Fetal, neonatal and infant death and their relationship to best gestational age for delivery at term: is 39 weeks best for everyone?

Abstract

Recent recommendations have stated that ‘non-medically indicated delivery before 39 weeks gestation should be avoided.’ The current work examines much of the published national data used as a foundation for those recommendations, which are based on stated improvements to fetal, neonatal and infant mortality as well as neonatal morbidity. In this work, each of these factors is analyzed, with a specific aim to delineate the role of week of gestation along with other possible confounding variables affecting outcome, and to explain several methodological shortcomings that have characterized the research up to now. The analysis suggests that delaying delivery until 39 weeks would increase fetal deaths and have little or no influence on neonatal and infant deaths. Further, confounding factors that effect both neonatal and maternal morbidity have not been adequately examined. Decisions aimed at optimizing perinatal outcomes require simultaneous consideration of multiple, complex, inter-related dynamic factors and would be highly unlikely to be optimized with a simple recommendation such as ‘avoidance of delivery before 39 weeks.’ It is the aim of this work to encourage current stakeholders to recognize the need to re-examine this issue, with an understanding that an individualized approach to decisions regarding the timing of delivery at term is essential. Proper analysis of current and future data will likely point to a different approach that is clearly away from the same recommendation for all.