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Temporal Trends in Pregnancy Rate, Live Birth Rates, and Rates of Gestational Outcomes, 2012-2023.

Shalmali Bane1, Fei Xu1, Susanna Mitro1

  • 1Kaiser Permanente Northern California Division of Research, Pleasanton, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Department of Obstetrics and Gynecology and Department of Pediatrics, Kaiser Permanente Northern California, Oakland, California; and Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara, California.

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Pregnancy and live birth rates declined between 2012 and 2023 in a large health system. This trend, mirroring national data, was linked to an increase in induced abortions, as other gestational outcomes decreased.

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Area of Science:

  • Reproductive Health
  • Maternal Health Trends
  • Public Health Surveillance

Background:

  • Understanding temporal trends in pregnancy and live birth rates is crucial for public health planning and resource allocation.
  • Previous studies have indicated shifts in reproductive outcomes, necessitating updated data from diverse healthcare systems.

Purpose of the Study:

  • To analyze trends in pregnancy, live birth, and gestational outcomes from 2012 to 2023 within an integrated healthcare system.
  • To examine variations in these rates across different maternal demographic characteristics, including age and race/ethnicity.

Main Methods:

  • A retrospective cohort study analyzed 700,159 pregnancies from 2012 to 2023.
  • Quasi-Poisson regression models were used to calculate adjusted temporal trends in pregnancy and live birth rates per 1,000 individuals (15-44 years).
  • Rates of plurality, stillbirth, ectopic pregnancy, molar pregnancy, miscarriage, and induced abortion were assessed per 1,000 singleton pregnancies.

Main Results:

  • Adjusted pregnancy rates decreased by 10.2% and live birth rates by 13.8% from 2012 to 2023.
  • Rates of miscarriage, molar pregnancy, and ectopic pregnancy declined among singleton pregnancies.
  • The rate of induced abortions increased by 27.3%, while stillbirth rates remained stable but rare.

Conclusions:

  • Pregnancy and live birth rates have declined in this integrated health system, consistent with national trends.
  • The observed disparity between declining live birth rates and pregnancy rates is largely attributable to an increase in induced abortions.
  • These findings highlight evolving reproductive patterns and underscore the need for continued monitoring of gestational outcomes.