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Medical Care:
doi: 10.1097/MLR.0000000000000153
Original Articles

Trends in Childbirth Before 39 Weeks’ Gestation Without Medical Indication

Kozhimannil, Katy B. PhD, MPA*; Macheras, Michelle MA; Lorch, Scott A. MD, MSCE

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Abstract

Background:

There is increasing attention to labor induction and cesarean delivery occurring at 37 0/7–38 6/7 weeks’ gestation (early-term) without medical indication.

Objective:

To measure prevalence, change over time, patient characteristics, and infant outcomes associated with early-term nonindicated births.

Research Design and Subjects:

Retrospective analysis using linked hospital discharge and birth certificate data for the 7,296,363 uncomplicated births (>37 0/7 wk’ gestation) between 1995 and 2009 in 3 states.

Measures:

Early-term nonindicated birth is calculated using diagnosis codes and birth certificate records. Secondary outcomes included infant prolonged length of stay and respiratory distress.

Results:

Across uncomplicated term births, the early-term nonindicated birth rate was 3.18%. After adjustment, the risk of nonindicated birth before 39 0/7 weeks was 86% higher in 2009 than in 1995 [hazard ratio (HR)=1.86; 95% confidence interval (CI), 1.81–1.90], peaking in 2006 (HR=2.03; P<0.001). Factors independently associated with higher odds included maternal age, higher education levels, private health insurance, and delivering at smaller-volume or nonteaching hospitals. Black women had higher risk of nonindicated cesarean birth (HR=1.29; 95% CI, 1.27–1.32), which was associated with greater odds of prolonged length of stay [adjusted odds ratio (AOR)=1.60; 95% CI, 1.57–1.64] and infant respiratory distress (AOR=2.44; 95% CI, 2.37–2.50) compared with births after 38 6/7 weeks. Early-term nonindicated induction was also associated with comparatively greater odds of prolonged length of stay (AOR=1.20; 95% CI, 1.17–1.23).

Conclusions:

Nearly 4% of all uncomplicated births to term infants occurred before 39 0/7 weeks’ gestation without medical indication. These births were associated with adverse infant outcomes.

Copyright © 2014 by Lippincott Williams & Wilkins

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