout and 30s
their childbearing years, the age- Trends in Age-Specific Birth Rates The 2008 birth rate for women aged 20
specific birth rates observed in a given to 24 years was 103.1 births per 1000
Teenaged Childbearing
year. women (Table 2), a decrease of 3%
Teenage birth rates in the United
Racial and Ethnic Composition compared with the rate in 2007 (106.4)
States started a 14-year decrease in
(Fig 1).1 The rate for women aged 25 to
The general fertility rate declined for 1991 and then had a 2-year increase in
29 years also decreased in 2008 to
the 3 largest race and Hispanic-origin 2006 and 2007 (Table 3). The birth rate
115.1 (a decrease of 2%). The birth rate
groups between 2007 and 2008.1 De- for teenagers decreased 2% in 2008
in 2008 for women aged 30 to 34 years
creases ranged from ⬍1% for non- from 2007. The 2008 rate was 41.5
declined ⬍1% to 99.3 from 99.9 in
Hispanic white and non-Hispanic black births per 1000 teenagers aged 15 to
2007. For women aged 35 to 39 years
women to 3% for Hispanic women. 19 years, down from 42.5 in 2007 (Table
the rate declined 1% in 2008 to 46.9 per
1000 women from 47.5 in 2007. This is
140 the first decline for women aged 35 to
Rate per 1000 women in specified age group

39 years since 1978.1,3

120 1990
2005
100 2007 Childbearing for Women Aged 40
2008 Years and Older
80

60 The birth rate for women aged 40 to

44 years increased 4% between 2007
40
and 2008 to 9.9 births per 1000
20 women (Table 2; Fig 1), the highest
0 rate in 4 decades. The birth rate for
15–19 20–24 25–29 30–34 35–39 40–44
women aged 45 to 49 years also in-
Mother’s age, y
creased in 2008, from 0.6 to 0.7 (data
FIGURE 1
Birth rates according to age of mother, United States, selected years: 1990, 2005, and 2007 (final) and not shown). This rate has more than
2008 (preliminary). tripled since 1990.

148 MATHEWS et al
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 SPECIAL ARTICLES

TABLE 2 Age-Specific Birth Rates and Total Fertility Rates According to Race and Hispanic Origin of Mother: United States, 2008 (Preliminary)
Age-Specific Birth Rate According to Age of Mothera Total Fertility
b Ratec
15–44 y 15–17 y 18–19 y 20–24 y 25–29 y 30–34 y 35–39 y 40–44 y
Total 68.7 21.7 70.7 103.1 115.1 99.3 46.9 9.9 2085.5
Non-Hispanic white 59.6 11.6 48.6 80.8 106.2 98.9 44.8 8.8 1835.0
Non-Hispanic black 71.2 34.9 104.7 130.8 105.8 75.1 36.7 8.8 2110.5
Native Americand 64.6 32.5 96.7 115.6 94.4 63.8 28.8 6.4 1843.5
Asian or Pacific Islander 71.4 8.0 28.4 64.5 120.3 126.8 66.8 15.2 2056.0
Hispanice 98.6 46.1 127.0 170.4 152.3 109.3 55.9 13.7 2905.5
Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. Race categories are consistent with 1977 OMB standards. Thirty states
reported multiple-race data for 2008. Multiple-race data for these states were bridged to the single-race categories of the 1977 OMB standards for comparability with other states.
a Rates per 1000 women in age-specific group.

b Relates the number of births to women of all ages to women aged 15 to 44 years.

c Sum of age-specific birth rates times 5 (includes rates for ages 10 –14, 15–19 and 45– 49 years, not shown separately).

d Includes births to Aleuts and Eskimos.

e Includes all persons of Hispanic origin of any race.

Data source: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System, natality.

TABLE 3 Birth Rates for Teenagers According to Age, Race, and Hispanic Origin, United States, Selected Years: 1991–2007 (Final) and 2008 (Preliminary)
Age, Race, and Hispanic Birth Ratea Percent Change
Origin of Mother
2008 2007 2006 2005 1991 2007–2008 2005–2007 1991–2005
15–19 y
All races 41.5 42.5 41.9 40.5 61.8 ⫺2 5 ⫺34
Non-Hispanic whiteb 26.7 27.2 26.6 25.9 43.4 ⫺2 5 ⫺40
Non-Hispanic blackb 62.9 64.2 63.7 60.9 118.2 ⫺2 5 ⫺48
Asian or Pacific Islander 16.2 16.9 17.0 17.0 27.3 ⫺4 ⫺1 ⫺38
Native Americanc 58.4 59.3 55.0 52.7 84.1 ⫺2 13 ⫺37
Hispanicb,d 77.4 81.8 83.0 81.7 104.6 ⫺5 0 ⫺22
15–17 y
All races 21.7 22.1 22.0 21.4 38.6 ⫺2 3 ⫺45
Non-Hispanic whiteb 11.6 11.8 11.8 11.5 23.6 ⫺2 3 ⫺51
Non-Hispanic blackb 34.9 35.8 36.2 34.9 86.1 ⫺3 3 ⫺59
Asian or Pacific Islander 8.0 8.2 8.8 8.2 16.3 ⫺2 0 ⫺50
Native Americanc 32.5 31.8 30.7 30.5 51.9 2 4 ⫺41
Hispanicb,d 46.1 47.9 47.9 48.5 69.2 ⫺4 ⫺1 ⫺30
18–19 y
All races 70.7 73.9 73.0 69.9 94.0 ⫺4 6 ⫺26
Non-Hispanic whiteb 48.6 50.4 49.3 48.0 70.6 ⫺4 5 ⫺32
Non-Hispanic blackb 104.7 109.3 108.4 103.0 162.2 ⫺4 6 ⫺36
Asian or Pacific Islander 28.4 29.9 29.5 30.1 42.2 ⫺5 ⫺1 ⫺29
Native Americanc 96.7 101.6 93.0 87.6 134.2 ⫺5 16 ⫺35
Hispanicb,d 127.0 137.2 139.7 134.6 155.5 ⫺7 2 ⫺13
Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. Race categories are consistent with 1977 OMB standards. Thirty states
in 2008, 27 in 2007, 23 in 2006, and 19 in 2005 reported multiple-race data. Multiple-race data for these states were bridged to the single-race categories of the 1977 OMB standards for
comparability with other states.
a Rates per 1000 women in specified group.

b In 1991 excludes data for New Hampshire, which did not report Hispanic origin on birth certificates.

c Includes births to Aleuts and Eskimos.

d Includes all persons of Hispanic origin of any race.

Data source: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System, natality.

Unmarried Mothers
The total number of births to unmarried
women increased nearly 1%, to
1 727 950 in 2008. The 2008 total is up
27% from 2002, when recent increases
began.17 The birth rate for unmarried
women in 2008 was 52.0 births per 1000
unmarried women aged 15 to 44 years.
The rate had increased 21% from 2002
(43.7) to 2007 (52.9), after several years
of relative stability. The proportion of all
births to unmarried women increased to
40.6% in 2008, up from 39.7% in 2007.
This proportion increased for the 3 larg-
est race and Hispanic-origin population
groups (Table 4). Births to unmarried
women increased from 2007 to 2008
for ages ⱖ25 years. In 2008, 87% of
births to teenagers, 61% to women
aged 20 to 24, and 33% to women aged
25 to 29 years were to unmarried
women.1
Smoking During Pregnancy
For the 21 states with revised infor-
mation on tobacco use in 2007, the
overall smoking rate during preg-

PEDIATRICS Volume 127, Number 1, January 2011 149

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TABLE 4 Percentage of Births With Selected Characteristics According to Race and Hispanic Origin of Mother, United States, Selected Years: 1990 and
2007 (Final) and 2008 (Preliminary)
All Races, % Non-Hispanic White, % Non-Hispanic Black, % Hispanic, %a
2008 2007 1990 2008 2007 1990b 2008 2007 1990b 2008 2007 1990b
Mother
⬍20 y of age 10.4 10.5 12.8 7.5 7.5 9.6 17.1 17.3 23.2 14.2 14.2 16.8
ⱖ40 y of age 2.7 2.6 1.2 2.9 2.9 1.2 2.1 2.1 0.8 2.1 2.0 1.2
Unmarried 40.6 39.7 28.0 28.6 27.8 16.9 72.3 71.6 66.7 52.5 51.3 36.7
Diabetes during pregnancy — 4.5 2.1 — 4.2 2.2 — 3.9 1.8 — 4.6 2.0
Pregnancy-associated hypertension — 3.9 2.7 — 4.4 3.0 — 4.6 2.8 — 2.8 1.8
Health care utilization
Midwife-attended birthsc — 7.3 3.9 — 7.1 3.2 — 6.9 4.4 — 8.1 6.2
Cesarean delivery rate 32.3 31.8 22.7 32.4 32.0 23.4 34.5 33.9 22.1 31.0 30.4 21.2
Weight gain of ⬎40 lbd — 20.7 15.9 — 23.2 16.5 — 20.2 14.8 — 16.7 14.1
Infant
Birth weight
LBWe 8.2 8.2 7.0 7.2 7.3 5.6 13.7 13.9 13.3 7.0 6.9 6.1
VLBWe 1.46 1.49 1.27 1.18 1.19 0.93 3.01 3.20 2.93 1.20 1.21 1.03
Gestational age
Preterm birthf 12.3 12.7 10.6 11.1 11.5 8.5 17.5 18.3 18.9 12.1 12.3 11.0
Earlyf 3.6 3.6 3.3 3.0 3.0 2.4 6.3 6.5 7.4 3.3 3.4 3.2
Latef 8.8 9.0 7.3 8.2 8.5 6.1 11.3 11.8 11.5 8.8 8.9 7.8
Multiple births per 1000 total births
Live births in twin deliveries (not — 32.2 22.6 — 36.2 22.9 — 36.8 26.7 — 22.0 18.0
percentage)
Live births in higher-order multiple — 1.5 0.7 — 2.0 0.9 — 1.0 0.5 — 0.8 0.4
deliveries (not percentage)
Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. Race categories are consistent with 1977 OMB standards. Thirty states
in 2008 and 27 in 2007 reported multiple-race data. Multiple-race data for these states were bridged to the single- race categories of the 1977 OMB standards for comparability with other
states. — indicates that data are not available.
a Includes all persons of Hispanic origin of any race.

b Excludes data for New Hampshire and Oklahoma, which did not report Hispanic origin.

c Delivered by certified nurse midwives.

d Mother gained ⬎40 lb during pregnancy.

e Very low birth weight (VLBW) is a birth weight of ⬍1500 g (3 lb 4 oz), and LBW is a birth weight of ⬍2500 g (5 lb 8 oz).

f Preterm indicates birth before 37 completed weeks of gestation, early preterm indicates birth before 34 completed weeks of gestation, and late preterm indicates birth between 34 and

36 completed weeks of gestation.

Data source: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System, natality.

nancy was 10.4%.3 The rate for non-
Hispanic white women (16.3%) was
60% more than that for non-Hispanic
black women (10.1%) and more than
7 times as high as that for Hispanic
women (2.1%).3 These racial-ethnic
variations are consistent with pat-
terns observed for many years
before the tobacco-use item was
revised.18
Prenatal Care
For the 22 states with revised prenatal
care data in 2007, 70.8% of mothers
were reported to have begun care
within the first 3 months of pregnancy.
For the 18 states with revised prenatal
care data for both 2006 and 2007, the
percentage of women with timely pre-
natal care declined 2% to 67.5% and
those with late or no care increased
6% to 8.4%. The year 2007 was the
fourth consecutive year for which lev-
els of timely receipt of prenatal care
did not improve.19,20
Large disparities according to race
and Hispanic origin persisted in prena-
tal care receipt for the 22 states with
revised prenatal care data. In 2007, as
in earlier years, non-Hispanic black
and Hispanic women were less likely
than non-Hispanic white women to
begin care in the first trimester of
pregnancy (59.2%, 64.7%, and 76.2%,
respectively).3
Cesarean Delivery
The total cesarean-delivery rate rose
to 32.3% in 2008, which marks the 12th
consecutive year of increase and an-
other record high for the nation (Table
4).1 This rate has climbed by 56% since
1996 (20.7%); however, in the past few
years the pace of increase has slowed.
From 2007 to 2008, increases in the
percentage of births via cesarean de-
livery were reported for all age, race,
and Hispanic-origin groups: non-
Hispanic white (by 1%), non-Hispanic
black and Hispanic (by 2% each), and
Asian or Pacific Islander (by nearly
4%). More detailed discussion of dif-
ferences in cesarean deliveries ac-
cording to race and ethnicity is pre-
sented later.
Multiple Births
The rise over the last several decades
in multiple-birth rates seems to have

150 MATHEWS et al
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halted. The 2007 twin birth rate was
essentially unchanged for the third
straight year at 32.2 per 1000 births
(Table 4).3 This rate (twin deliveries
per 1000 births) had risen 70% from
1980 to 2004. The extended rise of trip-
let and higher-order multiple births
(triplet/⫹) may have ended. The trip-
let/⫹ rate for 2007 was 148.9 per
100 000 total births, not significantly
different from 2006 (153.3). The trip-
let/⫹ rate (the number of triplets, qua-
druplets, quintuplets, and other
higher-order multiples per 100 000 live
births) increased rapidly during the
1980s and 1990s but has generally
trended downward since the all-time
high in 1998 (193.5).
Infants born in twin and triplet/⫹ de-
liveries are much more likely to be
born too soon and too small and, ac-
cordingly, to not survive the first year
of life. Fifty-seven percent of twins and
nearly all (96%) triplets were LBW in
2007 compared with 6% of singletons.3
Preterm Birth
The preterm birth rate was 12.3% for
2008, a decline of 3% from 2007, which
follows a slight decline between 2006
and 2007 (12.8%–12.7%) (Table 4).1 The
preterm rate (infants delivered at ⬍37
completed weeks of gestation per 100
births) had previously been on the rise
for more than 2 decades.3 The decline
for 2008 occurred predominantly
among infants born at 34 to 36 weeks,
or late preterm. The late-preterm rate,
which had climbed over 25% since
1990, was down 2% between 2007 and
2008 from 9.0% to 8.8% (Fig 2). The to-
tal preterm rate declined among
births to non-Hispanic white (from
11.5% to 11.1%), non-Hispanic black
(from 18.3% to 17.5%), and Hispanic
(from 12.3% to 12.1%) mothers.21
The rise in the preterm birth rate from
the mid-1980s to 2006 has been attrib-
uted to increased induction of labor
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12
11
10
Percentage
9
8
7
6
0
Total Non-Hispanic
FIGURE 2
Percentage of late-preterm births according to race and Hispanic origin: United States, 1990, 2000,
2006, and 2007 (final) and 2008 (preliminary). Note that late-preterm birth is at 34 to 36 completed
weeks of gestation.
and cesarean delivery at ⬍37 com-
pleted weeks of gestation.21–23
Low Birth Weight
The low birth weight (LBW) (⬍2500 g)
rate was unchanged in 2008 at 8.2%
(Table 4).1 The percentage of infants
born at a LBW had been rising fairly
steadily since the mid-1980s (6.7% in
1984) but declined slightly between
2006 and 2007.3 A small decline in the
total LBW rate was reported for non-
Hispanic black women, but levels were
essentially unchanged for other
groups (Table 4). The very LBW (⬍1500
g) rate declined slightly from 2007 to
2008 (from 1.49% to 1.46%).
Over the past several decades, na-
tional LBW levels have been strongly
influenced by the rise in the rate of
multiple births, more than one-half of
which are delivered at ⬍2500 g (see
“Multiple Births”). A rise in LBW was
also observed between 1990 and 2006
for singleton deliveries.3
The full birth weight distribution has
changed markedly in recent years for
all births as well as for singletons
only.3 During 1990 –2007, the percent-
age of births weighing 4000 g or more
decreased by nearly 30% (from 10.9%
to 7.7%). The average birth weight
seems to have declined even among
low-risk term births.24 The reasons for
this shift toward lower birth weights
SPECIAL ARTICLES
1990
2000
2006
2007
2008
White non-Hispanic black Hispanic
are not fully understood but may in-
clude obstetric intervention earlier in
pregnancy, older maternal age, and in-
creased use of infertility therapies.24–26
INFANT MORTALITY
In 2008 a total of 28 033 infant deaths
were reported in the United States ac-
cording to preliminary data.2 The IMR
was 6.59 infant deaths per 1000 live
births, a figure that is significantly lower
(by 2%) than the 2007 rate of 6.75. The
NMR for 2008 was 4.27, also significantly
lower than the 2007 NMR of 4.41 neonatal
deaths per 1000 live births.
The 2006 linked birth/infant death data
show wide and persistent variation in
IMRs according to race and Hispanic
origin. As in past years, the highest
rate was for infants born to non-
Hispanic black mothers: 13.35 deaths
per 1000 live births, which is more
than double the rate of infants born to
non-Hispanic white mothers (5.58) (Fig
3).12 Among Hispanic subgroups, rates
ranged from 4.52 for Central and South
American mothers to 8.01 for Puerto
Rican mothers. The IMRs for Hispanic
subgroups have fluctuated slightly
since 2000.
Geographic Variation in Infant
Outcomes
Table 5 lists information for states on
the percentages of preterm birth, per-
151
 14
13.35
12
10
Per 1000 live births
8
6 5.58
0
Non-Hispanic
black
Alaska Native
FIGURE 3
IMR according to race and ethnicity: United States, 2006.
centages of LBW births, IMRs, and
NMRs for 2008, which are based on
preliminary data. For 2008, Mississippi
had the highest percentages of LBW
(11.8%) and preterm (18.0%) births.
Alaska had the lowest percentage of
LBW births (6.0%), and Vermont had
the lowest preterm rate (9.5%) in 2008.
States in the southeastern United
States had the highest IMR and NMR. In
2008, IMRs for the states ranged from
3.95 in New Hampshire to 9.97 in Mis-
sissippi. The IMR for the District of Co-
lumbia was 10.89. These geographic
patterns have been observed for many
years.
Leading Causes of Infant Death
In 2008, 56.1% of all infant deaths (Ta-
ble 6) were attributable to 5 leading
causes: congenital malformations,
deformations, and chromosomal ab-
normalities (20.1%); disorders re-
lated to short gestation and LBW, not
elsewhere classified (16.9%); sudden
infant death syndrome (SIDS) (8.2%);
newborn affected by maternal com-
plications of pregnancy (6.3%); and
152 MATHEWS et al
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8.28 8.01
6.68
5.34
American Puerto Rican Total Non-Hispanic Mexican
Indian or white
accidents (unintentional injuries)
(4.6%).2 These 5 leading causes of in-
fant death are the same as they were
in 2007.4
INTERNATIONAL COMPARISONS
Table 7 lists births for 2008 and IMRs
for 2006, 2007, and 2008 for the United
States and 28 other countries.16 Final
2008 data are not available for a few
countries. The countries are ranked
from the lowest to highest IMR in the
latest available year. Seven countries
had an IMR that was less than half the
US rate (6.6) in 2008; their rates were
⬍3.0 infant deaths per 1000 live births.
Discussed elsewhere27–30 are potential
reasons that the United States has a
higher IMR than other industrialized
countries.
DEATHS
There were 2 473 018 deaths in the
United States in 2008 (Table 1), 49 306
more than in 2007. Age-adjusted death
rates are better indicators of the risk
of mortality over time than crude
5.08
4.55 4.52
Cuban Asian or Pacific Central and
Islander South
American
death rates, because they control for
changes in the age composition of the
population. The age-adjusted death
rate decreased by 0.2% from 760.2
deaths per 100 000 US standard popu-
lation in 2007 to 758.7 in 2008,2 which
was a record low for the United
States.2
In 2008, life expectancy at birth was
77.8 for the US population and was 80.6
years for white women, 76.8 years for
black women, 75.7 years for white
men, and 70.2 years for black men. The
estimated life expectancy at birth for a
given year represents the average
number of years that a group of in-
fants would be expected to live if,
throughout their lifetime, they were to
experience the age-specific death
rates that prevailed during the year of
their birth.
Deaths Among Children
A total of 22 844 children and adoles-
cents aged 1 to 19 years died in the
United States in 2008 (Table 8).2 The
death rate for children aged 1 to 19
 SPECIAL ARTICLES

TABLE 5 Preterm, LBW, IMR, and NMR, United TABLE 6 Deaths, Percentages of Total Deaths, and Mortality Rates for the 10 Leading Causes of
States and Each State: 2008 Infant Death: United States, 2007 (Final) and 2008 (Preliminary)
(Preliminary) Causes of Death and International Ranka 2008 2007
State of Preterm, LBW, IMRc NMRd Classification of Diseases,
n % Rate b n % Rateb
Residence %a %b 10th Revision Codes10
United States 12.3 8.2 6.59 4.27 All causes — 28 033 100.0 659.3 29 138 100.0 674.9
Alabama 15.6 10.5 9.53 5.86 Congenital malformations, 1 5647 20.1 132.8 5785 19.9 134.0
Alaska 10.4 6.0 5.84 2.27 deformations, and chromosomal
Arizona 12.9 7.1 6.35 4.26 abnormalities (Q00–Q99)
Arkansas 13.5 9.2 7.35 4.38 Disorders related to short gestation 2 4733 16.9 111.3 4857 16.7 112.5
California 10.5 6.8 5.09 3.45 and LBW, not elsewhere classified
Colorado 11.4 8.9 6.24 4.48 (P07)
Connecticut 10.4 8.0 5.99 4.45 Sudden infant death syndrome (R95) 3 2292 8.2 53.9 2453 8.4 56.8
Delaware 12.9 8.5 8.36 5.63 Newborn affected by maternal 4 1764 6.3 41.5 1769 6.1 41.0
District of 15.5 10.5 10.89 8.25 complications of pregnancy (P01)
Columbia Accidents (unintentional injuries) 5 1299 4.6 30.6 1285 4.4 29.8
Florida 13.8 8.8 7.21 4.59 (V01–X59)
Georgia 13.4 9.6 8.04 5.28 Newborn affected by complications 6 1073 3.8 25.2 1135 3.9 26.3
Hawaii 12.8 8.1 5.54 3.64 of placenta, cord, and membranes
Idaho 9.8 6.5 5.93 4.06 (P02)
Illinois 12.7 8.4 6.74 4.18 Bacterial sepsis of newborn (P36) 7 696 2.5 16.4 820 2.8 19.0
Indiana 12.4 8.3 6.94 4.28 Respiratory distress of newborn 8 625 2.2 14.7 789 2.7 18.3
Iowa 11.5 6.6 5.67 3.51 (P22)
Kansas 11.2 7.2 7.27 4.66 Diseases of the circulatory system 9 590 2.1 13.9 624 2.1 14.5
Kentucky 14.0 9.2 6.78 4.11 (I00–I99)
Louisiana 15.4 10.8 9.06 4.87 Neonatal hemorrhage (P50–P52, P54) 10 551 2.0 13.0 597 2.0 13.8
Maine 10.3 6.7 5.51 3.75 — indicates that data are not applicable.
Maryland 13.0 9.2 8.01 5.86 a Rank is based on 2008 data.

Massachusetts 10.8 7.8 5.08 3.87 b IMRs are per 100 000 live births.

Michigan 12.7 8.6 7.38 5.03 Data source: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System: mortality, 2008 and 2007
Minnesota 10.0 6.4 5.99 3.80 (www.cdc.gov/nchs/nvss/mortality_tables.htm).
Mississippi 18.0 11.8 9.97 5.72
Missouri 12.3 8.1 7.23 4.42
Montana 11.5 7.4 6.90 3.86 years decreased by a statistically sig- Hispanic origin groups since the mid-
Nebraska 11.8 7.0 5.41 3.33 nificant 5.5% from 30.9 per 100 000 1990s.1 During this period, they were
Nevada 13.5 8.0 5.67 3.02
New Hampshire 9.6 6.5 3.95 2.85 population in 2007 to 29.2 in 2008. highest for non-Hispanic black wom-
New Jersey 12.5 8.4 5.55 3.59 For all children aged 1 to 19 years, the en.31 According to 2008 preliminary
New Mexico 12.3 8.5 5.60 3.28
leading cause of death was accident data, 34.5% of non-Hispanic black
New York 12.0 8.2 5.41 3.66
North Carolina 12.9 9.1 8.20 5.24 (unintentional injuries), which ac- women had a cesarean delivery com-
North Dakota 11.1 6.8 5.82 4.59 counted for 38.8% of all deaths in 2008 pared with 32.4% and 31.0% of non-
Ohio 12.6 8.6 7.69 5.08
and 42.5% of all deaths in 2007. The Hispanic white and Hispanic women,
Oklahoma 13.4 8.3 7.48 4.73
Oregon 10.1 6.1 5.13 3.15 second leading cause of death was ho- respectively.1 Although cesarean-
Pennsylvania 11.6 8.3 7.36 5.26 micide, which accounted for 12.4% of delivery rates increase with maternal
Rhode Island 11.2 7.9 5.89 4.40
all deaths in 2008 and 12.3% of all age for all race and ethnic groups, they
South Carolina 14.3 9.9 8.06 4.94
South Dakota 11.9 6.5 8.37 5.05 deaths in 2007. Between 2007 and are highest for non-Hispanic black
Tennessee 13.5 9.2 8.10 4.97 2008, the death rate decreased signifi- women at all ages (Table 9).
Texas 13.3 8.4 6.24 3.90 cantly for unintentional injuries and
Utah 11.0 6.8 4.76 3.16 A 2005 report of low-risk births re-
Vermont 9.5 7.0 4.57 3.31 homicide, whereas the rate increased
significantly for suicide and for influ- vealed that, even among low-risk first
Virginia 11.3 8.3 6.87 4.56
Washington 10.7 6.3 5.44 3.33 enza and pneumonia. Rates did not births, non-Hispanic black women had
West Virginia 13.7 9.5 7.63 4.37
change significantly for the other lead- a higher likelihood of cesarean deliv-
Wisconsin 11.1 7.0 6.96 4.57
Wyoming 11.2 8.3 7.09 4.30 ing causes of death among children. ery overall and in all maternal age
a Preterm birth is ⬍37 weeks of completed gestation.
groups.32 We explored possible rea-
b LBW is a birth weight of ⬍2500 g. Why Are Cesarean-Delivery Rates sons for the higher cesarean-delivery
c Infant deaths (at ⬍1 year of age) per 1000 live births.

d Neonatal deaths (at ⬍28 days of age) per 1000 live

births.
Data source: Centers for Disease Control and Prevention/
NCHS, National Vital Statistics System.
Higher for Non-Hispanic Black rate among non-Hispanic black women
Women? in 2007, the most recent year for which
Cesarean-delivery rates have in- final birth data are available. Analysis
creased for all maternal age, race, and was limited to low-risk women (single-

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TABLE 7 Number of Live Births for 2008 and TABLE 8 Deaths and Death Rates for the 5 Leading Causes of Childhood Death in Specified Age
IMRs for 2006, 2007, and 2008 for 29 Groups: United States, 2007 (Final) and 2008 (Preliminary)
Countries Age, Causes of Death and International Classification of Ranka 2008 2007
Country No. of Births IMR Diseases, Tenth Revision Codes10
n % Rateb n % Rateb
in 2008
2008 2007 2006 Total: 1–19 y
Hong Kong 78 822 1.8 1.8 1.8 All causes — 22 844 100 29.2 24 149 100 30.9
Sweden 109 301 2.5 2.5 2.8 Accidents (unintentional injuries) (V01–X59, Y85–Y86) 1 8866 38.8 11.3 10 275 42.5 13.2
Japan 1 091 156 2.6 2.6 2.6 Assault (homicide) (*U01–*U02, X85–Y09, Y87.1) 2 2840 12.4 3.6 2968 12.3 3.8
Finland 59 530 2.6 2.7 2.8 Malignant neoplasms (C00–C97) 3 1970 8.6 2.5 1996 8.3 2.6
Norway 60 497 2.7 3.1 3.2 Intentional self-harm (suicide) (*U03, X60–X84, Y87.0) 4 1831 8.0 2.3 1665 6.9 2.1
Greece 118 302 2.7 3.5 3.7 Congenital malformations, deformations and 5 1079 4.7 1.4 1111 4.6 1.4
Czech Republic 119 570 2.8 3.1 3.3 chromosomal abnormalities (Q00–Q99)
Portugal 104 594 3.3 3.4 3.3 Diseases of heart (I00–I09, I11, I13, I20–I51) 6 768 3.4 1.0 760 3.1 1.0
Korea 465 892 3.4 3.5 3.8 Influenza and pneumonia (J09–J18)c 7 299 1.3 0.4 264 1.1 0.3
Spain 519 050 3.6a 3.5 3.5 Chronic lower respiratory diseases (J40–J47) 8 242 1.1 0.3 246 1.0 0.3
Italy 576 659 3.6a 3.5 3.6 Cerebrovascular diseases (I60–I69) 9 230 1.0 0.3 206 0.9 0.3
France 796 044 — 3.6 3.6 Septicemia (A40–A41) 10 211 0.9 0.3 205 0.8 0.3
Austria 77 752 3.7 3.7 3.6 1–4 y
Israel 156 923 3.8 3.9 4.0 All causes — 4752 100 28.5 4703 100 28.6
Netherlands 184 634 3.8 4.1 4.4 Accidents (unintentional injuries) (V01–X59, Y85–Y86) 1 1469 30.9 8.8 1588 33.8 9.6
Germany 682 514 — 3.9 3.8 Congenital malformations, deformations and 2 520 10.9 3.1 546 11.6 3.3
Switzerland 76 691 4.0 3.9 4.4 chromosomal abnormalities (Q00–Q99)
Denmark 65 038 4.0 4.0 3.9 Assault (homicide) (*U01–*U02, X85–Y09, Y87.1) 3 421 8.9 2.5 398 8.5 2.4
Belgium 120 663b — 4.0 4.0 Malignant neoplasms (C00–C97) 4 394 8.3 2.4 364 7.7 2.2
Australia 296 621 4.1 4.2 4.7 Diseases of heart (I00–I09, I11, I13, I20–I51) 5 182 3.8 1.1 173 3.7 1.1
Croatia 43 753 4.5 5.6 5.2 5–9 y
Cuba 122 569 4.7 5.3 5.3 All causes — 2502 100 12.5 2711 100 13.7
United 772 245b — 4.8 5.0 Accidents (unintentional injuries) (V01–X59, Y85–Y86) 1 832 33.3 4.1 965 35.6 4.9
Kingdom Malignant neoplasms (C00–C97) 2 457 18.3 2.3 480 17.7 2.4
New Zealand 64 343 5.0 4.9 5.1 Congenital malformations, deformations and 3 169 6.8 0.8 196 7.2 1.0
Canada 367 864b — 5.1c 5.0 chromosomal abnormalities (Q00–Q99)
Hungary 99 149 5.6 5.9 5.7 Assault (homicide) (*U01–*U02, X85–Y09, Y87.1) 4 112 4.5 0.6 133 4.9 0.7
Poland 414 499 — 6.0 6.0 Diseases of heart (I00–I09, I11, I13, I20–I51) 5 96 3.8 0.5 110 4.1 0.6
Malaysia 470 900a 6.4a 6.3a 6.2 10–14 y
United States 4 251 095a 6.6a,d 6.8 6.7 All causes — 3157 100 15.7 3436 100 16.9
— indicates that data are not available. Accidents (unintentional injuries) (V01–X59, Y85–Y86) 1 1031 32.7 5.1 1229 35.8 6.0
a Provisional or preliminary data. Malignant neoplasms (C00–C97) 2 433 13.7 2.2 479 13.9 2.4
b Data are for 2007.
Intentional self-harm (suicide) (*U03, X60–X84, Y87.0) 3 214 6.8 1.1 180 5.2 0.9
c Statistics Canada, CANSIM, Table 102– 0504.
Assault (homicide) (*U01–*U02, X85–Y09, Y87.1) 4 208 6.6 1.0 213 6.2 1.0
d See ref 2.
Congenital malformations, deformations and 5 162 5.1 0.8 178 5.2 0.9
Data source: United Nations. Tables 9 and 15. In: United
chromosomal abnormalities (Q00–Q99)
Nations Demographic Yearbook, 2008. New York, NY:
15–19 y
United Nations; 2010. Available at: http://unstats.un.org/
unsd/demographic/products/dyb/dyb2008.htm. All causes — 12 433 100 57.8 13 299 100 61.9
Accidents (unintentional injuries) (V01–X59, Y85–Y86) 1 5534 44.5 25.7 6493 48.8 30.2
Assault (homicide) (*U01–*U02, X85–Y09, Y87.1) 2 2099 16.9 9.8 2224 16.7 10.4
Intentional self-harm (suicide) (*U03, X60–X84, Y87.0) 3 1611 13.0 7.5 1481 11.1 6.9
ton pregnancy, term birth, cephalic Malignant neoplasms (C00–C97) 4 686 5.5 3.2 673 5.1 3.1
presentation, as defined by Healthy Diseases of heart (I00–I09, I11, I13, I20–I51) 5 358 2.9 1.7 346 2.6 1.6
People 2010 goals,33 and having their — indicates that data are not available.
a Rank is based on 2008 data.
first birth). Data were from the 22- b Rate per 100 000 population in specified group.

state revised reporting area (de- c New code J09 (influenza due to identified avian influenza virus) was added to the category in 2007.

scribed above), because many items
such as cephalic presentation,
prepregnancy diabetes, and prepreg-
nancy weight were only available on
the 2003 revised birth certificate. Pat-
terns of cesarean delivery according
to race, Hispanic origin, and maternal
age for the 22 revised states are simi-
lar to those shown in Table 9 for all
states.
Data source: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System: mortality, 2008 and 2007
(www.cdc.gov/nchs/nvss/mortality_tables.htm).
The results show that a number of non-Hispanic black women than non-
known risk factors for cesarean deliv- Hispanic white and Hispanic women
ery, such as diabetes, hypertension, (data not shown), but non-Hispanic
macrosomia, and labor induction, do black women were more likely to suf-
not explain the higher rates for non- fer from prepregnancy diabetes and
Hispanic black women. For example, chronic hypertension. Even when
macrosomia was less common among women with these conditions or risk

154 MATHEWS et al
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 SPECIAL ARTICLES

TABLE 9 Cesarean Delivery According to Age of Mother and Race and Hispanic Origin: United Fig 4). These data also indicate that
States, Preliminary 2008
low-risk non-Hispanic black women
Race and Hispanic Age of Mother, per 100 Live Births
who weighed more than 200 lb were
origin of Mother
Total ⬍20 y 20–24 y 25–29 y 30–34 y 35–39 y 40–54 y nearly twice as likely to give birth via
All races a 32.3 23.0 27.8 31.2 36.0 42.5 49.0 cesarean delivery as low-risk non-
Non-Hispanic whiteb 32.4 23.2 27.5 30.6 35.2 41.8 48.4
Non-Hispanic blackb 34.5 25.3 31.4 35.4 40.5 47.4 52.8
Hispanic black women who weighed
Hispanicc 31.0 21.4 26.7 30.9 36.7 42.8 49.0 between 100 and 150 lb (45% vs 24%).
a Includes races other than white and black and origin not stated.
b
A limitation of this analysis is that
Race and Hispanic origin are reported separately on the birth certificates. Persons of Hispanic origin may be of any race.
Race categories are consistent with 1977 OMB standards. Thirty states reported multiple-race data for 2008. The multiple- prepregnancy weight has been shown
race data for these states were bridged to the single-race categories of the 1977 OMB standards for comparability with to be a weaker predictor of cesarean-
other states (see ref 5).
c Includes all persons of Hispanic origin of any race. delivery risk than BMI.34 A woman’s
Data source: Centers for Disease Control and Prevention/NCHS, National Vital Statistics System. height also may be an independent
contributory factor, because short
stature has been shown to have an
factors were excluded from the analy- Hispanic black women had a signifi-
additive effect on cesarean-delivery
sis, cesarean-delivery rates for non- cantly higher mean prepregnancy
risk.35
Hispanic black women remained weight (155 lb) than non-Hispanic
higher (data not shown). white (150 lb) and Hispanic (140 lb) Although it seems that obesity has
women, and the differences in mean an influence on the differences in
Studies have shown that obesity is also
prepregnancy weight according to cesarean-delivery rates according to
a risk factor for cesarean delivery.34–36
race and Hispanic origin, it is un-
Women who are obese (BMI ⱖ 30) are race and Hispanic origin increased
with maternal age. clear how strong that influence may
at least twice as likely to have a cesar-
be. Indeed, there is evidence that
ean delivery as women with normal Prepregnancy weight of more than even when controlling for BMI,
weight (BMI ⬍ 25).36 Data from the Na- 200 lb among low-risk pregnancies higher rates for non-Hispanic black
tional Health and Nutrition Survey indi- was also examined as a surrogate women have persisted.38,39 Other pos-
cate that non-Hispanic black women measure for obesity, because these sible contributing factors that may
have higher rates of obesity than non- women would generally be consid- influence the differences according
Hispanic white and Hispanic women,37 ered obese even among tall women. to race and Hispanic origin in cesar-
which may influence their higher Non-Hispanic black women in every ean deliveries are maternal choice,
cesarean-delivery rates. age group were more likely to weigh patient education, and physician
Although data on BMI are not yet more than 200 lb. For the ⱖ25-year practice patterns. Further study is
available in the national birth data, age group, at least 17% of non- necessary to fully understand differ-
we examined prepregnancy weight Hispanic black women weighed more ences in cesarean-delivery rates ac-
of women who gave birth in 2007 than 200 lb compared with ⬃10% cording to race and Hispanic origin.
in the 22-state revised reporting and 7% of non-Hispanic white and
area. Among low-risk women, non- Hispanic women, respectively (see CONCLUSIONS
Vital statistics remain a valuable
25 tool for monitoring the health of the
Non-Hispanic black US population. Efforts to speed up
Non-Hispanic white
20 data receipt and processing are
Hispanic
ongoing.40
centage

15

ACKNOWLEDGMENTS
Perc

10
We thank Joyce A. Martin, Brady E.
5 Hamilton, Marian F. MacDorman, Sha-
0
ron Kirmeyer, Stephanie J. Ventura,
Total >20 20–24 25–29 30–34 35–39 40–54 Jiaquan Xu, Sherry L. Murphy, Ken-
Age of mother, y neth D. Kochanek, and Betzaida Tejada-
FIGURE 4 Vera for contributions to the manu-
Prepregnancy weight of ⬎200 lb for women with low-risk pregnancies according to race and Hispanic
origin and age of mother: revised reporting area, 2007. Low risk is defined as a term, singleton, first script and Yashodhara Patel and
pregnancy with cephalic presentation (see ref 3). Elizabeth Wilson for content review.

PEDIATRICS Volume 127, Number 1, January 2011 155

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NUTMEG: Enjoying a large glass of eggnog liberally sprinkled with nutmeg, I

wondered about the provenance of the spice. After all, I had been enjoying
nutmeg for decades. According to an article in Saveur (2010;134:79), nutmeg
has been a prized spice for centuries. Nutmeg, Myristica fragrans or musky
scent, is indigenous to Indonesia. For hundreds of years, the two spices made
from nutmeg, nutmeg made from the seed’s kernel, and mace made from the
waxy red covering of the seed, were only produced in the Banda Islands. The
spice became a prized commodity in medieval Europe and was used liberally by
the wealthy to create richly flavored dishes. As nutmeg moved west along the
spice trail, its cost rose dramatically. When nutmeg became the treatment of
choice for the plague, a small sack was worth the cost of a house in London with
servant included. The Dutch and English East India companies waged merciless
campaigns for control of the nutmeg producing islands. In the 18th century,
however, seedlings were smuggled out of Indonesia and soon nutmeg was
growing in far-flung tropical regions of the world including the Caribbean. As
the highly-spiced dishes of the medieval ages waned in popularity, others
turned to nutmeg for its narcotic properties. In high concentrations, myristicin,
the compound that gives nutmeg much of it pungency, can induce euphoria and
even hallucinations. Nutmeg was grated over the infamous punch drinks of 18th
and 19th century England and may have been responsible for some of the more
outrageous behaviors associated with the drink. Historic figures as disparate
as Lord Byron and Malcolm X used the spice recreationally. Currently, while
nutmeg is often associated with eggnog and the winter holiday season, it is used
to flavor innumerable dishes and drinks, including Coca-Cola. The enduring
popularity of nutmeg may be due to its ability to enhance other flavors. As for
me, a little nutmeg goes a long way to enhance the taste of cakes, pies, eggs, and
savory dishes. Yum.
Noted by WVR, MD

PEDIATRICS Volume 127, Number 1, January 2011 157

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 Annual Summary of Vital Statistics: 2008
T. J. Mathews, Arialdi M. Miniño, Michelle J. K. Osterman, Donna M. Strobino and
Bernard Guyer
Pediatrics 2011;127;146-157; originally published online Dec 20, 2010;
DOI: 10.1542/peds.2010-3175
Updated Information including high-resolution figures, can be found at:
& Services http://www.pediatrics.org/cgi/content/full/127/1/146
References This article cites 24 articles, 2 of which you can access for free
at:
http://www.pediatrics.org/cgi/content/full/127/1/146#BIBL
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