Birth MICA - Indicators

Through the Interjurisdictional Exchange Agreement supported by the National Association of Public Health Statistics and Information Systems, Missouri cooperates with other states in the exchange of birth records. Therefore, data concerning birth of Missouri residents include virtually all Missouri resident births regardless of where the birth took place.

The rate for all indicators will also take into account any filters or demographic selections (such as race, age, sex, etc.) of interest.

Birth Place: Not in a Hospital

Live births, which were delivered in a non-hospital setting including homes, clinics, ambulances, etc. The rate of this number is per 100 live births with known birth place.

Birth Place: Very Low Birth Weight Births Delivered in a Level 3 Facility

Live births with a birth weight less than 1500 grams (3.3 pounds) that were born in a Level 3 facility. The rate of this number is per 100 very low weight resident live births recorded in Missouri.

Birth Spacing: Less Than 18 Months

Live births occurring to mothers who had a prior live birth within 18 months. As of the 2010 report, the full date of the last live birth is collected making it possible to identify prior births greater than 17 months but less than 18 full months. This contributed to the rate increase seen in 2010. The rate of this number is per 100 second and higher order births of a singleton or a first live birth of a multiple set.

Birth Weight: Very Low (less than 1500 g)

A live birth with a weight of less than 1500 grams (3.3 pounds). The rate of this number is per 100 live births with known birth weight.

Birth Weight: Low (less than 2500 g)

A live birth of less than 2,500 grams (five and one-half pounds). The rate of this number is per 100 live births with known birth weight.

Birth Weight: Normal (2500-4499 g)

A live birth with a weight between 2500-4499 grams (5.5-9.9 pounds). The rate of this number is per 100 live births with known birth weight.

Birth Weight: High (greater than 4499 g)

A live birth with a weight greater than 4499 grams (9.9 pounds). The rate of this number is per 100 live births with known birth weight.

Delivery Place: High Risk Deliveries in a Level 2 or 3 Facility

Live births weighing less than 2,000 grams and/or with gestational age of less than 34 weeks plus all intrapartum fetal deaths in Level 2 or 3 facilities. The rate of this number is per 100 high-risk resident deliveries recorded in Missouri.

Education Status: Less Than 12 Years

Live births to women with less than 12 years of education. These women have not earned their high school degree or GED. The rate of this number is per 100 live births with known maternal education status.

Gestation: Low Birth Weight and Full Term

Live births with a low birth weight (less than 2500g) that are full term (gestational age of 37 or more weeks). The rate of this number is per 100 full term live births.

Gestation: Preterm (less than 37 completed weeks)

A live birth of less than 37 weeks gestation. Before 2014, the Gestational Age was calculated primarily based on the period between the date of last normal menses (DLNM) and the date of birth. Starting in 2014, the Obstetric (Physician’s) Estimate was used as recommended by the National Center for Health Statistics (NCHS) because it is considered more accurate. The obstetrical estimate tends to increase the gestational age and reduce the preterm rate substantially. The rate of this number is per 100 live births with known gestational age.

Gestation: Singleton Births Small For Gestational Age

A singleton live birth where the birth weight is at or below the 10th percentile of births of the same gender and gestational age. Tenth percentile cut points were acquired from the 1991 United States National Reference for Fetal Growth (Alexander GR et al., Obst & Gyn. Vol. 87, No. 2, Feb. 1996 p. 167). The rate of this number is per 100 singleton live births with known gestational age.

Marital Status: Not Married

Live births to mothers not married at time of conception, birth, or any time between. The rate of this number is per 100 live births with known marital status.

Method of Delivery: C-Section

Live births delivered through cesarean section. The rate of this number is per 100 live births with known delivery method.

Method of Delivery: Vaginal Birth After C-Section

Number of vaginal live births to women known to have had one or more previous cesarean sections. The rate is per 100 live births to women known to have had one or more prior cesarean sections.

Number Born: Twin or Other Multiple Birth

A live birth resulting from a pregnancy with more than one fetus conceived. A single surviving live birth resulting from a multiple gestation pregnancy is considered a twin or other multiple birth. The rate of this number is per 100 live births.

Prenatal Care: Began First Trimester

Trimester that prenatal care began as indicated by the time between the date of the last normal menses and date of the first prenatal visit. The rate of this number is per 100 live births with known prenatal care status.

Prenatal Care: None

Live births where the mother did not receive any form of prenatal care during the pregnancy. The rate of this number is per 100 live births with known prenatal care status.

Prenatal Care Adequacy (Missouri Index): Inadequate

Live births with fewer than five prenatal care visits for pregnancies less than 37 weeks gestation, fewer than eight visits for pregnancies 37 or more weeks, or prenatal care began after the first four months of pregnancy. Before 1994 records with unknown month prenatal care began or unknown prenatal visits were excluded. Beginning in 1994, if adequacy of prenatal care could be determined, even if month care began or number of visits were unknown, then these records were included. (This is referred to as the Missouri Index of Adequacy of Prenatal Care Utilization.) The rate for this number is per 100 live births where adequacy of prenatal care using the Missouri Index was known.

Both the Missouri and Kotelchuck indices use the American College of Obstetricians and Gynecologists (ACOG) prenatal care standards for uncomplicated pregnancies as a guide to determine if a mother receives an adequate or inadequate amount of prenatal care during her pregnancy. Both assume inadequate care if a mother starts prenatal care after the fourth month or receives no care. The Kotelchuck index (see below) uses a complex formula to calculate an expected number of visits based on the ACOG guidelines adjusted for timing of first month of prenatal care and exact gestational age at delivery. The Missouri index is more simplified and has just two categories. The Kotelchuck index has been recognized nationally since the mid 1990s. The Missouri index has been used in the Missouri annual Vital Statistics report since 1979. Those favoring the Missouri index feel the quality of the data does not justify the precision required from the Kotelchuck index. Rates of inadequate prenatal care generally run 15 to 20 percent higher using the Missouri index. Nearly all of those classified as inadequate in the Missouri index are also classified as inadequate in the Kotelchuck, but some classified as inadequate in the Missouri index are classified as intermediate in the Kotelchuck index.

Prenatal Care Adequacy (Kotelchuck Index): Inadequate

The Kotelchuck Index uses two crucial elements obtained from birth certificate data-1) when prenatal care began (initiation) and 2) the number of prenatal visits from when prenatal care began until delivery (received services). The Kotelchuck index classifies the adequacy of initiation as follows:

  • pregnancy months 1 and 2,
  • months 3 and 4,
  • months 5 and 6,
  • and months 7 to 9,

with the underlying assumption that the earlier prenatal care begins the better. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery.

A ratio of observed to expected visits is calculated and grouped into four categories:

  1. Inadequate (received less than 50% of expected visits),
  2. Intermediate (50%-79%),
  3. Adequate (80%-109%),
  4. Adequate Plus (110% or more).

The rate of this number is per 100 live births where prenatal care adequacy using the Kotelchuck Index was known.

Prenatal Service Utilization: Mother on Food Stamps

Number of live births to mothers participating in Food Stamps during their pregnancy. Food Stamp status is acquired from the birth certificate. Surrounding states do not collect Food Stamp participation information on their birth certificates. Therefore, for those counties where a large number of women go to a surrounding state to deliver (e.g., Atchison, Cass, Clark, Shelby, Harrison, Jackson, Lewis, McDonald, Marion, Mercer, Ozark, Putnam, Ralls, Knox and Pemiscot), the actual number participating in the Food Stamps program is underreported which also can affect their reported rate on Food Stamps. The rate of this number is per 100 live births with known Food Stamp status.

Prenatal Service Utilization: Mother on Medicaid

Number of live births to mothers participating in Medicaid anytime during their pregnancy. As of 2010 data, Medicaid status is indicated only if the mother’s delivery is primarily paid for by Medicaid. As a result, Medicaid births are somewhat lower beginning in 2010. Medicaid participation is acquired from the birth certificate. The rate of this number is per 100 live births with known Medicaid status.

Prenatal Service Utilization: Mother on WIC

Number of live births to mothers participating in WIC during their pregnancy. WIC status is acquired from the birth certificate. The rate of this number is per 100 live births with known WIC status.

Prior Live Births: Four or More

Live births to a mother with four or more prior live births. The rate for this number is per 100 live births.

Prior Live Births: Mother Under Age 20

Live births to females under the age of 20 years of age who already have one or more prior live births. The rate of this number is per 100 live births with known maternal age.

Smoked During Pregnancy: Yes

Live births to mothers who reported smoking during pregnancy. The rate of this number is per 100 live births.

Smoked During Pregnancy: Yes, 1 or More Packs Per Day

Live birth to a woman who smoked an average of 20 or more cigarettes per day over the course of the entire three-trimester pregnancy. The rate of this number is per 100 live births with maternal smoking status and amount known.

Weight Change: Gained Less Than 15 Pounds - Full Term Singleton Birth

Full term singleton live births to females who gained less than 15 pounds or lost weight during pregnancy. The amount of weight gained or lost is noted on the birth certificate. The rate of this number is per 100 full-term singleton live births with mother's weight gain/loss known.

Weight Change: Gained More Than 44 Pounds - Full Term Singleton Birth

Full term singleton live births to females who gained 45 or more pounds during pregnancy. The amount of weight gained or lost is noted on the birth certificate. The rate of this number is per 100 full-term singleton live births with mother's weight gain/loss known.

Weight for Height: Mother Overweight 20% or More

Live births to women 20 percent or more over the desired weight for height according to the 1959 Metropolitan Life Insurance tables. The rate of this number is per 100 live births with known pre-pregnancy weight and height.

Weight for Height: Mother Underweight More Than 15%

Live births to women 15 percent or more under the desired weight for height according to the 1959 Metropolitan Life Insurance tables. The rate of this number is per 100 live births with known pre-pregnancy weight and height.

Weight for Height (Underweight): Mother's BMI Less Than 18.5

Live births to women who had a pre-pregnancy BMI index less than 18.5. Pre-pregnancy classification as underweight, normal, overweight, or obese is based on a woman’s body mass index (BMI). The BMI formula uses the woman’s age, height, and weight, all recorded on the birth certificate, to calculate this body measurement. The rate for this number is per 100 live births with known pre-pregnancy age, weight, and height.

Weight for Height (Normal): Mother's BMI Between 18.5 and 24.9

Live births to women who had a pre-pregnancy BMI index between 18.5 and 24.9. Pre-pregnancy classification as underweight, normal, overweight, or obese is based on a woman’s body mass index (BMI). The BMI formula uses the woman’s age, height, and weight, all recorded on the birth certificate, to calculate this body measurement. The rate for this number is per 100 live births with known pre-pregnancy age, weight, and height.

Weight for Height (Overweight): Mother's BMI Between 25.0 and 29.9

Live births to women who had a pre-pregnancy BMI index between 25.0 and 29.9. Pre-pregnancy classification as underweight, normal, overweight, or obese is based on a woman’s body mass index (BMI). The BMI formula uses the woman’s age, height, and weight, all recorded on the birth certificate, to calculate this body measurement. The rate for this number is per 100 live births with known pre-pregnancy age, weight, and height.

Weight for Height (Obese): Mother's BMI 30 or Greater

Live births to women who had a pre-pregnancy BMI index greater than 30. Pre-pregnancy classification as underweight, normal, overweight, or obese is based on a woman’s body mass index (BMI). The BMI formula uses the woman’s age, height, and weight, all recorded on the birth certificate, to calculate this body measurement. The rate for this number is per 100 live births with known pre-pregnancy age, weight, and height.