Trends in childbirth before 39 weeks' gestation without medical indication.

Abstract

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. To measure prevalence, change over time, patient characteristics, and infant outcomes associated with early-term nonindicated births. 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. Early-term nonindicated birth is calculated using diagnosis codes and birth certificate records. Secondary outcomes included infant prolonged length of stay and respiratory distress. 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). 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.