X Zhang1, M S Kramer. 1. Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, Canada.
Abstract
OBJECTIVE: To assess the extent to which increased rates of labour induction and caesarean section have contributed to the recent rise in preterm birth. DESIGN: National birth cohort study. SETTING: USA. POPULATION AND SAMPLE: Singleton live births, with primary analysis based on non-Hispanic white women. METHODS: Ecological study based on the 50 states and the District of Columbia during two time periods 10 years apart: 1992-94 and 2002-04. MAIN OUTCOME MEASURE: Preterm birth (live birth <37 completed weeks of gestation), based on an algorithm combining menstrual and clinical estimates of gestational age. RESULTS: The state-level ecological analysis among non-Hispanic white women showed that the change in preterm birth rate from 1992-94 to 2002-04 was significantly associated with the change in rate of labour induction (r = 0.50, 95% CI 0.26-0.68), but not with the change in rate of caesarean delivery (r = -0.06, 95% CI -0.33 to 0.22). Weaker but otherwise similar associations with labour induction were observed in Hispanic women and in non-Hispanic black women. CONCLUSIONS: Increasing use of labour induction is probably an important cause of the observed increased rate in preterm birth.
OBJECTIVE: To assess the extent to which increased rates of labour induction and caesarean section have contributed to the recent rise in preterm birth. DESIGN: National birth cohort study. SETTING: USA. POPULATION AND SAMPLE: Singleton live births, with primary analysis based on non-Hispanic white women. METHODS: Ecological study based on the 50 states and the District of Columbia during two time periods 10 years apart: 1992-94 and 2002-04. MAIN OUTCOME MEASURE: Preterm birth (live birth <37 completed weeks of gestation), based on an algorithm combining menstrual and clinical estimates of gestational age. RESULTS: The state-level ecological analysis among non-Hispanic white women showed that the change in preterm birth rate from 1992-94 to 2002-04 was significantly associated with the change in rate of labour induction (r = 0.50, 95% CI 0.26-0.68), but not with the change in rate of caesarean delivery (r = -0.06, 95% CI -0.33 to 0.22). Weaker but otherwise similar associations with labour induction were observed in Hispanic women and in non-Hispanic black women. CONCLUSIONS: Increasing use of labour induction is probably an important cause of the observed increased rate in preterm birth.
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