Amer J Perinatol
DOI: 10.1055/s-0037-1608787
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial

Alan T. Tita1, Lindsay Doherty2, Jim M. Roberts3, Leslie Myatt4, Kenneth J. Leveno5, Michael W. Varner6, Ronald J. Wapner7, John M. Thorp Jr8, Brian M. Mercer9, Alan Peaceman10, Susan M. Ramin11, Marshall W. Carpenter12, Jay Iams13, Anthony Sciscione14, Margaret Harper15, Jorge E. Tolosa16, George R. Saade17, Yoram Sorokin18, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
  • 1Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
  • 2The Biostatistics Center, The George Washington University, Washington, District of Columbia
  • 3Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
  • 5Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
  • 6Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
  • 7Department of Obstetrics and Gynecology, Columbia University, New York, New York
  • 8Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • 9Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
  • 10Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
  • 11Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
  • 12Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
  • 13Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
  • 14Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
  • 15Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
  • 16Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
  • 17Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
  • 18Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
Further Information

Publication History

13 September 2017

10 October 2017

Publication Date:
30 November 2017 (eFirst)


Objective To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB).

Methods A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity.

Results Of 9,867 women, 10.4% (N = 1,038) were PTBs; 32.7% (n = 340) IPTBs and 67.3% (n = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB—4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4–11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1–3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times).

Conclusion Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.


This study was conducted with the ethics board approval from each of the participating clinical centers and the data coordinating center. This study was presented in part at the 32nd Annual meeting of the Society for Maternal-Fetal Medicine in Dallas, TX, on February 8–11, 2012.

Authors' Contribution

All authors approve of this submission and agree to be accountable for all aspects of the work as related to accuracy and integrity. In addition, authors contributed as follows: A.T.T. contributed to the conception and design analysis and interpretation of data and drafted and revised the manuscript. L.D. contributed to the design, acquisition of data, data analysis, and interpretation and contributed to the drafting and revision of the manuscript; J.M.R. and L.M. contributed to conception and design, analysis, and interpretation and revised the article critically; and all other authors (K.J.L., M.W.V., R.J.W., J.M.T., B.M.M., A.P., S.M.R., M.W.C., J.I., A.S., M.H., J.E.T., G.S., Y.S.) contributed to acquisition of data, analysis, and interpretation and revising the article critically.


The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD34208, HD27869, HD40485, HD40560, HD40544, HD34116, HD40512, HD21410, HD40545, HD40500, HD27915, HD34136, HD27860, HD53118, HD53097, HD27917, and HD36801]; the National Heart, Lung, and Blood Institute; and the National Center for Research Resources [M01 RR00080, UL1 RR024153, UL1 RR024989], and its contents do not necessarily represent the official view of NICHD, NHLBI, NCRR, or NIH.