727: Neonatal morbidity and mortality associated with induction of labor at 39 weeks versus expectant management

Abstract

To investigate the neonatal morbidity and mortality associated with induction of labor at 39 weeks gestation versus expectant management through 42 weeks gestation. This retrospective national cohort study was performed using data abstracted from the Center for Disease Control and Prevention National Center for Health Statistics from the Division of Vital Statistics. The study included singleton non-anomalous pregnancies that were delivered between 39 and 42 weeks of gestation from January 1st 2015 to December 31st 2017. Neonatal data was collected through 28 days of life. Neonatal morbidity examined included 5 min Apgar score ≤3, prolonged ventilation use, seizures, neonatal intensive care unit stay, and neonatal death. Multivariable log-binomial regression analysis was conducted to estimate the relative risk of neonatal complications associated with 39 weeks induction of labor compared with expectant management until 42 weeks, adjusting for possible confounding factors. This study included a total of 1,986,040 women, with 499,920 women in the 39 week induction of labor group. Neonates were statistically less likely to have 5 min Apgar ≤3 (p-value < 0.001; aRR: 0.69; 95% CI [0.65=4-0.73]), prolonged ventilation (p-value < 0.001; aRR: 0.73; 95% CI [0.69-0.77]), and NICU admission (p-value < 0.001; aRR: 0.79; 95% CI [0.78-0.81]) in the induction group when compared to the expectant management group. There were no differences in neonatal seizure or neonatal death between the two groups. Induction of labor at 39 weeks gestation is associated with a decreased risk of neonatal morbidity as compared to expectant management beyond 39 weeks.