Definitions of Measures Used in Birth-Related Modules
The information in the WISH birth-related modules is from Wisconsin resident birth certificate data. The Infant Mortality module is based on both
birth data and death certificate data.
On January 1, 2011, the Wisconsin State Vital Records Office began collecting birth certificate information based on the 2003 U.S. Standard
Certificate of Live Birth using a new electronic system. Before January 1, 2011, Wisconsin had been collecting birth certificate information
based on the 1989 U.S. Standard Certificate of Live Birth. Birth data collection changed in many ways when Wisconsin began using the 2003
U.S. Standard Certificate of Live Birth. For a detailed description of changes, please see
Technical Notes: Wisconsin Births and Infant Deaths,
2011 (P45364-11) and Births to Teens in Wisconsin, 2011 (P45365-11) (PDF, 497 KB).
- Body Mass Index (pre-pregnancy)
- Beginning in 2011, height and pre-pregnancy weight of the mother were collected on the birth record. A mother's body mass index (BMI) was
calculated based on these measures.
- Birth Order
- The total number of live births to this mother, up to and including this birth.
- The newborn's weight is reported in grams, or in pounds and ounces and converted to grams.
- Low birthweight: Infants weighing less than 2,500 grams (about 5.5 pounds) at birth.
- Very low birthweight: Infants weighing less than 1,500 grams (about 3.3 pounds) at birth.
- Extremely low birthweight: Infants weighing less than 1,000 grams (about 2.2 pounds) at birth.
- Fertility Measures
- Birth Rate or Crude Birth Rate: The number of live births per 1,000 total population.
- General Fertility Rate: The number of live births per 1,000 females ages 15-44.
- Age-specific Fertility Rate: The number of live births per 1,000 females in a specific age group.
- Gestational Age, Prematurity
- Gestational age is based on the computed difference between the date of reported last normal menses and the date of the infantís birth.
If the date of last normal menses is missing or the computed difference is less than 16 weeks or more than 45 weeks, then the attending
physicianís clinical estimate of gestational age is substituted. This minimizes the number of births with unknown gestational age.
- Premature or preterm: Births are classified as premature (less than full term) if the gestational age was less than 37 weeks. Births
before 32 weeks of gestational age are "very preterm." Those at 32 to 35 weeks are "moderately preterm" and those at 36 weeks are "late
- Premature low birthweight: Births that have both a gestational age of less than 37 weeks and a birthweight of less than 2,500 grams
(about 5.5 pounds).
- Term low birthweight: Full-term births with low birthweight; that is, births that have a gestational age of 37 weeks or more
and a weight at birth of less than 2,500 grams (about 5.5 pounds).
- Hepatitis B Vaccine Administered to Infant
- Beginning in 2011, information on vaccines administered to newborns in the hospital was collected on the birth record. Note that the birth
record includes only vaccines administered shortly after birth. (Immunization data for all infants/children is available from the Wisconsin
- Infant Breastfed
- Beginning in 2011, the birth record collected information on whether or not the infant was breastfed before being discharged from the
- Infant Mortality
- Infant mortality refers to deaths that occur within the first year of life.
- Infant mortality rate: The number of infant deaths per 1,000 live births during the year.
- Neonatal mortality: Infant deaths that occur before 28 days of age.
- Postneonatal mortality: Infant deaths that occur from 28 to 364 days of age.
- Interval Since Last Delivery
- The time between the mother's last live birth and this delivery. This measure is computed from the infant's date of birth and the reported
month and year of the previous last live birth. Unlike the Inter-Pregnancy Interval, it includes the gestation period of the current
- Inter-Pregnancy Birth Interval
- The time between the end of the mother's last pregnancy resulting in a live birth and the estimated date of conception for this pregnancy.
The beginning of this pregnancy is computed from the gestational age of this birth and the birth date.
- Method of Delivery
- Beginning in 2011, additional categories for describing the method of delivery were added: vaginal/spontaneous, vaginal/forceps,
vaginal/vacuum, cesarean, and unknown. Additional fields collected under the Risk Factors checklist ask if the mother had any previous
cesarean deliveries and, if so, how many. Information from the previous cesarean deliveries field was combined with information from the
field for final route and method of delivery to define vaginal birth after cesarean (VBAC), primary C-section, and repeat C-section deliveries.
However, there are birth records for which the previous cesarean deliveries item was not completed (unknown) and cesarean was indicated as the
final route and method of delivery. Those records were categorized as C-section (unknown if primary or repeat).
- Mother's Birthplace
- Three groups based on motherís country of birth: United States, Foreign Born, Unknown/Not Classifiable.
- Mother's Education
- Beginning in 2011, information on mother's education was collected in different categories than for previous years. This resulted in two
- Education (7 categories): Mother's education in categories consistent with how mother's education was collected prior to 2011.
- Education (9 categories): Mother's education as collected beginning in 2011. The old categories could not be
configured into these new categories, so only birth records beginning in 2011 are included. The new categories modify the measures of
post-high school education.
- Mother's Race and Ethnicity
- Seven groups based on reported race of mother and whether or not the mother reported Hispanic/Latina ethnicity. The groups are:
The category titled "Two or more races (Non-Hispanic)" is only available from 2011 forward.
- White (Non-Hispanic)
- Black/African American (Non-Hispanic)
- American Indian/Alaska Native (Non-Hispanic)
- Laotian or Hmong (Non-Hispanic)
- Other (Non-Hispanic)
- Two or more races (Non-Hispanic)
- Mother Received WIC Food During Pregnancy
- Indicates whether the mother reported receiving food from the WIC program for herself during pregnancy.
- Newborn Transferred to Another Hospital
- Beginning in 2011, this indicates whether the newborn was transferred from the birth hospital to a different hospital within the first
Prior to 2011, the definition was whether the infant was transferred from the birth hospital to a different hospital. The birth hospital
reported whether the infant was 'treated in an NICU or transferred to another hospital' and also reported the name of the transfer/NICU
hospital, which may have been the birth hospital itself. If this item was checked on the birth report and the transfer/NICU hospital was not
the birth hospital, then this was coded 'yes.'
- NICU Utilization
- Indicates whether the infant was admitted to a neonatal intensive care unit, either in the birth hospital or in a hospital to which the
infant was transferred from the birth hospital.
Prior to 2011, the definition was whether the infant was treated in a Level 3 neonatal intensive care unit, either in the birth hospital or in
a hospital to which the infant was transferred from the birth hospital. The birth hospital reported whether the infant was 'treated in an NICU
or transferred to another hospital' and also reported the name of the transfer/NICU hospital, which may have been the birth hospital itself.
If this item was checked on the birth report and the birth hospital had a Level 3 NICU, then NICU Utilization was 'yes.' If this item was
checked and the birth hospital reported transferring the infant to another hospital and that hospital had a Level 3 NICU, then NICU Utilization
was also coded as 'yes.'
- Number of Previous Pregnancies
- The number of previous pregnancies for this mother, regardless of outcome (live birth, miscarriage, other outcome).
- Single or Multiple Birth
- Plurality: the number of fetuses in this pregnancy (single, twins, triplets, etc.). Not all may result in live births.
- Prenatal Care, Adequacy of Prenatal Care
- Trimester prenatal care began: Prior to 2011, the month prenatal care began was reported by the birth hospital and grouped by
trimester. Beginning in 2011, the month prenatal care began is calculated from the date of last normal menses and the date of first prenatal
Due to changes in the standard birth certificate, the measure for percent of births to mothers who received first trimester prenatal care is
not comparable to the measure used in previous years, starting in 2008 for U.S. data and in 2011 for Wisconsin data.
Two other common measures of adequate prenatal care are the 'Kessner Index' and the 'Kotelchuck Index,' both of which consider
the month care began and the number of visits, taking into account the gestational age at delivery (preterm births mean less time for prenatal
The Kessner Index of Prenatal Care Adequacy uses the following classifications for a full-term birth:
The number of visits is adjusted for preterm births.
- Adequate: Initiation in the first trimester with nine or more visits.
- Intermediate: Initiation in the first trimester with five to eight visits, or initiation in the second trimester with five or
- Inadequate: Initiation in the second trimester with one to four visits, or initiation in the third trimester with one or more
- None: No prenatal care.
The Kotelchuck Adequacy of Prenatal Care Utilization Index also takes into account the month that prenatal care began and the number of
prenatal visits, and adjusts for gestational age. It includes categories for adequate, intermediate, and inadequate levels of prenatal care
utilization. The number of prenatal visits is compared to the expected number for gestational age, based on the American College of
Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies.
- Principal Source of Payment for this Delivery
- Beginning in 2011, the principal source of payment for the delivery was collected. Please use caution when using this field. The information
reported by the hospital on the birth record may change weeks to months after the birth, due to coordination of benefits and Medicaid
eligibility changes. This field is not the definitive source of information about payment for this delivery.
- Teen Births
- Births to women less than 20 years of age are considered teen births. This group is often divided into older teens (18-19) and younger
teens (15-17). Very few births occur to females under age 15 and they are included in counts and rates for the 'under 18' and 'under 20'
- Teen birth rate: The number of births to mothers less than 20 years of age per 1,000 females ages 15-19.
- Tobacco Use
- Tobacco use during pregnancy: Indicates whether the mother smoked during the pregnancy. Mothers who smoked in the three months
prior to pregnancy but did not report smoking during the pregnancy are excluded from this measure. Does not measure the amount or duration
of tobacco use during pregnancy.
- Maternal smoking: Beginning in 2011, the motherís smoking status before and during pregnancy in six categories was collected.
Does not measure the amount or frequency of tobacco use during pregnancy. This field is calculated in the following ways:
- Did not smoke — Mothers who reported they did not smoke at any point before or during pregnancy.
- Quit prior to pregnancy — Mothers who reported smoking in the three months prior to pregnancy but not smoking at all
- Quit first trimester — Mothers who reported smoking in the three months prior to pregnancy and the first trimester but
who did not smoke during the remainder of the pregnancy.
- Quit second trimester — Mothers who reported smoking in the three months prior to pregnancy, in the first trimester, and
in the second trimester, but who did not smoke in the third trimester. Only births with a gestational age greater than 28 weeks are
included in this category.
- Smoked entire pregnancy — Mothers who reported smoking in the three months prior to pregnancy, in the first trimester, in
the second trimester and/or in the third trimester. This category includes preterm births to mothers who smoked through the second
trimester and full-term births to mothers who smoked through the third trimester.
- Smoked intermittently throughout pregnancy — Mothers who reported smoking on and off throughout the pregnancy.
- Mother lives with smoker: Based on mother's report of currently living with a person who smokes (Yes/No indicator). Collection
of this information started in 2011.
- Type of Birth Attendant
- Beginning in 2011, licensed midwives were added as a distinct category. In Wisconsin, these midwives are licensed through the Department
of Safety and Professional Services.
- ZIP Codes (City of Milwaukee)
- Birth Modules: ZIP code of motherís mailing address, for those mothers reporting their residence is in the City of Milwaukee. WISH
birth data modules offer the 24 individual ZIP codes that have had at least 1,000 births since 1989. All other Milwaukee ZIP codes are
grouped into an 'other' category.
Infant Mortality Module: ZIP code of infant's residence at time of death, for those infants whose residence was in the City of Milwaukee.
This module offers the same ZIP code choices as in the birth modules.
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Last Revised: June 10, 2014