Burden of early-term birth on adverse infant outcomes: a population-based cohort study in Brazil

Abstract

ObjectivesTo estimate the national rate of early-term live births in Brazil and to evaluate the effect of birth at 37 and 38 weeks’ gestation, as compared with 39 and 40 weeks’ gestation on infant outcomes according to precursors of birth and the existence of maternal/fetal medical conditions.DesignNational perinatal population-based cohort study.Setting266 maternity services located in the five Brazilian macroregions.Participants18 652 singleton live newborns from 37 0/7 to 40 6/7 weeks of gestation.Main outcome measuresResuscitation in delivery room, oxygen therapy, transient tachypnoea, admission to neonatal intensive care unit (NICU), hypoglycaemia, use of antibiotics, phototherapy, phototherapy after hospital discharge, neonatal death and breastfeeding.ResultsEarly terms accounted for 35% (95% CI 33.4% to 36.7%) of all live births. Among provider-initiated births in women without medical conditions, infants of 37 and 38 weeks’ gestation had higher odds of oxygen therapy (adjusted OR (AOR) 2.93, 95% CI 1.72 to 4.98 and AOR 1.92 95% CI 1.18 to 3.13), along with admission to NICU (AOR 2.01, 95% CI 1.18 to 3.41 and AOR 1.56, 95% CI 1.02 to 2.60), neonatal death (AOR 14.40, 95% CI 1.94 to 106.69 and AOR 13.76,95% CI 2.84 to 66.75), hypoglycaemia in the first 48 hours of life (AOR 7.86, 95% CI 1.95 to 31.71 and AOR 5.76, 95% CI 1.63 to 20.32), transient tachypnoea (AOR 2.98, 95% CI 1.57 to 5.65 and AOR 2.12, 95% CI 1.00 to 4.48) and the need for phototherapy within the first 72 hours of life (AOR 3.59, 95% CI 1.95 to 6.60 and AOR 2.29, 95% CI 1.49 to 3.53), yet lower odds of breastfeeding up to 1 hour after birth (AOR 0.67, 95% CI 0.53 to 0.86 and AOR 0.87, 95% CI 0.76 to 0.99) and exclusive breastfeeding during hospital stay (AOR 0.68, 95% CI 0.51 to 0.89 and AOR 0.84, 95% CI 0.71 to 0.99).ConclusionBirth at 37 and 38 weeks’ gestation increased the risk of most adverse infant outcomes analysed, especially among provider-initiated births and should be avoided before 39 weeks’ gestation in healthy pregnancies.

Epidemiology of late preterm and early term births – An international perspective

“…Because rates for moderate and late preterm births were combined, we only have partial data on the specific burden of late preterm birth. Only sparse data exist from lower-and middle-income countries on early term birth rates; Brazil reports 35% [33] and China between 23% and 29% among singleton live births [34]. This lack of information on the burden of early term delivery in lower-and middle-income countries constitutes an important limit to our knowledge.…”

“…Our review of the literature shows that differences in indicated early deliveries are likely to explain part of the cross-country variation and that changes in medical practices constitute one lever for lowering preterm and early term birth rates. In countries where there is a relatively high proportion of early term births (> 30%), such as the USA, Portugal and Brazil, there has been a recent push by professional societies to reduce the number of elective obstetric deliveries before 39 weeks [23,33,72], and in the USA financial incentives are used to limit these births based on Medicaid policy [75]. It would be of interest to evaluate management strategies by comparing decision-making and indications for provider-initiated deliveries across countries with high and low rates of early delivery.…”

Cost-Effectiveness Analysis of A Quality Improvement Program to Reduce Cesarean Sections in Brazilian Private Hospitals: A Case Study

“…However, women in the standard of care model presented almost twice the proportion of early term births, most of them associated with antepartum cesarean sections. It is estimated that, in Brazil, about 35% of live births are early term 31 , corresponding to more than 300 thousand early term births per year, with a higher prevalence in places with cesarean rates above 80% 32 . In a previous nationwide Brazilian study, early term births, especially non-spontaneous births, were associated with several negative outcomes, such as oxygen use, neonatal ICU admission and neonatal death 31 .…”

Parto e nascimento no Brasil: um cenário em processo de mudança

“…The finding was highly relevant, since these children were shown to be at increased risk of negative outcomes such as oxygen use, neonatal ICU admissions, hypoglycemia, respiratory problems, jaundice, and delays in breastfeeding, especially in neonates born by prelabour cesarean sections 6 . The Federal Board of Medicine issued a crucial resolution (Resolution CFM n. 2,144/2016) according to which cesareans in normal-risk pregnancies can only be performed at 39 weeks' gestational age or greater 7 , in line with the decision made by the American College of Obstetrics and Gynecology (ACOG) in 2013 8 .…”