Changes in obstetrical practices and pregnancy outcomes following the ARRIVE trial

The ARRIVE trial demonstrated the benefit of induction of labor at 39 weeks gestation. Obstetrics departments across the United States faced the challenge of adapting clinical practice in light of these data while managing logistical constraints. To determine if there were changes in obstetrical pra...

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Published in:American journal of obstetrics and gynecology 2022-05, Vol.226 (5), p.716.e1-716.e12
Main Authors: Gilroy, Laura C., Al-Kouatly, Huda B., Minkoff, Howard L., McLaren, Rodney A.
Format: Article
Language:English
Subjects:
39 weeks induction
ARRIVE trial
cesarean delivery rate
Cesarean Section
Female
Humans
induction of labor
Infant, Newborn
Infant, Newborn, Diseases
nulliparous
perinatal outcomes
Pregnancy
Pregnancy Outcome
Retrospective Studies
Seizures
Surface-Active Agents
United States - epidemiology
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creator Gilroy, Laura C.
Al-Kouatly, Huda B.
Minkoff, Howard L.
McLaren, Rodney A.
description The ARRIVE trial demonstrated the benefit of induction of labor at 39 weeks gestation. Obstetrics departments across the United States faced the challenge of adapting clinical practice in light of these data while managing logistical constraints. To determine if there were changes in obstetrical practices and perinatal outcomes in the United States after the ARRIVE trial publication. This was a population-based retrospective cohort study of low-risk, nulliparous women who initiated prenatal care by 12 weeks gestation with singleton, nonanomalous pregnancies delivering at ≥39 weeks. Data were obtained from the US Natality database. The pre-ARRIVE group were women who delivered between January 1, 2015 and December 31, 2017. The post-ARRIVE group consisted of women who delivered between January 1, 2019 and December 31, 2019. Births that occurred in 2018 were excluded. Practice outcomes were rates of induction of labor, timing of delivery, and cesarean delivery rate. Adverse maternal outcomes were blood transfusion and admission to medical intensive care unit. Adverse neonatal outcomes were need for assisted ventilation (immediate and >6 hours), 5-minute APGAR score
doi_str_mv 10.1016/j.ajog.2022.02.003
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Obstetrics departments across the United States faced the challenge of adapting clinical practice in light of these data while managing logistical constraints. To determine if there were changes in obstetrical practices and perinatal outcomes in the United States after the ARRIVE trial publication. This was a population-based retrospective cohort study of low-risk, nulliparous women who initiated prenatal care by 12 weeks gestation with singleton, nonanomalous pregnancies delivering at ≥39 weeks. Data were obtained from the US Natality database. The pre-ARRIVE group were women who delivered between January 1, 2015 and December 31, 2017. The post-ARRIVE group consisted of women who delivered between January 1, 2019 and December 31, 2019. Births that occurred in 2018 were excluded. Practice outcomes were rates of induction of labor, timing of delivery, and cesarean delivery rate. Adverse maternal outcomes were blood transfusion and admission to medical intensive care unit. Adverse neonatal outcomes were need for assisted ventilation (immediate and &gt;6 hours), 5-minute APGAR score &lt;3, neonatal intensive care unit admission, seizures, and surfactant use. Univariate and multivariate analyses were performed. Trends were tested across the time period represented by the pre-ARRIVE group using Cochran–Armitage trend test. There were 1,966,870 births in the pre-ARRIVE group and 609,322 in the post-ARRIVE group. The groups differed in age, race, body mass index, marital status, infertility treatment, and smoking history (P&lt;.001). After adjusting for these differences, the post-ARRIVE group was more likely to undergo induction (36.1% vs 30.2%; adjusted odds ratio, 1.36 [1.36–1.37]) and deliver by 39+6 weeks of pregnancy (42.8% vs 39.9%; adjusted odds ratio, 1.14 [1.14–1.15]). The post-ARRIVE group had a significantly lower rate of cesarean delivery than the pre-ARRIVE group (27.3 % vs 27.9%; adjusted odds ratio, 0.94 [0.93–0.94]). Patients in the post-ARRIVE group were more likely to receive a blood transfusion (0.4% vs 0.3%; adjusted odds ratio, 1.43 [1.36–1.50]) and be admitted to medical intensive care unit (0.09% vs 0.08%; adjusted odds ratio, 1.20 [1.09–1.33]). Neonates in the post-ARRIVE group were more likely to need assisted ventilation at birth (3.5% vs 2.8%; adjusted odds ratio, 1.28 [1.26–1.30]) and &gt;6 hours (0.6% vs 0.5%; adjusted odds ratio, 1.36 [1.31–1.41]). The neonates in the post-ARRIVE group were more likely to have low 5-minute APGAR scores (0.4% vs 0.3%; adjusted odds ratio, 0.91 [0.86–0.95]). Neonatal intensive care unit admission did not differ between the 2 groups (4.9% vs 4.9%; adjusted odds ratio, 1.01 [0.99–1.03]). There were no differences in neonatal seizures (0.04% vs 0.04%; adjusted odds ratio, 0.97 [0.84–1.13]), and surfactant use (0.08% vs 0.07%; adjusted odds ratio, 1.05 [0.94–1.17]) between the 2 groups. There were more inductions of labor, more deliveries at 39 weeks’ gestation, and fewer cesarean deliveries in the year after the ARRIVE trial publication. The small but statistically significant increase in some adverse maternal and neonatal outcomes should be explored to determine if they are related with concurrent changes in obstetrical practices.</description><identifier>ISSN: 0002-9378</identifier><identifier>ISSN: 1097-6868</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2022.02.003</identifier><identifier>PMID: 35139334</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>39 weeks induction ; ARRIVE trial ; cesarean delivery rate ; Cesarean Section ; Female ; Humans ; induction of labor ; Infant, Newborn ; Infant, Newborn, Diseases ; nulliparous ; perinatal outcomes ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Seizures ; Surface-Active Agents ; United States - epidemiology</subject><ispartof>American journal of obstetrics and gynecology, 2022-05, Vol.226 (5), p.716.e1-716.e12</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. 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Obstetrics departments across the United States faced the challenge of adapting clinical practice in light of these data while managing logistical constraints. To determine if there were changes in obstetrical practices and perinatal outcomes in the United States after the ARRIVE trial publication. This was a population-based retrospective cohort study of low-risk, nulliparous women who initiated prenatal care by 12 weeks gestation with singleton, nonanomalous pregnancies delivering at ≥39 weeks. Data were obtained from the US Natality database. The pre-ARRIVE group were women who delivered between January 1, 2015 and December 31, 2017. The post-ARRIVE group consisted of women who delivered between January 1, 2019 and December 31, 2019. Births that occurred in 2018 were excluded. Practice outcomes were rates of induction of labor, timing of delivery, and cesarean delivery rate. Adverse maternal outcomes were blood transfusion and admission to medical intensive care unit. Adverse neonatal outcomes were need for assisted ventilation (immediate and &gt;6 hours), 5-minute APGAR score &lt;3, neonatal intensive care unit admission, seizures, and surfactant use. Univariate and multivariate analyses were performed. Trends were tested across the time period represented by the pre-ARRIVE group using Cochran–Armitage trend test. There were 1,966,870 births in the pre-ARRIVE group and 609,322 in the post-ARRIVE group. The groups differed in age, race, body mass index, marital status, infertility treatment, and smoking history (P&lt;.001). After adjusting for these differences, the post-ARRIVE group was more likely to undergo induction (36.1% vs 30.2%; adjusted odds ratio, 1.36 [1.36–1.37]) and deliver by 39+6 weeks of pregnancy (42.8% vs 39.9%; adjusted odds ratio, 1.14 [1.14–1.15]). The post-ARRIVE group had a significantly lower rate of cesarean delivery than the pre-ARRIVE group (27.3 % vs 27.9%; adjusted odds ratio, 0.94 [0.93–0.94]). Patients in the post-ARRIVE group were more likely to receive a blood transfusion (0.4% vs 0.3%; adjusted odds ratio, 1.43 [1.36–1.50]) and be admitted to medical intensive care unit (0.09% vs 0.08%; adjusted odds ratio, 1.20 [1.09–1.33]). Neonates in the post-ARRIVE group were more likely to need assisted ventilation at birth (3.5% vs 2.8%; adjusted odds ratio, 1.28 [1.26–1.30]) and &gt;6 hours (0.6% vs 0.5%; adjusted odds ratio, 1.36 [1.31–1.41]). The neonates in the post-ARRIVE group were more likely to have low 5-minute APGAR scores (0.4% vs 0.3%; adjusted odds ratio, 0.91 [0.86–0.95]). Neonatal intensive care unit admission did not differ between the 2 groups (4.9% vs 4.9%; adjusted odds ratio, 1.01 [0.99–1.03]). There were no differences in neonatal seizures (0.04% vs 0.04%; adjusted odds ratio, 0.97 [0.84–1.13]), and surfactant use (0.08% vs 0.07%; adjusted odds ratio, 1.05 [0.94–1.17]) between the 2 groups. There were more inductions of labor, more deliveries at 39 weeks’ gestation, and fewer cesarean deliveries in the year after the ARRIVE trial publication. The small but statistically significant increase in some adverse maternal and neonatal outcomes should be explored to determine if they are related with concurrent changes in obstetrical practices.</description><subject>39 weeks induction</subject><subject>ARRIVE trial</subject><subject>cesarean delivery rate</subject><subject>Cesarean Section</subject><subject>Female</subject><subject>Humans</subject><subject>induction of labor</subject><subject>Infant, Newborn</subject><subject>Infant, Newborn, Diseases</subject><subject>nulliparous</subject><subject>perinatal outcomes</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Retrospective Studies</subject><subject>Seizures</subject><subject>Surface-Active Agents</subject><subject>United States - epidemiology</subject><issn>0002-9378</issn><issn>1097-6868</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9UE1LAzEQDaLYWv0DHmSPXrbmYzebBS-lVC0UhKJeQzaZbVO2m5rsKv33prR6FB4MM_PeY-YhdEvwmGDCHzZjtXGrMcWUjnEEZmdoSHBZpFxwcY6GGGOalqwQA3QVwubQ0pJeogHLCSsZy4ZoOV2rdgUhsW3iqtBB561WTbLzSndWx4VqTexg1apW7xPXd9pt47h2TeO-bbtKujUkk-Vy_jFLolg11-iiVk2Am1Mdofen2dv0JV28Ps-nk0WqWc67tCoVqVhBS8jiJYIWJssZ1xwqQo1SJsdM07rOBMlzIzAXpKpVXJbKEMgFZyN0f_TdeffZQ-jk1gYNTaNacH2QlNMiE5jhIlLpkaq9C8FDLXfebpXfS4LlIUu5kYcs5SFLiSMwi6K7k39fbcH8SX7Di4THIwHil18WvAzaQqvBWA-6k8bZ__x_AGTVhQQ</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Gilroy, Laura C.</creator><creator>Al-Kouatly, Huda B.</creator><creator>Minkoff, Howard L.</creator><creator>McLaren, Rodney A.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2771-2991</orcidid></search><sort><creationdate>202205</creationdate><title>Changes in obstetrical practices and pregnancy outcomes following the ARRIVE trial</title><author>Gilroy, Laura C. ; Al-Kouatly, Huda B. ; Minkoff, Howard L. ; McLaren, Rodney A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-b9a1b3729e4334827d4536c6eb12daad503c2ff48155d80681bfaeb19ad1e5863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>39 weeks induction</topic><topic>ARRIVE trial</topic><topic>cesarean delivery rate</topic><topic>Cesarean Section</topic><topic>Female</topic><topic>Humans</topic><topic>induction of labor</topic><topic>Infant, Newborn</topic><topic>Infant, Newborn, Diseases</topic><topic>nulliparous</topic><topic>perinatal outcomes</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Retrospective Studies</topic><topic>Seizures</topic><topic>Surface-Active Agents</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gilroy, Laura C.</creatorcontrib><creatorcontrib>Al-Kouatly, Huda B.</creatorcontrib><creatorcontrib>Minkoff, Howard L.</creatorcontrib><creatorcontrib>McLaren, Rodney A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gilroy, Laura C.</au><au>Al-Kouatly, Huda B.</au><au>Minkoff, Howard L.</au><au>McLaren, Rodney A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in obstetrical practices and pregnancy outcomes following the ARRIVE trial</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2022-05</date><risdate>2022</risdate><volume>226</volume><issue>5</issue><spage>716.e1</spage><epage>716.e12</epage><pages>716.e1-716.e12</pages><issn>0002-9378</issn><issn>1097-6868</issn><eissn>1097-6868</eissn><abstract>The ARRIVE trial demonstrated the benefit of induction of labor at 39 weeks gestation. Obstetrics departments across the United States faced the challenge of adapting clinical practice in light of these data while managing logistical constraints. To determine if there were changes in obstetrical practices and perinatal outcomes in the United States after the ARRIVE trial publication. This was a population-based retrospective cohort study of low-risk, nulliparous women who initiated prenatal care by 12 weeks gestation with singleton, nonanomalous pregnancies delivering at ≥39 weeks. Data were obtained from the US Natality database. The pre-ARRIVE group were women who delivered between January 1, 2015 and December 31, 2017. The post-ARRIVE group consisted of women who delivered between January 1, 2019 and December 31, 2019. Births that occurred in 2018 were excluded. Practice outcomes were rates of induction of labor, timing of delivery, and cesarean delivery rate. Adverse maternal outcomes were blood transfusion and admission to medical intensive care unit. Adverse neonatal outcomes were need for assisted ventilation (immediate and &gt;6 hours), 5-minute APGAR score &lt;3, neonatal intensive care unit admission, seizures, and surfactant use. Univariate and multivariate analyses were performed. Trends were tested across the time period represented by the pre-ARRIVE group using Cochran–Armitage trend test. There were 1,966,870 births in the pre-ARRIVE group and 609,322 in the post-ARRIVE group. The groups differed in age, race, body mass index, marital status, infertility treatment, and smoking history (P&lt;.001). After adjusting for these differences, the post-ARRIVE group was more likely to undergo induction (36.1% vs 30.2%; adjusted odds ratio, 1.36 [1.36–1.37]) and deliver by 39+6 weeks of pregnancy (42.8% vs 39.9%; adjusted odds ratio, 1.14 [1.14–1.15]). The post-ARRIVE group had a significantly lower rate of cesarean delivery than the pre-ARRIVE group (27.3 % vs 27.9%; adjusted odds ratio, 0.94 [0.93–0.94]). Patients in the post-ARRIVE group were more likely to receive a blood transfusion (0.4% vs 0.3%; adjusted odds ratio, 1.43 [1.36–1.50]) and be admitted to medical intensive care unit (0.09% vs 0.08%; adjusted odds ratio, 1.20 [1.09–1.33]). Neonates in the post-ARRIVE group were more likely to need assisted ventilation at birth (3.5% vs 2.8%; adjusted odds ratio, 1.28 [1.26–1.30]) and &gt;6 hours (0.6% vs 0.5%; adjusted odds ratio, 1.36 [1.31–1.41]). The neonates in the post-ARRIVE group were more likely to have low 5-minute APGAR scores (0.4% vs 0.3%; adjusted odds ratio, 0.91 [0.86–0.95]). Neonatal intensive care unit admission did not differ between the 2 groups (4.9% vs 4.9%; adjusted odds ratio, 1.01 [0.99–1.03]). There were no differences in neonatal seizures (0.04% vs 0.04%; adjusted odds ratio, 0.97 [0.84–1.13]), and surfactant use (0.08% vs 0.07%; adjusted odds ratio, 1.05 [0.94–1.17]) between the 2 groups. There were more inductions of labor, more deliveries at 39 weeks’ gestation, and fewer cesarean deliveries in the year after the ARRIVE trial publication. The small but statistically significant increase in some adverse maternal and neonatal outcomes should be explored to determine if they are related with concurrent changes in obstetrical practices.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35139334</pmid><doi>10.1016/j.ajog.2022.02.003</doi><orcidid>https://orcid.org/0000-0003-2771-2991</orcidid></addata></record>
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source ScienceDirect Freedom Collection 2022-2024
subjects 39 weeks induction
ARRIVE trial
cesarean delivery rate
Cesarean Section
Female
Humans
induction of labor
Infant, Newborn
Infant, Newborn, Diseases
nulliparous
perinatal outcomes
Pregnancy
Pregnancy Outcome
Retrospective Studies
Seizures
Surface-Active Agents
United States - epidemiology
title Changes in obstetrical practices and pregnancy outcomes following the ARRIVE trial
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