A Proactive Approach to Neonates Born at 23 Weeks of Gestation

Backes, Carl H.; Rivera, Brian K.; Haque, Urbee; Srouji, Lara; Beck, Stacy; Yin, Hui; Smith, Charles V.; Iams, Jay D.; Nelin, Leif D.

doi:10.1097/aog.0000000000001098

Cited by 16 publications

(5 citation statements)

References 24 publications

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“…As our definitions for periviability and viability are evolving, delivery in this time frame involves complex decision making for patients and providers [10,11]. The inherent morbidity and mortality to the periviable neonate are apparent [12,13]; however, the implications to maternal reproductive health, particularly related to classical cesarean delivery (CD), are important considerations and require thoughtful deliberation. Even if a classical CD can be avoided, a recent study has shown that periviable low transverse CDs are associated with an increased risk of uterine rupture in subsequent pregnancies compared to low transverse CD performed at term (1.8% versus 0.4%; OR 4.7, 95% CI 1.7–13.4, p = .004) [14].…”

Section: Discussionmentioning

confidence: 99%

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Shree

Caughey

Chandrasekaran

2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Objectives Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy. Methods A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤ 6 months. IPI >6 months was categorized into two groups: IPI 7–23 months and IPI ≥ 24 months. PPROM was defined as premature rupture of membranes between 160 and 366 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤240, 241–280, 281–320, 321–340, and 341–366 weeks). Results 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70–1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 281 and 320 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m2, BMI ≥30 kg/m2, use of social services, tobacco use, and a prior PTB. Conclusion Our data demonstrate that an IPI of ≤6 months is significantly associated with an increased risk of developing PPROM in the subsequent pregnancy. Of greater clinical relevance is that these women were more likely to deliver between 281 and 320 weeks as compared with women with a longer IPI. Novel to this study is the establishment of a specific link between a short IPI and PPROM with subsequent early delivery. Several maternal demographic factors known to be associated with PTB risk were also found to be associated with an increased risk of PPROM. Further studies are necessary to elucidate plausible biologic mechanisms ultimately leading to the development and implementation of preventive and therapeutic strategies for this high-risk cohort.

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Section: Discussionmentioning

confidence: 99%

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Shree

Caughey

Chandrasekaran

2017

The Journal of Maternal-Fetal & Neonatal Medicine

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“…11 Care practices aimed at reducing morbidity and mortality of extremely preterm neonates have demonstrated success. 9, 22 Our analysis was an attempt to quantify the relative contributions of prolonging gestation and improving survival when preterm birth occurs. The successes are noteworthy but the work must continue.…”

Section: Commentmentioning

confidence: 99%

Explaining the recent decrease in US infant mortality rate, 2007–2013

Callaghan

MacDorman

Shapiro-Mendoza

et al. 2017

American Journal of Obstetrics and Gynecology

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Background The U.S. infant mortality rate has been steadily decreasing in recent years as has the preterm birth rate; preterm birth is a major factor associated with death during the first year of life. The degree to which changes in gestational age-specific mortality and changes in the distribution of births by gestational age have contributed to the decrease in the infant mortality rate requires clarification. Objectives To better understand the major contributors to the 2007–2013 infant mortality decline for the total population, and for infants born to non-Hispanic black, non-Hispanic white, and Hispanic women. Study Design We identified births and infant deaths from 2007 and 2013 Centers for Disease Control and Prevention National Vital Statistics System’s period linked birth and infant death files. We included all deaths and births for which there was a reported gestational age at birth on the birth certificate of 22 weeks or greater. The decrease in the infant mortality rate was disaggregated such that all of the change could be attributed to improvements in gestational age-specific infant mortality rates and changes in the distribution of gestational age, by week of gestation, using the Kitagawa method. Sensitivity analyses were performed to account for records where obstetric estimate of gestational age was missing and for deaths and births less than 22 weeks gestation. Maternal race and ethnicity information was obtained from the birth certificate. Results The infant mortality rates after exclusions were 5.72 and 4.92 per 1000 live births for 2007 and 2013 respectively with an absolute difference of −0.80 (14% decrease). Infant mortality rates declined by 11% for non-Hispanic whites, by 19% for non-Hispanic blacks, and by 14% for Hispanics during the period. Compared to 2007, the proportion of births in each gestational age category was lower in 2013 with the exception of 39 weeks where there was an increase in the proportion of births from 30.1 percent in 2007 to 37.5 percent in 2013. Gestational age-specific mortality decreased for each gestational age category between 2007 and 2013 except 33 weeks and >42 weeks. About 31 percent of the decrease in the US infant mortality rate from 2007–2013 was due to changes in the gestational age distribution, and 69 percent was due to improvements in gestational age-specific survival. Improvements in the gestational age distribution from 2007–2013 benefitted infants of non-Hispanic white women (48%) the most, followed by infants of non-Hispanic black (31%) and Hispanic (17%) women. Conclusions Infant mortality improved between 2007 and 2013 as a result of both improvements in the distribution of gestational age at birth and improvements in survival after birth. The differential contribution of improvements in the gestational age distribution at birth by race and ethnicity suggests that preconception and antenatal health and health care aimed at preventing or delaying preterm birth may not be reaching all populations.

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“…Worldwide, survival among infants born very preterm varies by available resources for obstetric and neonatal care, and perceptions of viability. 15–17 Preterm survival at the earliest gestational ages has improved dramatically in developed countries, where the limit of viability has extended to 22 to 23 weeks gestation; yet survival at these gestational ages in developing countries is rare. 15 Improvements in the survival of very preterm infants in developed countries are the result of a variety of factors including improved insurance coverage during pregnancy; advanced obstetric and antenatal care; and improved systems of risk-appropriate care, including resuscitation and stabilization of high-risk newborns.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Public Health Implications of Very Preterm Birth

Barfield

2018

Clinics in Perinatology

173

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With advanced perinatal care and technology, survival among infants born very preterm (<32 weeks gestation) has improved dramatically over the last several decades. However, adverse medical and neurodevelopmental outcomes for those born very preterm remains high, particularly at the lowest gestational ages. Public health plays a critical role in providing data to assess population-based risks associated with very preterm birth, addressing disparities, and identifying opportunities for prevention, including improving the health of reproductive-age women, before, during, and after pregnancy.

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A Proactive Approach to Neonates Born at 23 Weeks of Gestation

Abstract: II.

Cited by 16 publications

References 24 publications

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Explaining the recent decrease in US infant mortality rate, 2007–2013

Public Health Implications of Very Preterm Birth

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