PDF herunterladen
Am J Perinatol 2021; 38(S 01): e269-e283
DOI: 10.1055/s-0040-1709673
Original Article

Adverse Outcomes among Low-Risk Pregnancies at 39 to 41 Weeks: Stratified by Birth Weight Percentile

Hector Mendez-Figueroa
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Han Yang Chen
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Suneet P. Chauhan
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective This study aimed to assess the risk of adverse outcomes among low-risk pregnancies at 39 to 41 weeks, stratified by birth weight percentile.

Study Design This retrospective cohort study utilized the U.S. vital statistics datasets (2013–2017) and evaluated low-risk women with nonanomalous cephalic singleton gestations who labored and delivered at 39 to 41 weeks, regardless of ultimate mode of delivery. Newborns were categorized as small (<10th percentile), large (>90th percentile), or appropriate (10–90th percentile) for gestational ages (SGA, LGA, and AGA, respectively). The primary outcome, composite neonatal adverse outcome (CNAO), included Apgar's score <5 at 5 minutes, assisted ventilation >6 hours, seizure, or neonatal death. The secondary outcome, composite maternal adverse outcome (CMAO), included intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson's regression was used to estimate the association (using adjusted relative risk [aRR] and 95% confidence interval [CI]).

Results Of 19.8 million live births during the study interval, approximately 8.9 million (44.9%) met the inclusion criteria, with 9.9% being SGA, 9.2% being LGA, and 80.9% being AGA. SGA newborns delivered at 40 (aRR = 1.17; 95% CI: 1.12–1.23) and at 41 weeks (aRR = 1.55; 95% CI: 1.45–1.66) had a higher risk of CNAO than at 39 weeks. Similarly, LGA newborns delivered at 40 (aRR = 1.13; 95% CI: 1.07–1.19) and 41 weeks (aRR = 1.44; 95% CI: 1.35–1.54) and AGA newborns delivered at 40 (aRR = 1.24; 95% CI: 1.21–1.26) and 41 weeks (aRR = 1.57; 95% CI: 1.53–1.61) also had a higher risk of CNAO than at 39 weeks. CMAO was also significantly higher at 40 and 41 weeks than at 39 weeks, regardless of whether the mothers delivered SGA, LGA, or AGA newborns.

Conclusion Among low-risk pregnancies, the risks of composite neonatal and maternal adverse outcomes increase from 39 through 41 weeks' gestation, irrespective of whether newborns are SGA, LGA, or AGA.

Keywords

neonatal outcomes - low-risk pregnancy - term - birth weight

Note

The abstract of this manuscript was presented at the Central Association of Obstetricians and Gynecologists at Cancun, Mexico, October 16–19, 2019.




Publikationsverlauf

Eingereicht: 28. November 2019

Angenommen: 07. März 2020

Artikel online veröffentlicht:
27. April 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
    Google Scholar
  • 2 ACOG Committee Opinion No. ACOG Committee Opinion No. 764: medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2019; 133 (02) e151-e155
    CrossrefPubMedGoogle Scholar
  • 3 Caughey AB, Washington AE, Laros Jr RK. Neonatal complications of term pregnancy: rates by gestational age increase in a continuous, not threshold, fashion. Am J Obstet Gynecol 2005; 192 (01) 185-190
    CrossrefPubMedGoogle Scholar
  • 4 Cheng YW, Nicholson JM, Nakagawa S, Bruckner TA, Washington AE, Caughey AB. Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation?. Am J Obstet Gynecol 2008; 199 (04) 370.e1-370.e7
    CrossrefPubMedGoogle Scholar
  • 5 Tita AT, Lai Y, Bloom SL. et al. Timing of delivery and pregnancy outcomes among laboring nulliparous women. Am J Obstet Gynecol 2012; 206 (03) 239.e1-239.e8
    CrossrefPubMedGoogle Scholar
  • 6 Ananth CV, Friedman AM, Goldenberg RL, Wright JD, Vintzileos AM. Association between temporal changes in neonatal mortality and spontaneous and clinician-initiated deliveries in the United States, 2006-2013. JAMA Pediatr 2018; 172 (10) 949-957
    CrossrefPubMedGoogle Scholar
  • 7 Chen HY, Grobman WA, Blackwell SC, Chauhan SP. Neonatal and maternal morbidity among low-risk nulliparous women at 39-41 weeks of gestation. Obstet Gynecol 2019; 133 (04) 729-737
    CrossrefPubMedGoogle Scholar
  • 8 Chen HY, Grobman WA, Blackwell SC, Chauhan SP. Neonatal and maternal adverse outcomes among low-risk parous women at 39-41 weeks of gestation. Obstet Gynecol 2019; 134 (02) 288-294
    CrossrefPubMedGoogle Scholar
  • 9 Miller NR, Cypher RL, Foglia LM, Pates JA, Nielsen PE. Elective induction of labor compared with expectant management of nulliparous women at 39 weeks of gestation: a randomized controlled trial. Obstet Gynecol 2015; 126 (06) 1258-1264
    CrossrefPubMedGoogle Scholar
  • 10 Walker KF, Bugg GJ, Macpherson M. et al; 35/39 Trial Group. Randomized trial of labor induction in women 35 years of age or older. N Engl J Med 2016; 374 (09) 813-822
    CrossrefPubMedGoogle Scholar
  • 11 Grobman WA, Rice MM, Reddy UM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
    CrossrefPubMedGoogle Scholar
  • 12 Mattioli KP, Sanderson M, Chauhan SP. Inadequate identification of small-for-gestational-age fetuses at an urban teaching hospital. Int J Gynaecol Obstet 2010; 109 (02) 140-143
    CrossrefPubMedGoogle Scholar
  • 13 Chauhan SP, Beydoun H, Chang E. et al. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinatol 2014; 31 (03) 187-194
    PubMedGoogle Scholar
  • 14 Heywood RE, Magann EF, Rich DL, Chauhan SP. The detection of macrosomia at a teaching hospital. Am J Perinatol 2009; 26 (02) 165-168
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Sparks TN, Cheng YW, McLaughlin B, Esakoff TF, Caughey AB. Fundal height: a useful screening tool for fetal growth?. J Matern Fetal Neonatal Med 2011; 24 (05) 708-712
    CrossrefPubMedGoogle Scholar
  • 16 Carter EB, Stockburger J, Tuuli MG, Macones GA, Odibo AO, Trudell AS. Large for gestational age and stillbirth: is there a role for antenatal testing?. Ultrasound Obstet Gynecol 2019; 54 (03) 334-337
    CrossrefPubMedGoogle Scholar
  • 17 Ashimi Balogun O, Sibai BM, Pedroza C, Blackwell SC, Barrett TL, Chauhan SP. Serial third-trimester ultrasonography compared with routine care in uncomplicated pregnancies: a randomized controlled trial. Obstet Gynecol 2018; 132 (06) 1358-1367
    CrossrefPubMedGoogle Scholar
  • 18 Mendez-Figueroa H, Chauhan SP, Barrett T, Truong VTT, Pedroza C, Blackwell SC. Population versus customized growth curves: prediction of composite neonatal morbidity. Am J Perinatol 2019; 36 (08) 818-827
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Chauhan SP, Rice MM, Grobman WA. et al; MSCE, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Neonatal morbidity of small- and large-for-gestational-age neonates born at term in uncomplicated pregnancies. Obstet Gynecol 2017; 130 (03) 511-519
    CrossrefPubMedGoogle Scholar
  • 20 Mendez-Figueroa H, Truong VT, Pedroza C, Khan AM, Chauhan SP. Small-for-gestational-age infants among uncomplicated pregnancies at term: a secondary analysis of 9 maternal-fetal medicine units network studies. Am J Obstet Gynecol 2016; 215 (05) 628.e1-628.e7
    CrossrefPubMedGoogle Scholar
  • 21 Mendez-Figueroa H, Truong VTT, Pedroza C, Chauhan SP. Large for gestational age infants and adverse outcomes among uncomplicated pregnancies at term. Am J Perinatol 2017; 34 (07) 655-662
    PubMedGoogle Scholar
  • 22 Martin JA, Menacker F. Expanded health data from the new birth certificate, 2004. Natl Vital Stat Rep 2007; 55 (12) 1-22
    PubMedGoogle Scholar
  • 23 Osterman MJ, Martin JA, Mathews TJ, Hamilton BE. Expanded data from the new birth certificate, 2008. Natl Vital Stat Rep 2011; 59 (07) 1-28
    PubMedGoogle Scholar
  • 24 Martin JA, Osterman MJ, Kirmeyer SE, Gregory EC. Measuring gestational age in vital statistics data: transitioning to the obstetric estimate. Natl Vital Stat Rep 2015; 64 (05) 1-20
    Google Scholar
  • 25 Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstet Gynecol 2014; 124 (01) 16-22
    CrossrefPubMedGoogle Scholar
  • 26 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014; 12 (12) 1495-1499
    CrossrefPubMedGoogle Scholar
  • 27 Grobman WA, Caughey AB. Elective induction of labor at 39 weeks compared with expectant management: a meta-analysis of cohort studies. Am J Obstet Gynecol 2019; 221 (04) 304-310
    CrossrefPubMedGoogle Scholar
  • 28 Saccone G, Della Corte L, Maruotti GM. et al. Induction of labor at full-term in pregnant women with uncomplicated singleton pregnancy: a systematic review and meta-analysis of randomized trials. Acta Obstet Gynecol Scand 2019; 98 (08) 958-966
    CrossrefPubMedGoogle Scholar
  • 29 Souter V, Painter I, Sitcov K, Caughey AB. Maternal and newborn outcomes with elective induction of labor at term. Am J Obstet Gynecol 2019; 220 (03) 273.e1-273.e11
    CrossrefPubMedGoogle Scholar
  • 30 Darney BG, Snowden JM, Cheng YW. et al. Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol 2013; 122 (04) 761-769
    CrossrefPubMedGoogle Scholar
  • 31 Gibbs Pickens CM, Kramer MR, Howards PP, Badell ML, Caughey AB, Hogue CJ. Term elective induction of labor and pregnancy outcomes among obese women and their offspring. Obstet Gynecol 2018; 131 (01) 12-22
    CrossrefPubMedGoogle Scholar
  • 32 Kaimal AJ, Little SE, Odibo AO. et al. Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Am J Obstet Gynecol 2011; 204 (02) 137.e1-137.e9
    CrossrefPubMedGoogle Scholar
  • 33 Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Caughey AB. Risk of stillbirth and infant death stratified by gestational age. Obstet Gynecol 2012; 120 (01) 76-82
    CrossrefPubMedGoogle Scholar
  • 34 Page JM, Snowden JM, Cheng YW, Doss AE, Rosenstein MG, Caughey AB. The risk of stillbirth and infant death by each additional week of expectant management stratified by maternal age. Am J Obstet Gynecol 2013; 209 (04) 375.e1-375.e7
    CrossrefPubMedGoogle Scholar
  • 35 Bailit JL, Lappen JR. Stillbirth and the 39-week rule: can we be reassured?. Obstet Gynecol 2015; 126 (06) 1131-1132
    CrossrefPubMedGoogle Scholar
  • 36 Muglu J, Rather H, Arroyo-Manzano D. et al. Risks of stillbirth and neonatal death with advancing gestation at term: a systematic review and meta-analysis of cohort studies of 15 million pregnancies. PLoS Med 2019; 16 (07) e1002838
    CrossrefPubMedGoogle Scholar
  • 37 Khan K. ; Chief Editors of Journals participating in The CROWN Initiative (Appendix 1). The CROWN Initiative: journal editors invite researchers to develop core outcomes in women's health. BJOG 2016; 123 (Suppl. 03) 103-104
    CrossrefPubMedGoogle Scholar
  • 38 Egan AM, Galjaard S, Maresh MJA. et al. A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes. Diabetologia 2017; 60 (07) 1190-1196
    CrossrefPubMedGoogle Scholar
  • 39 van 't Hooft J, Alfirevic Z, Asztalos EV. et al. CROWN initiative and preterm birth prevention: researchers and editors commit to implement core outcome sets. BJOG 2018; 125 (01) 8-11
    CrossrefPubMedGoogle Scholar
  • 40 Aliyu MH, Jolly PE, Ehiri JE, Salihu HM. High parity and adverse birth outcomes: exploring the maze. Birth 2005; 32 (01) 45-59
    CrossrefPubMedGoogle Scholar
  • 41 Axt R, Meyberg R, Mink D, Wasemann C, Reitnauer K, Schmidt W. Immunohistochemical detection of apoptosis in the human term and post-term placenta. Clin Exp Obstet Gynecol 1999; 26 (02) 56-59
    PubMedGoogle Scholar
  • 42 Daher S, Guimarães AJ, Mattar R, Ishigai MM, Barreiro EG, Bevilacqua E. Bcl-2 and Bax expressions in pre-term, term and post-term placentas. Am J Reprod Immunol 2008; 60 (02) 172-178
    CrossrefPubMedGoogle Scholar
  • 43 Sultana Z, Maiti K, Dedman L, Smith R. Is there a role for placental senescence in the genesis of obstetric complications and fetal growth restriction?. Am J Obstet Gynecol 2018; 218 (2S): S762-S773
    CrossrefPubMedGoogle Scholar
  • 44 Stormdal Bring H, Hulthén Varli IA, Kublickas M, Papadogiannakis N, Pettersson K. Causes of stillbirth at different gestational ages in singleton pregnancies. Acta Obstet Gynecol Scand 2014; 93 (01) 86-92
    CrossrefPubMedGoogle Scholar
  • 45 Owen J, Albert PS, Buck Louis GM. et al. A contemporary amniotic fluid volume chart for the United States: The NICHD Fetal Growth Studies-Singletons. Am J Obstet Gynecol 2019; 221 (01) 67.e1-67.e12
    CrossrefPubMedGoogle Scholar
  • 46 Magann EF, Sanderson M, Martin JN, Chauhan S. The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy. Am J Obstet Gynecol 2000; 182 (06) 1581-1588
    CrossrefPubMedGoogle Scholar
  • 47 Ladella SJ, Desai M, Cho Y, Ross MG. Maternal plasma hypertonicity is accentuated in the postterm rat. Am J Obstet Gynecol 2003; 189 (05) 1439-1444
    CrossrefPubMedGoogle Scholar
  • 48 Martin JA, Wilson EC, Osterman MJ, Saadi EW, Sutton SR, Hamilton BE. Assessing the quality of medical and health data from the 2003 birth certificate revision: results from two states. Natl Vital Stat Rep 2013; 62 (02) 1-19
    Google Scholar
  • 49 Spitzer WO. Bias versus causality: interpreting recent evidence of oral contraceptive studies. Am J Obstet Gynecol 1998; 179 (3, Pt 2): S43-S50
    CrossrefPubMedGoogle Scholar
  • 50 Gibson KS, Waters TP, Bailit JL. Maternal and neonatal outcomes in electively induced low-risk term pregnancies. Am J Obstet Gynecol 2014; 211 (03) 249.e1-249.e16
    CrossrefPubMedGoogle Scholar
  • 51 Froehlich RJ, Sandoval G, Bailit JL. et al; MSCE, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Association of recorded estimated fetal weight and cesarean delivery in attempted vaginal delivery at term. Obstet Gynecol 2016; 128 (03) 487-494
    CrossrefPubMedGoogle Scholar
  • 52 Blackwell SC, Refuerzo J, Chadha R, Carreno CA. Overestimation of fetal weight by ultrasound: does it influence the likelihood of cesarean delivery for labor arrest?. Am J Obstet Gynecol 2009; 200 (03) 340.e1-340.e3
    CrossrefPubMedGoogle Scholar
  • 53 Parry S, Severs CP, Sehdev HM, Macones GA, White LM, Morgan MA. Ultrasonographic prediction of fetal macrosomia. Association with cesarean delivery. J Reprod Med 2000; 45 (01) 17-22
    PubMedGoogle Scholar