Standard methods based on last menstrual period dates misclassify and overestimate US preterm births

Ambrose, Christopher S.; Caspard, Hervé; Rizzo, Christopher; Stepka, Erin C.; Keenan, Gregory F.

doi:10.1038/jp.2015.25

Cited by 16 publications

(9 citation statements)

References 15 publications

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“…The finding of the present study that LMP-based gestational age overestimated PTB when compared to ultrasonography-based gestational age corroborates population data in the USA [8,13]. Until recently, the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC) in the USA-based national estimates of PTB on LMP dating, the sole determinant of gestational age at delivery on birth certificates in many states.…”

Section: Discussionsupporting

confidence: 88%

“…In a report that explained the rationale for this shift, the CDC demonstrated that the PTB rate in 2013 was 11.39% based on LMP alone, compared to 9.62% based on the best obstetric estimate [13]. Another study using data from the USA reported a similar difference in PTB rates based on LMP alone compared to obstetric estimate in 2012 [8]. The authors also demonstrated that two objective indicators of clinical prematurity—NICU admission and low birth weight —correlated more closely with the obstetric estimates of gestational age at delivery than with LMP dating [8].…”

Section: Discussionmentioning

confidence: 99%

“…Basing gestational age estimates on LMP alone can misclassify births owing to imperfect maternal recall, irregular menses, misinterpretation of vaginal bleeding in early pregnancy as a menstrual cycle, and individual variation in menstrual cycle length [7]. Whereas studies in resource-rich settings have suggested that using LMP alone to determine gestational age overestimates PTB rates [8], data from sub-Saharan Africa are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia

Price

Winston

Vwalika

et al. 2018

Intl J Gynecology & Obste

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Objective: To quantify differences in assessing preterm delivery when calculating gestational age from last menstrual period (LMP) versus ultrasonography biometry. Methods: The Zambian Preterm Birth Prevention Study is an ongoing prospective cohort study that commenced enrolment in August 2015 at Women and Newborn Hospital of University Teaching Hospital in Lusaka, Zambia. Women at less than 20 weeks of pregnancy who were enrolled between August 17, 2015, and August 31, 2017, and underwent ultrasonography examination were included in the present analysis. The primary outcome was the difference between ultrasonography- and LMP-based estimated gestational age. Associations between baseline predictors and outcomes were assessed using simple regression. The proportion of preterm deliveries using LMP- and ultrasonography-derived gestational dating was calculated using Kaplan–Meier analysis. Results: The analysis included 942 women. The discrepancy between estimating gestational age using ultrasonography and LMP increased with greater gestational age at presentation and among patients with no history of preterm delivery. In a Kaplan–Meier analysis of 692 deliveries, 140 (20.2%, 95% confidence interval [CI] 17.7–23.0) and 79 (11.4%, 95% CI 9.6–13.6) deliveries were classified as preterm by LMP and ultrasonography estimates, respectively. Conclusion: Taking ultrasonography as a standard, a bias was observed in LMP-based gestational age estimates; these increased with advancing gestation at presentation. This resulted in misclassification of term deliveries as preterm.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia

Price

Winston

Vwalika

et al. 2018

Intl J Gynecology & Obste

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“…Based on Centers for Disease Control natality statistics regarding the incidence of preterm births and published estimates of the prevalence of hemodynamically significant congenital heart disease among children 12–23 months of age, these aforementioned populations cumulatively represent approximately 0.77% of US children <24 months of age (Table 1 ). 2 – 5 …”

Section: To the Editorsmentioning

confidence: 99%

Statistical Power to Detect an Association Between Guideline-based Palivizumab Administration and Hospitalizations for Respiratory Syncytial Virus Infections

Ambrose¹

2017

Pediatric Infectious Disease Journal

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“… 1 There are limitations in the COID's use of NVSN data to describe a small subset of the population, such as preterm infants <35 or <32 wGA who only comprise 4% and 1.6% of all births, respectively. 3 Because palivizumab reduces RSV hospitalization in preterm infants, 4,5 it is also necessary to understand the proportion of infants receiving palivizumab when assessing RSV hospitalization rates in these infants.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of recent New Vaccine Surveillance Network data regarding respiratory syncytial virus hospitalization rates in US preterm infants

DeVincenzo

Ambrose

Makari

et al. 2016

Human Vaccines & Immunotherapeutics

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In July 2014, the Committee on Infectious Diseases (COID) updated their guidance on the use of palivizumab, recommending against use in preterm infants 29 to 35 weeks' gestational age (wGA). A primary data source cited to support this significant change was the low respiratory syncytial virus (RSV) hospitalization rate observed in the subpopulation of preterm (<37 wGA) infants evaluated from 2000 to 2005 through the New Vaccine Surveillance Network (NVSN). Here we critically appraise the preterm infant data from the NVSN in the context of data regarding the use of palivizumab in this same time period. Data from the NVSN, an analysis of Florida Medicaid data, and a national survey of US in-hospital palivizumab administration demonstrated that during 2001 to 2007, palivizumab was administered to 59% to 83% of preterm infants born at <32 wGA and 21% to 27% of all preterm infants (<37 wGA). When the NVSN data regarding incidence of RSV hospitalization in preterm infant subgroups were evaluated as a function of chronologic age, preterm infants <32 wGA showed a paradoxical increase in RSV hospitalization with older age, with the highest risk of RSV hospitalization occurring at 18 to 23 months of age. This pattern is most consistent with a reduction in RSV hospitalizations in <32 wGA infants in the first 12 to 18 months of life due to high palivizumab use at these young ages. The NVSN data were not designed to and cannot accurately describe RSV disease burden in preterm infants given the small size of the analyzed subpopulation and the high use of palivizumab during the study period.

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Standard methods based on last menstrual period dates misclassify and overestimate US preterm births

Abstract: Obstetric estimates provide the most clinically relevant estimates of US preterm births. Assessments calculated from LMP alone may overestimate prematurity incidence by ~20%.

Cited by 16 publications

References 15 publications

Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia

Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia

Statistical Power to Detect an Association Between Guideline-based Palivizumab Administration and Hospitalizations for Respiratory Syncytial Virus Infections

Evaluation of recent New Vaccine Surveillance Network data regarding respiratory syncytial virus hospitalization rates in US preterm infants

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