Massachusetts Department of Public Health seal Massachusetts Environmental Public Health Tracking

Reproductive and Birth Outcomes

Did You Know?
  • 71,484 babies were born to Massachusetts residences.
  • Over 81% of MA resident mothers who gave birth in 2015 received adequate or more than adequate prenatal care.
  • 5.5% of expecting women in MA reported smoking while pregnant in 2015 - a decline from 2014.

Over 70,000 babies are born to Massachusetts residents each year. While most women have normal pregnancies and healthy babies, about 10 percent of Massachusetts births in 2015 had at least one poor birth outcome of those tracked by the MA Environmental Public Health Tracking Program. Environmental factors where we live, work, and play can influence reproductive health. Contaminants in the air, water, and everyday items may also influence reproductive and birth outcomes. These factors, combined with personal attributes like age, genetics, and maternal health, can all play a role in having a healthy baby. Poor reproductive and birth outcomes include infertility, prematurity, low birthweight, and fetal and infant deaths. Birth defects are also tracked through the Environmental Public Health Tracking Program.

What are reproductive and birth outcomes?

Reproductive and birth outcomes cover a range of health measures relating to the ability to conceive, carry, and deliver a healthy, full-term baby that remains healthy throughout the first year of life.

The Massachusetts Environmental Public Health Tracking Program (MA EPHT) uses the following measures to track reproductive and birth outcomes:


Sex ratio:

The ratio of male births per 1,000 female births.

Preterm (premature) birth:

Preterm birth: When a baby is born early (before the 37th week of pregnancy).
Very preterm birth:
When a baby is born very early (before the 32nd week of pregnancy).

Low birthweight:

Low birthweight (among full-term births): When a baby is born at a low weight (less than 5.5 pounds). We track low birthweight among singleton, full-term births because babies born too early or as part of a multiple birth are often low weight. This measure is also called small for gestational age.
Very low birthweight (regardless of gestational age):When a baby is born at a very low weight (less than 3.3 pounds). We track very low birthweight among singleton births regardless of gestational age.

Infant mortality:

When a baby dies before their first birthday. We track perinatal (>= 28 weeks gestation to < 7 days of age), neonatal (<28 days of age), post-neonatal (>= 28 days of age to < 1 year of age), and infant (<1 year of age) mortality.

Total Fertility Rate:

An estimate of the number of births that a hypothetical group of 1,000 women would have over their lifetimes.

Why is MA EPHT tracking reproductive & birth outcomes?

Did You Know?
In the state of Massachusetts, low birthweight is tracked as one of 4 health criteria to identify Vulnerable Health Environmental Justice Populations. These groups are segments of the population that have evidence of higher than average rates of environmentally-related health outcomes.1 1

The Massachusetts Environmental Public Health Tracking Program (MA EPHT) helps us understand the connection between reproductive and birth outcomes and the environment. MA EPHT provides county, community, and census tract level data about reproductive and birth outcomes that can be linked to environmental exposure and hazard data nationally and within the state of Massachusetts. We study the trends and patterns in these data across time, geography, and demographics. This helps us better understand how the environment influences our health and to identify populations at risk for, or suffering from, poor health outcomes.

What environmental exposures affect reproductive and birth outcomes?

Exposure does not necessarily mean you or your baby will be harmed.  However, environmental toxins may be especially dangerous to babies while they are growing in the womb. Exposure to high levels of the following could impact you or your baby’s health:

  • Smoking and secondhand smoke from cigarettes is associated with premature birth, low birthweight, and possibly fetal death or miscarriage.
  • Air pollution from car exhaust and industrial sources is associated with low birthweight and premature birth.
  • Lead is often found in old homes. It can cause premature birth, low birthweight, spontaneous fetal death, or miscarriage.
  • Mercury, most commonly found in large fish, can harm an unborn baby’s nervous system.
  • Pesticides used in large amounts, such as in farming and agricultural areas, are associated with miscarriage, premature birth, low birthweight, and other health problems.
  • Endocrine-Disrupting Chemicals like BPA, PCBs, and phthalates, may impact fertility and child development. They can be found in many household products, such as make-up, plastic containers, and the lining of canned foods.

How can I reduce my risk?

A safe environment is just one part of a healthy pregnancy. Medical conditions, social and economic factors, and behaviors can all impact health outcomes.

To reduce your risk of poor reproductive and birth outcomes…

Talk to Your Healthcare Provider

  • See a healthcare provider before you get pregnant to discuss any health risks, including over-the-counter and prescription medications that are safe or unsafe to take during pregnancy and to become up-to-date on vaccinations.
  • Start prenatal care as soon as possible.
  • Talk to your healthcare provider about ways to prevent infections and seek help when you are sick.
  • If you work with any chemicals, ask how they may impact your pregnancy.

Try to Improve Your Health

  • Talk to your healthcare provider about maintaining a healthy weight.
  • Take a vitamin with 400 micrograms (mcg) of folic acid every day.
  • Treat any existing conditions you may have, such as diabetes.
  • Use birth control or condoms if you do not want to get pregnant.

Avoid Harmful Substances

Prevent Environmental Exposures

  • If possible, avoid using fireplaces and wood-burning stoves.
  • Do not handle chemicals or go to places where chemicals are sprayed.
  • Try to avoid pollution from traffic.
  • Avoid mosquitoes.
  • Stay away from wild or pet rodents, live poultry, lizards and turtles, and do not clean cat litter boxes while pregnant.
  • Wash your hands before and after preparing foods, after touching pets and animals, and after changing diapers or wiping runny noses. Do not put a young child’s food, utensils or pacifiers in your mouth.
  • Follow fish consumption guidelines to avoid exposure to mercury or other contaminants
  • Have your home tested for lead if it was built before 1978. Read more about lead here.
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