Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study

ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-ini...

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Bibliographic Details
Published in:BMJ open 2019, Vol.9 (1), p.e023004
Main Authors: Richter, Lindsay L, Ting, Joseph, Muraca, Giulia M, Synnes, Anne, Lim, Kenneth I, Lisonkova, Sarka
Format: Article
Language:English
Subjects:
Adult
Body mass index
Delivery, Obstetric - mortality
Epidemiology
Female
Fetal Membranes, Premature Rupture - mortality
Gestational Age
Health risk assessment
Humans
Infant
Infant mortality
Infant Mortality - trends
Infant, Newborn
Logistic Models
Male
Morbidity
Newborn babies
Population-based studies
Pregnancy
Premature babies
Premature birth
Premature Birth - mortality
Retrospective Studies
Time Factors
Washington - epidemiology
Womens health
Young Adult
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Summary:ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2018-023004