Early Elective Delivery Associated with Adverse Outcomes

Researchers at the University of Minnesota (Minneapolis, USA) and Children's Hospital of Philadelphia (Philadelphia, USA) conducted a retrospective analysis using linked hospital discharge and birth certificate data for 7,296,363 uncomplicated births in California, Missouri, and Pennsylvania between 1995 and 2009.

The researchers measured prevalence, patient characteristics, and infant outcomes associated with early-term non-indicated births. Secondary outcomes included infant prolonged length of stay and respiratory distress.

The researchers found that the early-term non-indicated birth rate was 3.18%, as calculated using diagnosis codes and birth certificate records. The probability of an early elective induction was higher among women 35 years of age or older, white with higher education levels, women who were privately insured, and those who gave birth at rural or nonteaching hospitals. Early elective cesareans were more likely for women less than 20 years old or over 35 years old, who were black, who had higher education levels, and who gave birth at smaller-volume hospitals.

The study also found that infants born by early elective cesareans were 60% more likely to stay longer in the hospital, and more than twice as likely to have respiratory distress when compared to infants born on or after 39 weeks, considered full-term. The study was published in the July 2014 issue of Medical Care.

“Our study showed that early elective deliveries made up more than 3% of US births each year over the past 20 years. This may seem to be a small number, but with 4 million births a year in the US, each percentage point represents 40,000 babies,” said lead author Assistant Professor Katy Kozhimannil, PhD, MPA. “In addition, we showed that there are important sociodemographic differences in the chances a pregnant woman has an early elective cesarean or an early elective induction of labor.”

“Contrary to the commonly-held belief that babies born after 37 weeks are considered term, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine say a pregnancy is full term only after 39 weeks,” added Dr. Kozhimannil. “Since our findings show there are differences in who is having an early elective delivery, the importance of a full-term birth needs to be communicated to all women, not just those who may traditionally be considered high risk for elective procedure or high risk for poor outcomes.”

Related Links:
University of Minnesota
Children's Hospital of Philadelphia