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Perinatal Outcomes and Hospital Costs in Gastroschisis Based on Gestational Age at Delivery

Cain, Mary Ashley MD; Salemi, Jason L. PhD; Paul Tanner, Jean MPH; Mogos, Mulubrhan F. PhD; Kirby, Russell S. PhD, MS; Whiteman, Valerie E. MD; Salihu, Hamisu M. MD, PhD

doi: 10.1097/AOG.0000000000000427
Contents: Original Research

OBJECTIVE: To investigate the association between gestational age at delivery and perinatal outcomes among gastroschisis-affected pregnancies that result in live birth.

METHODS: We conducted a retrospective cohort study using a linked maternal–infant database for more than 2.3 million liveborn neonates in Florida from 1998 to 2009. Cases were identified using a combination of International Classification of Diseases, 9th Edition, Clinical Modification, diagnosis and procedure codes indicative of gastroschisis. We restricted our analyses to singleton cases without another major birth defect or medical conditions that would justify early elective delivery. We categorized cases based on gestational age in weeks and compared perinatal outcomes.

RESULTS: Among 1,005 neonates with gastroschisis, 324 (32.3%) were isolated, singleton cases without an additional indication for early delivery. We observed decreased rates of adverse pregnancy outcomes among those neonates delivered in the early term period (37–38 weeks of gestation) compared with preterm (less than 34 weeks of gestation); specifically, jaundice (18.5% compared with 42.3%, P=.01) and respiratory distress syndrome (5.9% compared with 23.1%, P≤.01). As the gestational age at birth increased, we observed fewer mean number of days spent in the hospital (less than 34 weeks of gestation: 55.9, P<.01; 34–36 weeks of gestation: 51.9, P=.02; 37–38 weeks of gestation: 36.9 [reference]) and lower direct inpatient medical costs (in thousands, U.S. dollars; less than 34 weeks of gestation: 79, P=.01; 34–36 weeks of gestation: 71, P=.04; 37–38 weeks of gestation: 51 [reference]) per infant in the first year of life.

CONCLUSION: In pregnancies complicated by gastroschisis, and with no other known major indications, birth at early term or later term gestation, when compared with delivery before 37 weeks of gestation, is associated with improved perinatal outcomes and lower medical costs.

LEVEL OF EVIDENCE: II

In gastroschisis-affected pregnancies with no other medical indications, when compared with delivery before 37 weeks of gestation, early term and later term deliveries are associated with improved perinatal outcomes and lower medical costs.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, the Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, and the Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida.

Corresponding author: Mary Ashley Cain, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, USF Health South Tampa Center, 2 Tampa General Circle #6031, Tampa, FL 33606; e-mail: mcain@health.usf.edu.

Supported by grant number R01HS019997 from the Agency for Healthcare Research and Quality, which permitted the creation of the study database.

The authors thank the staff of the Florida Department of Health and the Agency for Health Care Administration for providing access to the hospital discharge and vital statistics data used in this project.

Presented at the 34th annual meeting of Society of Maternal-Fetal Medicine, February 3–8, 2014, New Orleans, Louisiana.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.