MHLU - Health Status Resource

Pregnancy and Fertility

Pregnancy and Fertility

Key Findings: 

Pregnancy rate

The pregnancy rate in Middlesex-London in 2016 was 49.5 per 100,000 females aged 15 to 49. This rate was significantly lower than Ontario (53.1 per 100,000) and the lowest rate observed in Middlesex-London between 2006 and 2016. Pregnancy rates were consistently lower in Middlesex-London compared to Ontario from 2006 to 2016; with the difference statistically significant every year except for 2014 and 2015 (Fig 11.4.1).

Pregnancy rates across age groups in Middlesex-London followed a similar trend to Ontario and the Peer Group from 2012 to 2016. Pregnancy rates were highest among females aged 30 to 34 years (Fig 11.4.2).

Pregnancy rates among women aged 30 to 34 were the highest in Middlesex-London from 2006 to 2016, followed by women aged 25 to 29. However, rates for both age groups decreased during this period. For example, for women aged 30 to 34, rates dropped from 115.0 per 100,000 in 2006, to 103.8 per 100,000 in 2016 (Fig 11.4.3).

From 2006 to 2010, the third and fourth highest pregnancy rates were among women aged 20 to 24 and 35 to 39, respectively. The two age groups have switched rankings since 2014 as pregnancy rates in women aged 20 to 24 decreased, and those in the older age group increased (Fig 11.4.3).

While pregnancy rates among women aged 34 or less decreased from 2006 to 2016, those among women aged 35 to 44 increased during this period (Fig 11.4.3).

Teenage pregnancy rates in Middlesex-London decreased significantly between 2006 and 2016. Rates also decreased in Ontario and the Peer Group during this period (Fig 11.4.4).

The teenage pregnancy rate in Middlesex-London was 16.9 per 100,000 females aged 15 to 19 in 2016. The rate in Middlesex-London was higher than Ontario (14.6 per 100,000) but the difference was not statistically significant (Fig 11.4.4).

In 2016, the pregnancy rate among women aged 35 to 49 in Middlesex-London was 24.0 per 100,000 females, a rate significantly lower than Ontario (28.1 per 100,000). Pregnancy rates among women in this age group increased in Middlesex-London, Ontario and the Peer Group from 2006 to 2016 (Fig 11.4.5).

Interpretive notes:

Pregnancy and childbirth among females who are particularly young (i.e., teenagers) or who are older (i.e., aged 35 and older) tend to be associated with greater odds of complications during pregnancy and delivery.1

Compared to previous generations, more women are now having children at older ages. The trend toward delaying parenthood can be attributed to many factors, including: delayed marriage, effective birth control, couples waiting to achieve a certain level of financial stability, and women pursuing higher education and career advancement.2-4 Furthermore, the development of new reproductive technologies and fertility treatments has meant that some women are able to get pregnant at later ages than before.3

Pregnancy among women 35 years of age or older tend to be associated with a higher risk of preeclampsia (high blood pressure), placental abruption (placenta detaches from the uterine wall too early, while the baby is still in the uterus), gestational diabetes, and giving birth prematurely (before 37 weeks of gestation).5 Babies born to these women have a higher risk of being born small for gestational age (SGA), requiring admission to the neonatal intensive care unit (NICU), and dying within the first 28 days of life.5

Babies born to teenage mothers have a higher risk of small for gestational age (SGA), dying within the first 28 days of life, and having a low Apgar score.6 In the past few decades, there has been an overall decline in the rate of teenage pregnancies in Canada; from 1990 to 2010, rates dropped by 37.2%.7


Fertility rate

Fertility rates among women of reproductive age (15 to 49) in Middlesex-London were similar to Ontario and the Peer Group between 2006 and 2017 (Fig. 11.4.6).

Fertility rates among women aged 30 to 34 and 25 to 29 were the highest for Middlesex-London from 2006 to 2017. However, rates for both age groups decreased during this period. For example, for women aged 25 to 29, rates dropped from 90.1 per 100,000 in 2006, to 65.3 per 100,000 in 2017 (Fig 11.4.7).

The third highest fertility rates in Middlesex-London from 2006 to 2017 were among women aged 35 to 39. Fertility rates among women in this age group increased during the time period (Fig 11.4.7).

Fertility rates across age groups in Middlesex-London followed a similar pattern to Ontario and the Peer Group in 2013 to 2017. In all three populations, fertility rates were highest among women aged 30 to 34, 25 to 29, and then 35 to 39 (Fig 11.4.8).

The fertility rate among teenage females in Middlesex-London was 6.7 per 100,000 females in 2017, a rate not significantly different from Ontario (5.9 per 100,000). Fertility rates among females in this age group decreased for Middlesex-London, Ontario and the Peer Group from 2006 to 2017 (Fig 11.4.9).

The fertility rate among women aged 35 to 39 in Middlesex-London was 55.0 per 100,000 females in 2017, a rate not significantly different from Ontario (58.6 per 100,000). Fertility rates among women in this age group increased for Middlesex-London, Ontario and the Peer Group from 2006 to 2017 (Fig 11.4.10).

The average number of children per female (i.e., the total fertility rate) in Middlesex-London was 1.3 in 2017, compared to 1.4 for Ontario. The rate declined slightly for Middlesex-London, Ontario and the Peer Group from 2006 to 2017 (Fig 11.4.11).

Interpretive notes

Fertility is measured in terms of the number of children born to women in a specific population. The fertility rate of a population is influenced by many different factors such as: the age structure of the population, the age at which females enter a first union or marriage, the availability of reliable contraceptive methods, the average age of mothers at birth, the cost of raising children, and the level of urbanization.10

In developed countries such as Canada, a total fertility rate of 2.1 children per female is needed for the population to replace itself from one generation to the next.10, 11 In Canada, the total fertility rate has been below the replacement level (2.1 children per female) since 1971.10

How this Indicator was Calculated: 
Ontario Public Health Standard: 

Healthy Growth and Development Guideline, 2018

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability


References:

1.      Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal Age and Risk of Labor and Delivery Complications. Matern Child Health J [Internet]. 2015 [cited 2018 Nov 8];19(6):1202-11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418963/ DOI: 10.1007/s10995-014-1624-7

2.      Benzies KM. Advanced Maternal Age: Are Decisions About the Timing of Child-Bearing a Failure to Understand the Risks? CMAJ [Internet]. 2008 [cited 2018 Nov 15];178(2):183-4. Available from: http://www.cmaj.ca/content/cmaj/178/2/183.full.pdf DOI: 10.1503/cmaj.071577

3.      Canadian Institute for Health Information. In Due Time: Why Maternal Age Matters [Internet]. Ottawa: 2011 2011 Sep [cited 2018 Nov 15]. Available from: https://secure.cihi.ca/free_products/AIB_InDueTime_WhyMaternalAgeMatters_E.pdf

4.      Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of Maternal Age on Obstetric Outcome. Obstet Gynecol [Internet]. 2005 [cited 2018 Nov 15];105(5 Pt 1):983-90. Available from: https://journals.lww.com/greenjournal/Fulltext/2005/05000/Impact_of_Maternal_Age... DOI: 10.1097/01.aog.0000158118.75532.51

5.      Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced Maternal Age and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis. PLoS One [Internet]. 2017 [cited 2018 Nov 15];12(10):e0186287. Available from: http://dx.plos.org/10.1371/journal.pone.0186287 DOI: 10.1371/journal.pone.0186287

6.      Chen X-K, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage Pregnancy and Adverse Birth Outcomes: A Large Population Based Retrospective Cohort Study. Int J Epidemiol [Internet]. 2007 [cited 2018 Nov 15];36(2):368-73. Available from: http://dx.doi.org/10.1093/ije/dyl284 DOI: 10.1093/ije/dyl284

7.      McKay A. Trends in Canadian National and Provincial/Territorialteen Pregnancy Rates: 2001-2010. Can J Hum Sex [Internet]. 2012 [cited 2018 Nov 15];21(3-4):161-75. Available from: http://www.sieccan.org/pdf/TeenPregancy.pdf

8.      The American College of Obstetricians and Gynecologists. Preeclampsia and High Blood Pressure During Pregnancy [Internet]. 2018 [cited 2018 Nov 15]. Available from: https://www.acog.org/-/media/For-Patients/faq034.pdf?dmc=1&ts=20181115T1957255816

9.      Committee on Obstetric Practice  American Academy of Pediatrics—Committee on Fetus and Newborn. The Apgar Score [Internet]. The American College of Obstetricians and Gynecologists, 2015 Reaffirmed 2017 [cited 2018 Nov 15]. Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/The-Apgar-Score?IsMobileSet=false

10.    Statistics Canada. Fertility: Fewer Children, Older Moms [Internet]. Ottawa: Statistics Canada; 2014 [cited 2018 Nov 8]. Available from: https://www150.statcan.gc.ca/n1/pub/11-630-x/11-630-x2014002-eng.htm

11.    Craig J. Replacement Level Fertility and Future Population Growth. Popul Trends 1994 (78):20-2.

Last modified on: January 24, 2019

Jargon Explained

Total pregnancy rate
The number of pregnancies among females of reproductive age (aged 15 to 49), per 1,000 females of reproductive age.

Age-specific pregnancy rate
The number of pregnancies among females in a given age group, per 1,000 females of the given age group.

Teenage pregnancy
Pregnancy in women aged 15 to 19.

Preeclampsia
A pregnancy disorder characterized by high blood pressure (hypertension) and one or more signs that the woman’s organ systems are not functioning normally (e.g., abnormal amount of protein in the urine, low number of platelets in the blood). It usually occurs after 20 weeks of pregnancy.8

Apgar score
A method to quickly assess the clinical status of a newborn baby at one and five minutes after birth. The score consists of five components: colour, heart rate, reflexes, muscle tone, and respiration, each of which is given a score of 0, 1, or 2.9

General fertility rate
The number of live births to females aged 15 to 49, per 1,000 females aged 15 to 49.

Age-specific fertility rate
The number of live births to females in a given 5-year age group, per 1,000 females in the given 5-year age group.

Total fertility rate
The average number of children that would be born to each female if she were to live to the end of her childbearing years and give birth to children according the age-specific fertility rates for that area and period of time.