{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T17:08:19Z","timestamp":1777741699559,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>We evaluated the birth rate of Down syndrome (DS) in the CDC birth certificate online database. From 2016 to 2025, live birth incidence could range greatly (depending on the proportion of unknown cases that are counted as DS+) due to relatively high numbers of unknown\/not stated status. The annual live birth incidence of DS in live-born infants using CDC birth certificate data from 2016 to 2025 shows a wide range of potential birth rates as calculated here, due to relatively high numbers of unknown\/not stated DS status. Although our findings overlap with published data, future studies are needed to further evaluate the current birth rate of DS in the US.<\/jats:p>","DOI":"10.3390\/children13050612","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:34:42Z","timestamp":1777458882000},"page":"612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Down Syndrome Births Among Live Births from the CDC Wonder Database"],"prefix":"10.3390","volume":"13","author":[{"given":"Stephanie L.","family":"Santoro","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA 02114, USA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chance","family":"Alvarado","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital Heart Center, Nationwide Children\u2019s Hospital, Columbus, OH 43205, USA"},{"name":"Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA"},{"name":"Biostatistics Resource at Nationwide Children\u2019s Hospital, Abigail Wexner Research Institute, Nationwide Children\u2019s Hospital, Columbus, OH 43205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen A.","family":"Hart","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital Heart Center, Nationwide Children\u2019s Hospital, Columbus, OH 43205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9409-6377","authenticated-orcid":false,"given":"Thomas","family":"Casto","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital Heart Center, Nationwide Children\u2019s Hospital, Columbus, OH 43205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9172-3874","authenticated-orcid":false,"given":"Clifford L.","family":"Cua","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital Heart Center, Nationwide Children\u2019s Hospital, Columbus, OH 43205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1038\/gim.2016.127","article-title":"Estimation of the number of people with Down syndrome in the United States","volume":"19","author":"Buckley","year":"2017","journal-title":"Genet. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1056\/NEJMra1706537","article-title":"Down Syndrome","volume":"382","author":"Bull","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/oxfordjournals.aje.a113979","article-title":"Congenital heart disease: Prevalence at livebirth: The Baltimore-Washington Infant Study","volume":"121","author":"Ferencz","year":"1985","journal-title":"Am. J. Epidemiol."},{"key":"ref_4","first-page":"1","article-title":"Morbidity and Mortality in Neonates with Down Syndrome vs Those Without Down Syndrome by Gestational Age","volume":"1","author":"Messick","year":"2025","journal-title":"Pediatr. Open Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1038\/s41372-025-02384-0","article-title":"Gestational age-based outcomes of neonates with Down syndrome in the neonatal intensive care unit (NICU): Review of pediatric health information system (PHIS) database","volume":"45","author":"Messick","year":"2025","journal-title":"J. Perinatol."},{"key":"ref_6","first-page":"1079","article-title":"Congenital cardiovascular malformations in the Baltimore-Washington area","volume":"34","author":"Rubin","year":"1985","journal-title":"Md. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1542\/peds.2005-2123","article-title":"Screening for celiac disease in asymptomatic children with Down syndrome: Cost-effectiveness of preventing lymphoma","volume":"118","author":"Swigonski","year":"2006","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s00431-010-1200-0","article-title":"Prevalence of congenital heart defects and persistent pulmonary hypertension of the neonate with Down syndrome","volume":"169","author":"Weijerman","year":"2010","journal-title":"Eur. J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jpeds.2007.09.045","article-title":"Prevalence, neonatal characteristics, and first-year mortality of Down syndrome: A national study","volume":"152","author":"Weijerman","year":"2008","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1542\/peds.2011-1605","article-title":"Health supervision for children with Down syndrome","volume":"128","author":"Bull","year":"2011","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mekonnen, T., Kristjansson, D., Bratsberg, B., Kohler, H.P., Selbaek, G., Larsen, F.K., Langballe, E.M., Engeland, J., Kirkevold, O., and Haberg, A.K. (2025). Changes in survival probabilities and mortality risks among population living with Down syndrome born 1967-2018: A Norwegian registry-based study. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-25326-z"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tsou, P.Y., Wang, Y.H., and Tapia, I.E. (2025). Inpatient outcomes among children with Down syndrome: A Kids\u2019 Inpatient Database study. BMC Pediatr., 25.","DOI":"10.1186\/s12887-025-05899-9"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ye, E., Wu, E., and Han, R. (2025). Global, regional, and national impact of Down syndrome on child and adolescent mortality from 1980 to 2021, with projections to 2050: A cross-sectional study. Front Public Health, 13.","DOI":"10.3389\/fpubh.2025.1554589"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tantalean Da Fieno, J., Leon Paredes, R., Palomo Luck, P., Del Aguila Villar, C., and Rizo Patron, E. (2024). Down syndrome and outcomes in critically ill pediatric patients. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1483944"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103062","DOI":"10.1016\/j.eclinm.2024.103062","article-title":"Hospitalizations in people with down syndrome across age groups: A population-based cohort study in Switzerland","volume":"80","author":"Gaechter","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.athoracsur.2024.09.037","article-title":"Outcomes in Adult Congenital Heart Disease Patients with Down Syndrome Undergoing a Cardiac Surgical Procedure","volume":"119","author":"Goldberg","year":"2025","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/bdra.20294","article-title":"National estimates and race\/ethnic-specific variation of selected birth defects in the United States, 1999-2001","volume":"76","author":"Canfield","year":"2006","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1002\/bdr2.1589","article-title":"National population-based estimates for major birth defects, 2010\u20132014","volume":"111","author":"Mai","year":"2019","journal-title":"Birth Defects Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1002\/bdra.23198","article-title":"Selected birth defects data from population-based birth defects surveillance programs in the United States, 2006 to 2010: Featuring trisomy conditions","volume":"97","author":"Mai","year":"2013","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1002\/bdra.20735","article-title":"Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006","volume":"88","author":"Parker","year":"2010","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1542\/peds.2009-0745","article-title":"Prevalence of Down syndrome among children and adolescents in 10 regions of the United States","volume":"124","author":"Shin","year":"2009","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e2301","DOI":"10.1002\/bdr2.2301","article-title":"National population-based estimates for major birth defects, 2016-2020","volume":"116","author":"Stallings","year":"2024","journal-title":"Birth Defects Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1002\/bdra.20404","article-title":"Prevalence of down syndrome among children and adolescents in metropolitan Atlanta","volume":"79","author":"Besser","year":"2007","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_24","first-page":"756","article-title":"Estimates of the live births, natural losses, and elective terminations with Down syndrome in the United States","volume":"167A","author":"Buckley","year":"2015","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_25","unstructured":"Centers for Disease Control and Prevention, and National Center for Health Statistics (2026, April 17). National Vital Statistics System, Natality on CDC WONDER Online Database. Data are from the Natality Records 2016\u20132022, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, Available online: https:\/\/wonder.cdc.gov\/natality-expanded-current.html."},{"key":"ref_26","unstructured":"Centers for Disease Control and Prevention, and National Center for Health Statistics (2026, April 17). National Vital Statistics System, Provisional Natality on CDC WONDER Online Database. Data are from the Natality Records for births occurring in 2023 through last month, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, Available online: https:\/\/wonder.cdc.gov\/natality-expanded-provisional.html."},{"key":"ref_27","unstructured":"Centers for Disease Control and Prevention (CDC) (1994). Down syndrome prevalence at birth\u2014United States, 1983\u20131990. MMWR Morb. Mortal. Wkly. Rep., 43, 617\u2013622."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3615","DOI":"10.1002\/ajmg.a.62408","article-title":"Delivering a new diagnosis of Down syndrome: Parent experience","volume":"185","author":"Lehman","year":"2021","journal-title":"Am. J. Med. Genet. A"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s41372-023-01834-x","article-title":"Declining birth rates, increasing maternal age and neonatal intensive care unit admissions","volume":"44","author":"Gamber","year":"2024","journal-title":"J. Perinatol."},{"key":"ref_30","first-page":"e45652","article-title":"Trends and Factors Associated with Mortality Rates of Leading Causes of Infant Death: A CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Database Analysis","volume":"15","author":"Okobi","year":"2023","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/pedsos.2024-000411","article-title":"The Dobbs Decision and Incidence of Live Births with Cyanotic Congenital Heart Disease","volume":"1","author":"Tseng","year":"2025","journal-title":"Pediatr. Open Sci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Santoro, S.L., Alvarado, C., Tseng, S.Y., Conroy, S., Kistler, I., Hart, S.A., Fichtner, S., and Cua, C.L. (2026). Down syndrome birth rate post Dobbs decision: Has it changed?. J. Perinatol.","DOI":"10.1038\/s41372-026-02560-w"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ammar, L., Bird, K., Nian, H., Maxwell-Horn, A., Lee, R., Ding, T., Riddell, C., Gebretsadik, T., Snyder, B., and Hartert, T. (2024). Development and Validation of a Diagnostic Algorithm for Down Syndrome Using Birth Certificate and International Classification of Diseases Codes. Children, 11.","DOI":"10.20944\/preprints202409.0231.v1"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2105\/AJPH.86.5.731","article-title":"The surveillance of birth defects: The usefulness of the revised US standard birth certificate","volume":"86","author":"Watkins","year":"1996","journal-title":"Am. J. Public Health"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:29:59Z","timestamp":1777462199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["children13050612"],"URL":"https:\/\/doi.org\/10.3390\/children13050612","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}