Health-related Behaviours
In Middlesex-London, 62.1% of women who had given birth reported in 2010 having visited a health care provider to help plan for a healthy pregnancy. Compared to 2001, this represents a 1.7 fold increase in this health-enhancing practice for Middlesex-London women. Also in 2010, almost two-thirds of Middlesex-London women who had given birth said they had taken a vitamin supplement containing folic acid within 12 months of becoming pregnant. Furthermore, about nine out of every ten pregnant women reported from 2001 to 2010 having received prenatal care from a health care provider during the first three months of their pregnancy. These are examples of practices recommended for healthy pregnancies which have been monitored through an ongoing telephone survey of adults in Middlesex-London.
Pregnancy & Fertility Rates
Pregnancy rates in Middlesex-London have increased slightly from 2001 to 2009 whereas those in Ontario and the Peer Group have remained relatively stable. Despite the slight increase, Middlesex-London’s pregnancy rates were still consistently lower than those in Ontario and similar to those of the Peer Group. Fertility rates are the number of live births per 1000 females of childbearing age. In Middlesex-London, fertility rates were for the most part slightly lower than those for Ontario and similar to the Peer Group. They have increased slightly since 2000 and reached Ontario rates by 2009. In 2009, the pregnancy rate in Middlesex-London was 25% higher than its fertility rate, whereas in Ontario, the pregnancy rate was 33% higher than its fertility rate. The difference likely reflects a lower rate of therapeutic abortions for Middlesex-London females compared to their Ontario counterparts, given that Middlesex-London and Ontario's fertility rates were very similar in 2009.
Mothers of newborns who are particularly young (ie. teenagers) or old (ie ages 35 and older) tend to experience more problems delivering the baby and with various birth outcomes, eg. prematurity, low birth weight, and neonatal death, to name a few. These mothers may therefore require more supports before and after birth than mothers in their twenties and early thirties.
Trends and rates of pregnancy and fertility varied significantly depending on mother’s age. Pregnancy and fertility rates across age groups in Middlesex-London followed the trend seen for Ontario but with lower rates in every age group except for ages 15-19 where fertility rates were higher than Ontario and pregnancy rates similar to Ontario, and ages 45 to 49 where pregnancy rates were similar to Ontario. This again would likely reflect a lower rate of therapeutic abortions for Middlesex-London teens ages 15 to 19 compared to Ontario. Teen pregnancies (ages 15 to 19) in Middlesex-London also appear to have mirrored the slight downward trend seen for Ontario which fell by 20% from 2001 to 2009. About 32 for every 1000 females ages 15 to 19 in Middlesex-London were pregnant in 2009.
Age groups 25 through to 34 had the highest fertility rates in Middlesex-London, Ontario and the Peer Group. Compared to the Peer Group, Middlesex-London females tended to be pregnant or give birth at older ages peaking at ages 30 to 34 rather than 25 to 29. Although the 40 to 44 age group had the second lowest pregnancy rate at 10.7 in 2009, rates for this age group showed the most growth by 47% from 2001 to 2009. During this time period, pregnancy rates in Middlesex-London rose by 24% for the 35 to 39 age group and by 20% for the 30 to 34 age group.
The average number of children per female ages 15 to 49 in Middlesex-London was 1.5 in 2007 compared to 1.6 for Ontario and the Peer Group. This is up from 1.4 for Middlesex-London and 1.5 for Ontario and the Peer Group in 2003. The rate of multiple births has increased steadily from 2003 to 2009 in Ontario. The rates for Middlesex-London appear for the most part to follow the trend for Ontario and the Peer Group.
Birth Outcomes
Rates of low birthweight, preterm birth (i.e. prematurity), small-for-gestational age (SGA) (i.e. growth restriction), and large-for-gestational age (LGA) are birth outcomes associated with health problems and mortality in childhood and sometimes beyond. Most birth outcomes were analyzed for singletons only since multiple births are associated with very high rates of the former three birth outcomes and have been increasing over time.
The low birth weight rate in Middlesex-London in 2009 was 6.1%. Rates were similar to those of Ontario and the Peer Group and appeared to increase slightly from 2000 to 2009. The percent of SGA babies in Middlesex-London was somewhat lower than those in Ontario and similar to the Peer Group from 2003 to 2006. In 2007, however, the rate in Middlesex-London rose to 8.6% almost reaching the Ontario rate of 8.8%. In Middlesex-London, SGA rates were lower than those for Ontario for younger maternal age groups up until about age 35 after which rates were more similar to Ontario. The SGA rate was highest for those babies whose mothers were youngest ie. ages 15 to 19 at 10.4% in Middlesex-London. Rates declined to 6.7% at ages 30 to 34 and then rose to 9.0% at ages 40 to 44.
Preterm birth rates in Middlesex-London were similar to Ontario and the Peer Group for the most part at 8.2% of live births in 2009. In general, preterm birth rates have been relatively stable from 2006 to 2009. Although Middlesex-London’s rates appear to have decreased over this time period, the decline is not statistically significant.
Preterm birth rates for singleton babies were highest for mothers ages 40 and older and those ages 15 to 19 to a lesser extent. Mothers ages 30 to 34 had the lowest rates.
LGA rates declined slightly from 2003 to 2007 in Middlesex-London, Ontario and the Peer Group. In Middlesex-London, LGA rates were higher than those in Ontario and generally lower than those in the Peer Group. Most of the differences, however, were not statistically significant. LGA rates were lowest for teen moms and increased steadily to ages 40 to 44. In Middlesex-London, a 35 to 39 year-old mom was 1.8 times more likely than a 15-19 year-old mom to have a LGA baby. Singleton babies of mothers ages 35 to 39 are twice as likely to be LGA than SGA. Teen mothers (ages 15 to 19) of singleton babies experience the lowest LGA rate and highest SGA rate of all maternal age groups.