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; Lindsay Doherty; Jim M. Roberts; Leslie Myatt; Kenneth J. Leveno; Michael W. Varner; Ronald J. Wapner; John M. Thorp Jr; Brian M. Mercer; Alan Peaceman; Susan M. Ramin; Marshall W. Carpenter; Jay Iams; Anthony Sciscione; Margaret Harper; Jorge E. Tolosa; George R. Saade; Yoram Sorokin; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

doi:10.1055/s-0037-1608787

American Journal of Perinatology, Table of Contents

Am 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

Authors

Alan T. Tita

¹Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
Lindsay Doherty

²The Biostatistics Center, The George Washington University, Washington, District of Columbia
Jim M. Roberts

³Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
Leslie Myatt

⁴Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
Kenneth J. Leveno

⁵Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
Michael W. Varner

⁶Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
Ronald J. Wapner

⁷Department of Obstetrics and Gynecology, Columbia University, New York, New York
John M. Thorp Jr

⁸Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Brian M. Mercer

⁹Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
Alan Peaceman

¹⁰Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
Susan M. Ramin

¹¹Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
Marshall W. Carpenter

¹²Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
Jay Iams

¹³Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
Anthony Sciscione

¹⁴Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
Margaret Harper

¹⁵Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
Jorge E. Tolosa

¹⁶Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
George R. Saade

¹⁷Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
Yoram Sorokin

¹⁸Department 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

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.

Keywords

spontaneous preterm birth - indicated preterm birth - preeclampsia - pregnancy outcomes

Full Text

References

References
1 American College of Obstetricians and Gynecologists; Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 127: management of preterm labor. Obstet Gynecol 2012; 119 (06) 1308-1317
2 Institute of Medicine. Preterm Birth: Causes, Consequences, and Prevention. Washington, D.C.: National Academies Collection; 2007
3 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
4 Martin JA, Hamilton BE, Ventura SJ. , et al. Births: final data for 2009. Natl Vital Stat Rep 2011; 60 (01) 1-70
5 Roberts JM, Myatt L, Spong CY. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med 2010; 362 (14) 1282-1291
6 Carey JC, Klebanoff MA, Hauth JC. , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342 (08) 534-540
7 Lee J, Seong HS, Kim BJ, Jun JK, Romero R, Yoon BH. Evidence to support that spontaneous preterm labor is adaptive in nature: neonatal RDS is more common in “indicated” than in “spontaneous” preterm birth. J Perinat Med 2009; 37 (01) 53-58
8 Chen A, Feresu SA, Barsoom MJ. Heterogeneity of preterm birth subtypes in relation to neonatal death. Obstet Gynecol 2009; 114 (03) 516-522
9 Moutquin JM. Classification and heterogeneity of preterm birth. BJOG 2003; 110 (Suppl. 20) 30-33
10 Kimberlin DF, Hauth JC, Owen J. , et al. Indicated versus spontaneous preterm delivery: an evaluation of neonatal morbidity among infants weighing </=1000 grams at birth. Am J Obstet Gynecol 1999; 180 (3 Pt 1): 683-689
11 Jelin AC, Kaimal AJ, Kuzniewicz M, Little SE, Cheng YW, Caughey AB. Preterm preeclampsia: 32 to 37 weeks gestation. J Matern Fetal Neonatal Med 2012; 25 (11) 2198-2201
12 Jelin AC, Cheng YW, Shaffer BL, Kaimal AJ, Little SE, Caughey AB. Early-onset preeclampsia and neonatal outcomes. J Matern Fetal Neonatal Med 2010; 23 (05) 389-392
13 Norman JE, Morris C, Chalmers J. The effect of changing patterns of obstetric care in Scotland (1980-2004) on rates of preterm birth and its neonatal consequences: perinatal database study. PLoS Med 2009; 6 (09) e1000153
14 Schaaf JM, Mol BW, Abu-Hanna A, Ravelli AC. Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007. BJOG 2011; 118 (10) 1196-1204
15 Ananth CV, Vintzileos AM. Epidemiology of preterm birth and its clinical subtypes. J Matern Fetal Neonatal Med 2006; 19 (12) 773-782
16 Barros FC, Vélez MP. Temporal trends of preterm birth subtypes and neonatal outcomes. Obstet Gynecol 2006; 107 (05) 1035-1041
17 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1): 323-333