TABLE 4

Unadjusted and aORs of Unexpected Complications in Term Newborns (Florida, 2004–2013)

Total Complications (n = 58 886)Severe (n = 28 853)Moderate (n = 30 033)
OR (95% CI)aOR (95% CI)aaOR (95% CI)aaOR (95% CI)a
Age, y (reference: <20 y)
 20–290.89 (0.87–0.91)1.10 (1.06–1.13)1.11 (1.06–1.16)1.09 (1.04–1.13)
 30–390.82 (0.79–0.84)1.18 (1.13–1.22)1.20 (1.14–1.26)1.15 (1.10–1.21)
 ≥400.88 (0.83–0.93)1.22 (1.15–1.30)1.28 (1.18–1.40)1.17 (1.07–1.27)
Race or ethnicity (reference: NH white)
 NH black0.94 (0.92–0.96)0.84 (0.82–0.86)0.97 (0.93–1.00)0.74 (0.71–0.77)
 Hispanic: Mexican0.80 (0.77–0.83)0.79 (0.75–0.82)0.81 (0.76–0.86)0.77 (0.73–0.82)
 Hispanic: Puerto Rican0.88 (0.85–0.92)0.84 (0.80–0.87)0.94 (0.89–1.00)0.76 (0.71–0.80)
 Hispanic: Cuban0.90 (0.86–0.95)0.84 (0.81–0.88)0.89 (0.84–0.94)0.80 (0.75–0.86)
 Hispanic: Central or South American0.81 (0.78–0.85)0.83 (0.79–0.86)0.88 (0.83–0.93)0.79 (0.75–0.84)
 Other Hispanic0.87 (0.83–0.91)0.83 (0.79–0.87)0.87 (0.82–0.93)0.79 (0.74–0.84)
 Haitian0.99 (0.94–1.03)0.91 (0.87–0.96)1.01 (0.94–1.08)0.84 (0.79–0.90)
 Other, NH0.83 (0.80–0.87)0.87 (0.83–0.91)0.95 (0.89–1.01)0.81 (0.76–0.86)
Not married1.27 (1.25–1.29)1.08 (1.06–1.11)1.05 (1.02–1.09)1.11 (1.08–1.14)
Father not acknowledged on BCb1.27 (1.30–1.24)1.12 (1.09–1.15)1.11 (1.07–1.15)1.12 (1.08–1.16)
Education (reference: college graduate)
 Less than high school1.31 (1.28–1.34)1.19 (1.16–1.23)1.21 (1.15–1.26)1.18 (1.13–1.23)
 High school graduate or GED1.26 (1.23–1.29)1.15 (1.12–1.18)1.16 (1.12–1.21)1.14 (1.10–1.18)
 Some college (no degree)1.19 (1.16–1.23)1.11 (1.08–1.14)1.10 (1.05–1.14)1.13 (1.08–1.17)
Insurance (reference: private)
 Medicaid1.29 (1.27–1.31)1.20 (1.17–1.22)1.20 (1.16–1.24)1.20 (1.16–1.23)
 Self-pay1.01 (0.97–1.06)1.03 (0.98–1.08)1.06 (0.99–1.13)1.00 (0.94–1.07)
 Other1.25 (1.16–1.34)1.23 (1.15–1.32)1.24 (1.11–1.37)1.23 (1.12–1.35)
Birth order and history (reference: second or third delivery, no previous CS)
 First delivery1.42 (1.39–1.45)1.41 (1.38–1.44)1.60 (1.56–1.65)1.25 (1.21–1.28)
 Second or third delivery, previous CS0.90 (0.87–0.93)0.89 (0.86–0.92)1.01 (0.97–1.06)0.79 (0.75–0.82)
 Fourth or later, no previous CS1.14 (1.10–1.18)1.02 (0.98–1.06)1.01 (0.96–1.06)1.03 (0.98–1.08)
 Fourth or later, previous CS1.21 (1.15–1.28)1.07 (1.01–1.13)1.14 (1.06–1.24)1.01 (0.93–1.09)
BMI (reference: normal, 18.5–24.9)
 Underweight (<18.5)1.03 (0.99–1.07)0.96 (0.92–1.00)0.95 (0.89–1.00)0.96 (0.91–1.02)
 Overweight or obese class I (25–34.9)1.10 (1.08–1.12)1.10 (1.08–1.13)1.16 (1.13–1.20)1.05 (1.02–1.08)
 Obese class II (35–39.9)1.21 (1.16–1.25)1.16 (1.12–1.21)1.24 (1.18–1.31)1.09 (1.04–1.15)
 Obese class III (≥40)1.39 (1.33–1.45)1.30 (1.25–1.36)1.47 (1.39–1.56)1.14 (1.07–1.21)
 Unknown1.17 (1.13–1.22)1.13 (1.09–1.17)1.13 (1.07–1.19)1.13 (1.07–1.19)
Tobacco use (reference: no)1.45 (1.41–1.49)1.28 (1.24–1.32)1.19 (1.14–1.24)1.37 (1.32–1.42)
GINDEX (reference: intensive or adequate)
 Intermediate0.99 (0.97–1.01)1.00 (0.98–1.02)1.00 (0.97–1.03)1.00 (0.97–1.03)
 Inadequate1.04 (1.02–1.07)1.04 (1.01–1.07)1.02 (0.98–1.06)1.06 (1.03–1.10)
 No care1.83 (1.72–1.95)1.78 (1.66–1.90)1.80 (1.63–1.98)1.76 (1.61–1.92)
 Unknown1.13 (1.09–1.17)1.12 (1.08–1.15)1.12 (1.07–1.18)1.11 (1.05–1.16)
Timing and reason for delivery initiation (reference: ≥39 wk, without medical indication)
 Spontaneous, 37–38 wk1.58 (1.54–1.62)1.54 (1.50–1.58)1.62 (1.56–1.68)1.46 (1.41–1.51)
 MI induction or CS at 37–38 wkc2.15 (2.09–2.21)2.12 (2.06–2.18)2.28 (2.19–2.38)1.98 (1.90–2.06)
 NMI induction at 37–38 wk1.17 (1.11–1.24)1.21 (1.14–1.28)1.20 (1.11–1.30)1.21 (1.13–1.30)
 NMI CS at 37–38 wk (without labor)1.18 (1.13–1.23)1.38 (1.32–1.45)1.55 (1.45–1.65)1.23 (1.15–1.32)
 ≥39 wk, with medical indicationc1.69 (1.66–1.73)1.56 (1.53–1.60)1.81 (1.76–1.87)1.36 (1.32–1.40)
Weekend (Saturday–Sunday) delivery1.13 (1.11–1.15)1.10 (1.08–1.12)1.14 (1.11–1.18)1.06 (1.03–1.09)
Hospital level of NICU and birth volume quartile (reference: level III, bottom quartile)d
 Level I, bottom1.06 (0.92–1.22)1.14 (0.99–1.30)1.58 (1.31–1.91)0.70 (0.56–0.87)
 Level I, second–third0.96 (0.85–1.08)1.04 (0.93–1.17)1.43 (1.22–1.69)0.72 (0.60–0.85)
 Level I, top0.94 (0.83–1.05)1.01 (0.90–1.13)1.27 (1.08–1.49)0.79 (0.67–0.93)
 Level II, bottom1.17 (1.03–1.32)1.19 (1.05–1.34)1.33 (1.13–1.56)1.09 (0.91–1.29)
 Level II, second–third0.98 (0.88–1.09)1.00 (0.90–1.11)1.07 (0.92–1.25)0.98 (0.84–1.13)
 Level II, top0.83 (0.74–0.92)0.87 (0.78–0.96)0.85 (0.73–0.99)0.92 (0.79–1.07)
 Level III, second–third1.09 (1.01–1.18)1.06 (0.98–1.14)1.09 (0.97–1.22)1.04 (0.94–1.15)
 Level III, top1.14 (1.04–1.25)1.08 (0.98–1.19)1.10 (0.96–1.27)1.05 (0.93–1.20)
Hospital Medicaid births percentage quartile (reference: bottom quartile)
 Second–third1.09 (1.04–1.14)1.06 (1.01–1.11)1.18 (1.10–1.26)0.97 (0.91–1.03)
 Top1.19 (1.11–1.27)1.17 (1.09–1.24)1.42 (1.30–1.56)0.95 (0.87–1.04)
Florida hospital geographic location (reference: Eastern)e
 Northwestern1.37 (1.04–1.81)1.19 (0.92–1.52)1.31 (0.94–1.83)1.02 (0.72–1.43)
 Northeastern1.24 (0.97–1.57)1.14 (0.92–1.41)1.26 (0.95–1.67)0.98 (0.73–1.31)
 Central1.21 (0.99–1.48)1.13 (0.94–1.35)1.04 (0.82–1.33)1.16 (0.91–1.49)
 Western1.11 (0.89–1.38)1.05 (0.86–1.27)1.07 (0.83–1.39)0.99 (0.76–1.29)
 Southern1.62 (1.28–2.04)1.65 (1.34–2.02)1.91 (1.45–2.51)1.29 (0.97–1.71)
Year of delivery (reference: 2006–2007)
 2004–20051.06 (1.03–1.08)1.06 (1.03–1.09)1.03 (0.99–1.07)1.08 (1.04–1.12)
 2008–20091.06 (1.03–1.08)1.04 (1.02–1.07)1.06 (1.02–1.10)1.03 (0.99–1.06)
 2010–20111.12 (1.10–1.15)1.12 (1.09–1.15)1.18 (1.13–1.22)1.07 (1.03–1.11)
 2012–20131.15 (1.12–1.18)1.15 (1.11–1.18)1.18 (1.13–1.22)1.11 (1.07–1.16)
  • BC, birth certificate; CS, cesarean delivery; GINDEX, Graduated Index of Prenatal Care Utilization; MI, medically indicated; NH, non-Hispanic; OR, odds ratio (univariable model).

  • a OR adjusted for all variables shown: maternal age, race and ethnicity, marital status, father acknowledgment, maternal education level, health insurance, birth order and history, prepregnancy BMI, tobacco use, adequacy of prenatal care, timing and reason for delivery initiation, delivery day of week (weekday, weekend), hospital level of NICU and birth volume, hospital Medicaid births percentage, hospital geographic location, and year of delivery.

  • b Based on whether the father’s age is reported on the BC.

  • c The Joint Commission’s List of Conditions Possibly Justifying Elective Delivery Prior to 39 Weeks Gestation, v2015A1; Supplemental Table 5.

  • d Specific to year of birth.

  • e Adapted from the American Congress of Obstetricians and Gynecologists District XII (Florida) map (Supplemental Table 6).