Kate L Bassil1, Abdool S Yasseen2, Mark Walker2, Michael D Sgro3, Prakesh S Shah4, Graeme N Smith5, Douglas M Campbell6, Muhammad Mamdani7, Ann E Sprague8, Shoo K Lee4, Jonathon L Maguire9. 1. Maternal-Infant Care Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. 2. BORN Ontario (Better Outcomes Registry & Network), Ottawa, ON, Canada; Department of Obstetrics and Gynecology, Ottawa Hospital Research Institute, and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 4. Maternal-Infant Care Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 5. Department of Obstetrics and Gynecology, Faculty of Medicine, Queen's University, Kingston, ON, Canada. 6. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada. 7. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 8. BORN Ontario (Better Outcomes Registry & Network), Ottawa, ON, Canada. 9. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: jonathon.maguire@utoronto.ca.
Abstract
OBJECTIVE: There is concern that obstetric interventions (prelabor cesarean section and induced delivery) are drivers of late preterm (LP) birth. Our objective was to evaluate the independent association between obstetric interventions and LP birth and explore associated independent maternal and fetal risk factors for LP birth. STUDY DESIGN: In this population-based cross-sectional study, the BORN Information System was used to identify all infants born between 34 and 40 completed weeks of gestation between 2005 and 2012 in Ontario, Canada. The association between obstetric interventions (preterm cesarean section and induced delivery) and LP birth (34 to 36 completed weeks' gestation vs 37 to 40 completed weeks' gestation) was assessed using generalized estimating equation regression. RESULTS: Of 917,013 births between 34 and 40 weeks, 49,157 were LP (5.4%). In the adjusted analysis, "any obstetric intervention" (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.57-0.74), induction (RR, 0.71; 95% CI, 0.61-0.82) and prelabor cesarean section (RR, 0.66; 95% CI, 0.59-0.74) were all associated with a lower likelihood of LP vs term birth. Several independent potentially modifiable risk factors for LP birth were identified including previous cesarean section (RR, 1.28; 95% CI, 1.16-1.40), smoking during pregnancy (RR, 1.28; 95% CI, 1.21-1.36) and high material (RR, 1.1; 95% CI, 1.03-1.18) and social (RR, 1.09; 95% CI, 1.02-1.16) deprivation indices. CONCLUSION: After accounting for differences in maternal and fetal risk, LP births had a 35% lower likelihood of obstetric interventions than term births. Obstetric care providers may be preferentially avoiding induction and prelabor cesarean section between 34 and 37 weeks' gestation.
OBJECTIVE: There is concern that obstetric interventions (prelabor cesarean section and induced delivery) are drivers of late preterm (LP) birth. Our objective was to evaluate the independent association between obstetric interventions and LP birth and explore associated independent maternal and fetal risk factors for LP birth. STUDY DESIGN: In this population-based cross-sectional study, the BORN Information System was used to identify all infants born between 34 and 40 completed weeks of gestation between 2005 and 2012 in Ontario, Canada. The association between obstetric interventions (preterm cesarean section and induced delivery) and LP birth (34 to 36 completed weeks' gestation vs 37 to 40 completed weeks' gestation) was assessed using generalized estimating equation regression. RESULTS: Of 917,013 births between 34 and 40 weeks, 49,157 were LP (5.4%). In the adjusted analysis, "any obstetric intervention" (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.57-0.74), induction (RR, 0.71; 95% CI, 0.61-0.82) and prelabor cesarean section (RR, 0.66; 95% CI, 0.59-0.74) were all associated with a lower likelihood of LP vs term birth. Several independent potentially modifiable risk factors for LP birth were identified including previous cesarean section (RR, 1.28; 95% CI, 1.16-1.40), smoking during pregnancy (RR, 1.28; 95% CI, 1.21-1.36) and high material (RR, 1.1; 95% CI, 1.03-1.18) and social (RR, 1.09; 95% CI, 1.02-1.16) deprivation indices. CONCLUSION: After accounting for differences in maternal and fetal risk, LP births had a 35% lower likelihood of obstetric interventions than term births. Obstetric care providers may be preferentially avoiding induction and prelabor cesarean section between 34 and 37 weeks' gestation.
Authors: Yulika Yoshida-Montezuma; Branavan Sivapathasundaram; Hilary K Brown; Charles Keown-Stoneman; Russell J de Souza; Teresa To; Cornelia M Borkhoff; Catherine S Birken; Jonathon L Maguire; Laura N Anderson Journal: JAMA Netw Open Date: 2022-05-02
Authors: Yulika Yoshida-Montezuma; Erica Stone; Saman Iftikhar; Vanessa De Rubeis; Alessandra T Andreacchi; Charles Keown-Stoneman; Lawrence Mbuagbaw; Hilary K Brown; Russell J de Souza; Laura N Anderson Journal: Paediatr Perinat Epidemiol Date: 2021-11-22 Impact factor: 3.103
Authors: Malia S Q Murphy; Deshayne B Fell; Ann E Sprague; Daniel J Corsi; Shelley Dougan; Sandra I Dunn; Vivian Holmberg; Tianhua Huang; Moya Johnson; Michael Kotuba; Lise Bisnaire; Pranesh Chakraborty; Susan Richardson; Mari Teitelbaum; Mark C Walker Journal: Int J Epidemiol Date: 2021-11-10 Impact factor: 7.196