Term Pregnancy

Reddy, Uma M.; Bettegowda, Vani R.; Dias, Todd; Yamada-Kushnir, Tomoko; Ko, Chia‐Wen; Willinger, Marian

doi:10.1097/aog.0b013e3182179e28

Cited by 160 publications

(61 citation statements)

References 12 publications

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“…In particular, non-Hispanic black women have elevated risks of both stillbirth and infant death, with rates of both more than double that seen in non-Hispanic whites (1-3). Hispanic and Asian women have rates of stillbirth similar to non-Hispanic white women with lower rates of infant death (2-5). Although complications of preterm delivery do play a large role in some of these disparities, 29% of all stillbirths after 24 weeks and 63% of infant deaths occur in term pregnancies, with similar rates of disparities seen.…”

Section: Introductionmentioning

confidence: 99%

“…Although complications of preterm delivery do play a large role in some of these disparities, 29% of all stillbirths after 24 weeks and 63% of infant deaths occur in term pregnancies, with similar rates of disparities seen. (2, 4, 5)…”

Section: Introductionmentioning

confidence: 99%

“…For example, infant death related to prematurity is less likely to occur if the pregnancy is prolonged, but the risks of placental insufficiency or cord accident increase as the gestation increases and disappear once delivery is achieved. Early delivery decreases the risk of stillbirth but neonatal complications are higher in babies born before 39 weeks, leading to efforts to decrease elective early term deliveries (5-10). Recently, an American College of Obstetricians and Gynecologists (ACOG) Committee Opinion restated that women should not be delivered without medical indication prior to 39 weeks’ gestation.…”

Section: Introductionmentioning

confidence: 99%

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The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity

Rosenstein

Snowden

Cheng

et al. 2014

American Journal of Obstetrics and Gynecology

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Objective To compare the mortality risk of expectant management with the risk of delivery at each week of term pregnancy in four racial/ethnic groups. Study Design Retrospective cohort study of all non-anomalous, term deliveries in California from 1997-2006 among white, black, Hispanic, and Asian women. In each racial/ethnic group, we compared the risk of infant death at each week with a composite risk representing the mortality risk of one week of expectant management. Results The risk of stillbirth and infant death is highest in black women (stillbirth risk: 18.0/10,000, infant death: 24.4/10,000, compared with 9.4/10,000 and 10.8/10,000 in white women, respectively; p<0.001). Although absolute risks differ by race/ethnicity, the composite risk of expectant management does not surpass the risk of delivery until 39 weeks in any group. At 39 weeks these absolute risk differences are low, however, with a number needed to deliver to prevent one death ranging from 751 (among black women) to 2587 (among Asian women). Conclusion The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in all racial/ethnic groups, despite variation in absolute risks.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity

Rosenstein

Snowden

Cheng

et al. 2014

American Journal of Obstetrics and Gynecology

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“…Historically, term infants born at 37 to 42 weeks have been considered a uniform group 31. However, more recently, early‐term infant vulnerability has been documented and several studies in infants without CCHD have shown that early‐term infants born at 37 to 38 weeks have a higher incidence of respiratory distress, developmental morbidities, and even infant mortality 32, 33. In infants with CCHD, 2 studies have shown increased mortality, neonatal morbidities, and postoperative complications in early‐term versus full‐term infants 7, 8.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fetal Growth on 1‐Year Mortality in Neonates With Critical Congenital Heart Disease

Steurer

Baer

Burke

et al. 2018

JAHA

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BackgroundInfants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1‐year mortality separately in preterm (GA <37 weeks), early‐term (GA 37–38 weeks), and full‐term (GA 39–42 weeks) infants with CCHD.Methods and ResultsLive‐born infants with CCHD and GA 22 to 42 weeks born in California 2007–2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1‐year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals (CIs). The authors identified 6903 infants with CCHD. For preterm and full‐term infants, only a Z score for birth weight <−2 was associated with increased mortality compared with the reference group (Z score 0–0.5, adjusted odds ratio, 2.15 [95% CI, 1.1–4.21] and adjusted odds ratio, 3.93 [95% CI, 2.32–6.68], respectively). In contrast, in early‐term infants, the adjusted odds ratios for Z scores <−2, −2 to −1, and −1 to −0.5 were 3.42 (95% CI, 1.93–6.04), 1.78 (95% CI, 1.12–2.83), and 2.03 (95% CI, 1.27–3.23), respectively, versus the reference group.Conclusions GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD. In preterm and full‐term infants, only the most severe small‐for‐GA infants (Z score <−2) were at increased risk for mortality, while, in early‐term infants, the risk extended to mild to moderate small‐for‐GA infants (Z score <−0.5). This information helps to identify high‐risk infants and is useful for surgical planning.

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“…We lacked the power to assess this issue and other data suggest that neonatal, postneonatal and infant mortality may be increased with early term compared with full-term delivery. 10 …”

Section: Commentmentioning

confidence: 99%

Neonatal outcomes of elective early-term births after demonstrated fetal lung maturity

Tita

Jablonski

Bailit

et al. 2018

American Journal of Obstetrics and Gynecology

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Background: Studies of early term birth after demonstrated fetal lung maturity show that respiratory and other outcomes are worse with early term birth (370–386) even after demonstrated fetal lung maturity when compared with full term birth (390–406). However these studies included medically indicated births and are therefore potentially limited by confounding by the indication for delivery. Thus the increase in adverse outcomes might be due to the indication for early term birth rather than the early term birth itself. Objective: We examined the prevalence and risks of adverse neonatal outcomes associated with early-term birth after confirmed fetal lung maturity as compared with full term birth in the absence of indications for early delivery. Study Design: Secondary analysis of an observational study of births to 115,502 women in 25 hospitals in the United States from 2008–11. Singleton non-anomalous births at 37–40 weeks with no identifiable indication for delivery were included; early term births after positive fetal lung maturity testing were compared with full-term births. The primary outcome was a composite of death, ventilator for ≥2 days, CPAP, proven sepsis, pneumonia or meningitis, treated hypoglycemia, hyperbilirubinemia (phototherapy) and 5 min Apgar <7. Logistic regression and propensity score matching (both 1:1 and 1:2) were used. Results: 48,137 births met inclusion criteria; the prevalence of fetal lung maturity testing in the absence of medical or obstetric indications for early delivery was 0.52% (n=249). There were 180 (0.37%) early-term births after confirmed pulmonary maturity and 47,957 full-term births. Women in the former group were more likely to be non-Hispanic White, smoke, have received antenatal steroids, have induction and have a cesarean. Risks of the composite (16.1% vs. 5.4%; adjusted odds ratio 3.2; 95% CI 2.1–4.8 from logistic regression) were more frequent with elective early term birth. Propensity scores matching confirmed the increased primary composite in elective early-term births: adjusted odds ratios 4.3 (1.8–10.5) for 1:1 and 3.5 (1.8–6.5) for 1:2 matching. Among components of the primary outcome, CPAP use and hyperbilirubinemia requiring phototherapy were significantly increased. Transient tachypnea of the newborn, neonatal intensive care unit admission and prolonged neonatal intensive care unit stay (>2 days) were also increased with early term birth. Conclusions: Even with confirmed pulmonary maturity, early term birth in the absence of medical or obstetric indications is associated with worse neonatal respiratory and hepatic outcomes compared with full-term birth, suggesting relative immaturity of these organ systems in early term births.

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Term Pregnancy

Cited by 160 publications

References 12 publications

The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity

The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity

Effect of Fetal Growth on 1‐Year Mortality in Neonates With Critical Congenital Heart Disease

Neonatal outcomes of elective early-term births after demonstrated fetal lung maturity

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