222: Mode of delivery at periviability and early childhood neurodevelopment

Abstract

Little is known regarding the impact of mode of delivery in the periviable period. Even less is understood regarding the effect of mode of delivery on neurodevelopment. Our objective is to determine if the mode of delivery at time of periviability impacts Bayley II scores at two years of age. This is a secondary analysis of the a randomized, controlled trial of Magnesium sulfate for the prevention of cerebral palsy, a multicenter trial where women at imminent risk for delivery between 24 and 31 weeks were assigned to receive magnesium sulfate or placebo. For this secondary analysis we included non-anomalous singleton gestations delivered between 22 0/7 -25 6/7 weeks. We excluded women with missing exposure or outcome data. The primary exposure of interest was mode of delivery. The primary outcomes were Bayley II scores <70 (mental and motor) at two years of age. Log-binomial regression was used to control for possible confounders including, gestational age at delivery, chorioamnionitis, years of maternal education, maternal BMI and original study treatment group. A total of 158 women met inclusion criteria. Ninety-one had a vaginal delivery and sixty-seven had a cesarean delivery. Exposure to magnesium sulfate, maternal education, chorioamnionitis, years of maternal education, and maternal BMI were similar in both groups. There was no difference in either mental or motor Bayley II scores <70 or <85 by mode of delivery in either univariable or multivariable analysis. There is no difference in Bayley II scores by mode of delivery at time of periviability. This adds to the literature supporting obstetric indications dictating mode of delivery at this gestational age.