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JAMA. 2016 Jul 26;316(4):410-9. doi: 10.1001/jama.2016.9635.

Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-Income Countries in North America and Europe and Association With Clinician-Initiated Obstetric Interventions.

Author information

1
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
2
Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
3
Centre for Chronic Disease Prevention, Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada.
4
Section of Social Medicine, University of Copenhagen, and Methods and Analysis, Statistics, Denmark, Copenhagen, Denmark.
5
Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.
6
Departments of Global Public Health and Primary Care and Clinical Sciences, University of Bergen, Norway7Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
7
Department of Global Public Health and Primary Care, University of Bergen, Norway.
8
Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
9
INSERM UMR 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.
10
Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
11
Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
12
Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Erratum in

Abstract

IMPORTANCE:

Clinicians have been urged to delay the use of obstetric interventions (eg, labor induction, cesarean delivery) until 39 weeks or later in the absence of maternal or fetal indications for intervention.

OBJECTIVE:

To describe recent trends in late preterm and early term birth rates in 6 high-income countries and assess association with use of clinician-initiated obstetric interventions.

DESIGN:

Retrospective analysis of singleton live births from 2006 to the latest available year (ranging from 2010 to 2015) in Canada, Denmark, Finland, Norway, Sweden, and the United States.

EXPOSURES:

Use of clinician-initiated obstetric intervention (either labor induction or prelabor cesarean delivery) during delivery.

MAIN OUTCOMES AND MEASURES:

Annual country-specific late preterm (34-36 weeks) and early term (37-38 weeks) birth rates.

RESULTS:

The study population included 2,415,432 Canadian births in 2006-2014 (4.8% late preterm; 25.3% early term); 305,947 Danish births in 2006-2010 (3.6% late preterm; 18.8% early term); 571,937 Finnish births in 2006-2015 (3.3% late preterm; 16.8% early term); 468,954 Norwegian births in 2006-2013 (3.8% late preterm; 17.2% early term); 737,754 Swedish births in 2006-2012 (3.6% late preterm; 18.7% early term); and 25,788,558 US births in 2006-2014 (6.0% late preterm; 26.9% early term). Late preterm birth rates decreased in Norway (3.9% to 3.5%) and the United States (6.8% to 5.7%). Early term birth rates decreased in Norway (17.6% to 16.8%), Sweden (19.4% to 18.5%), and the United States (30.2% to 24.4%). In the United States, early term birth rates decreased from 33.0% in 2006 to 21.1% in 2014 among births with clinician-initiated obstetric intervention, and from 29.7% in 2006 to 27.1% in 2014 among births without clinician-initiated obstetric intervention. Rates of clinician-initiated obstetric intervention increased among late preterm births in Canada (28.0% to 37.9%), Denmark (22.2% to 25.0%), and Finland (25.1% to 38.5%), and among early term births in Denmark (38.4% to 43.8%) and Finland (29.8% to 40.1%).

CONCLUSIONS AND RELEVANCE:

Between 2006 and 2014, late preterm and early term birth rates decreased in the United States, and an association was observed between early term birth rates and decreasing clinician-initiated obstetric interventions. Late preterm births also decreased in Norway, and early term births decreased in Norway and Sweden. Clinician-initiated obstetric interventions increased in some countries but no association was found with rates of late preterm or early term birth.

PMID:
27458946
PMCID:
PMC5318207
DOI:
10.1001/jama.2016.9635
[Indexed for MEDLINE]
Free PMC Article

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