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BJOG. 2012 Oct;119(11):1309-15. doi: 10.1111/j.1471-0528.2012.03453.x. Epub 2012 Aug 13.

The rise in singleton preterm births in the USA: the impact of labour induction.

Author information

1
Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, Canada.

Abstract

OBJECTIVE:

To assess the extent to which increased rates of labour induction and caesarean section have contributed to the recent rise in preterm birth.

DESIGN:

National birth cohort study.

SETTING:

USA.

POPULATION AND SAMPLE:

Singleton live births, with primary analysis based on non-Hispanic white women.

METHODS:

Ecological study based on the 50 states and the District of Columbia during two time periods 10 years apart: 1992-94 and 2002-04.

MAIN OUTCOME MEASURE:

Preterm birth (live birth <37 completed weeks of gestation), based on an algorithm combining menstrual and clinical estimates of gestational age.

RESULTS:

The state-level ecological analysis among non-Hispanic white women showed that the change in preterm birth rate from 1992-94 to 2002-04 was significantly associated with the change in rate of labour induction (r = 0.50, 95% CI 0.26-0.68), but not with the change in rate of caesarean delivery (r = -0.06, 95% CI -0.33 to 0.22). Weaker but otherwise similar associations with labour induction were observed in Hispanic women and in non-Hispanic black women.

CONCLUSIONS:

Increasing use of labour induction is probably an important cause of the observed increased rate in preterm birth.

[Indexed for MEDLINE]
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