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Nearly 1 in 25 U.S. Babies Are Born Too Soon

Large study analyzes C-sections, induced births done without medical indication, adding to risks for infants

A study covering millions of U.S. births over 15 years finds that nearly one in 25 babies is born earlier than medically justified, through elective cesarean sections and elective induced labor. The study reinforces long-standing recommendations by professional medical and public health organizations against early-term deliveries without appropriate medical reasons.

“A growing body of research suggests that health outcomes are worse for infants born before 40 weeks gestation, compared to full-term births,” said Scott A. Lorch, MD, MSCE, a neonatologist at The Children’s Hospital of Philadelphia (CHOP). “Unfortunately, many of these earlier births are ‘nonindicated,’ meaning there is not a medical rationale to deliver the baby early.”

The study appears in the July issue of Medical Care, published by the American Public Health Association. Lorch collaborated with lead author Katy B. Kozhimannil, PhD, MPA, of the University of Minnesota School of Public Health. “Our study showed that early elective deliveries are making up between 3 and 4% of U.S. births each year,” said Kozhimannil. “This may seem to be a small number, but with 4 million births a year in the U.S., each percentage point represents 40,000 babies.”

The population-based study covered all 7.3 million uncomplicated term births during calendar years 1995 to 2009 in California, Missouri, and Pennsylvania. The retrospective study used hospital discharge data linked to state birth certificate records, and included mothers and infants from diverse socioeconomic backgrounds. In addition to representing distinct geographic regions, said Lorch, the three states account for approximately 20% of all U.S. births. The 15-year span allowed researchers to discern trends over time.

Over the full period, the early-term nonindicated birth rate was 3.18% (232,139 deliveries out of 7,293,363 uncomplicated births). The rate peaked in 2006, when 4% of uncomplicated births to term infants occurred before 39 weeks’ gestation without medical indication. By 2009, the risk of nonindicated birth before 39 weeks was 3.74%, 86% higher than in 1995, the start of the study period.

“Our study team found that nonindicated early births had adverse consequences for newborns and families,” said Lorch. Early-term, nonindicated cesarean sections more than doubled the chance that a baby would have respiratory distress or need ventilation. Early-term nonindicated cesareans and early-term induced labor both lengthened the infant’s hospital stay.

Mothers were more likely to experience early-term nonindicated births if they were older, had higher education levels, had private health insurance, and delivered at a smaller-volume or a nonteaching hospital. Non-Hispanic black women were more likely to undergo nonindicated cesarean birth than non-Hispanic white women, but less likely to experience nonindicated labor induction.

Source: The Children’s Hospital of Philadelphia; June 23, 2014.

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