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"A growing body of research suggests that health outcomes are worse for infants born before 40 weeks gestation, compared to full-term births," said
The study appears in the July issue of Medical Care, published by the
Unlike previous studies based in specific institutions and healthcare systems, the current analysis was a population-based study, covering all 7.3 million uncomplicated term births during 15 calendar years, 1995 to 2009, in three large states:
Over the full period, the early-term nonindicated birth rate was 3.18 percent (232,139 deliveries out of 7,293,363 total uncomplicated births). The rate peaked in 2006, in which 4 percent of uncomplicated births to term infants occurred before 39 weeks' gestation without medical indication. By 2009, the risk of non-indicated birth before 39 weeks was 3.74 percent, 86 percent higher than in 1995, the start of the study period.
"Our study team found that nonindicated early births had adverse consequences for newborns and families," said Lorch. Early-term, nonindicated cesarean sections more than doubled the chance that a baby would have respiratory distress or need ventilation. Early-term nonindicated cesareans and early-term induced labor both lengthened the infant's hospital stay.
Further analysis revealed other patterns in the data. Mothers were more likely to experience early-term nonindicated births if they were older, had higher education levels, private health insurance, and if they delivered at a smaller-volume or a nonteaching hospital. Non-Hispanic black women were more likely to undergo nonindicated cesarean birth than non-Hispanic white women, but less likely to experience nonindicated labor induction.
Despite recommendations by professional organizations such as the
"While prior research has shown that early elective delivery policies can be highly effective within particular healthcare systems, there is a need to address this issue at the population level," said Kozhimannil. "It is our hope that this study will add fuel to the ongoing efforts to educate pregnant women and influence clinical and policy environments to facilitate healthy, full-term deliveries whenever possible."
Funds from the
Kozhimannil et al "Trends in Childbirth Before 39 Weeks' Gestation Without Medical Indication," Medical Care,
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