Amer J Perinatol 2018; 35(07): 624-631
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. Tita
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lindsay Doherty
The Biostatistics Center, The George Washington University, Washington, District of Columbia
,
Jim M. Roberts
Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Leslie Myatt
Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
,
Kenneth J. Leveno
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Michael W. Varner
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Ronald J. Wapner
Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
John M. Thorp Jr
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Brian M. Mercer
Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
,
Alan Peaceman
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Susan M. Ramin
Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
,
Marshall W. Carpenter
Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Jay Iams
Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Anthony Sciscione
Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
,
Margaret Harper
Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
,
Jorge E. Tolosa
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
George R. Saade
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network› Author Affiliations
Funding 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.
Further Information

Publication History

13 September 2017

10 October 2017

Publication Date:
30 November 2017 (eFirst)

Abstract

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.

Note

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.