Adverse perinatal outcomes in 665,244 term and post-term deliveries—a Norwegian population-based study

Abstract

Objective: To assess the prevalence and risk of adverse perinatal outcomes in early-term (37 +0 -38 +6 weeks), full-term (39 +0 -40 +6 weeks), late-term (41 +0 -41 +6 weeks), and post-term (>42 +0 weeks) deliveries with spontaneous labor onset. Study design:A population-based cohort with data from the Medical Birth Registry Norway (MBRN) and Statistics Norway (SSB) was conducted. The study population consisted of 665,244 women with cephalic singleton live births at term or post-term with spontaneous labor onset during the period of 1999-2014 in Norway. Maternal, obstetric, and fetal characteristics were obtained from the MBRN. Maternal education data were obtained from the SSB. The prevalence rates of adverse perinatal outcomes for each gestational age (GA) group were estimated. Inter-group differences were detected with Chi square tests.Multivariable regression analysis adjusted for maternal age, educational level, smoking, parity, maternal diabetes, and preeclampsia was used to assess adverse outcome prevalence for early-late-, and post-term births compared to full-term births.Results Deliveries at early-term were associated with an increased prevalence of neonatal jaundice, polyhydramnios, small for gestational age (SGA) status, respiratory support, and neonatal intensive care unit (NICU) admission compared with deliveries at GAs of 39-43 weeks (p < 0.001). Low 5-min Apgar scores and newborn antibiotic treatment occurred at an increased prevalence in both early-term and post-term infants, relative to the full-term group (p < 0.001). The prevalence of oligohydramnios, meconium-stained amniotic fluid, and newborn birth injuries increased with increasing GA. Conclusions More perinatal morbidity was observed among early-term infants compared to infants with later term deliveries, underscoring the need for cautious management of low-risk early-term deliveries.

Midwife annual delivery workload and maternal and neonatal adverse outcomes, is there an association?

“…With regard to neonatal outcomes, the statically significant higher rates of the composite adverse neonatal outcome among the low annual volume group (10.9% vs. 10.3%, p<0.001%) was attributed to jaundice (4.1% vs. 3.7%, p<0.001%) and mechanical ventilation (0.3% vs. 0.2%, p<0.001). These rates were comparable with a large Norwegian population-based study that assessed adverse perinatal outcomes in 665,244 term and post-term deliveries 20 Even with the statistically significant difference in the mechanical ventilation rate (0.3% vs. 0.2%) no other statistically significant difference in Apgar scores, neonatal asphyxia and NICU Admissions rates were determined.…”

Induction of labour from 39 weeks in low‐risk multiparas with ripe cervixes: A randomised controlled trial

“…A Norwegian population‐based study showed that deliveries at early term were associated with an increased number of neonatal jaundice, polyhydramnios, small for gestational age, respiratory support and neonatal intensive care unit admission compared with deliveries at 39 to 43 weeks. Poor Apgar scores and requirement for antibiotic treatment were higher in early‐term and post‐term new‐borns while meconium‐stained liquor and new‐born birth injuries increased with increasing gestational age 26 . The above suggest that full‐term delivery is probably best for short‐term infant outcomes.…”

Effects of gestational age at birth on perinatal structural brain development in healthy term‐born babies

“…The first large study to demonstrate this, published in 2012, used a cohort of 18,818 infants and found that individuals born between 37 and 38 weeks gestational age had a higher risk of adverse health and developmental outcomes at age 3 compared to those born between 39 and 41 weeks gestational age (Boyle et al, 2012). Subsequent studies have linked other adversities with early term birth, including higher risks of neonatal (Murzakanova et al, 2020) and later childhood illness (Coathup et al, 2020) and less favourable neurodevelopmental outcomes in early life (Hua et al, 2019; Rose et al, 2013).…”