We sought to determine the proportion of evidence-based (EB), vs non-EB (NEB) iatrogenic late preterm birth, and to compare corresponding rates of neonatal intensive care unit (NICU) admission.
We performed a retrospective cohort study. Cases were categorized as EB or NEB. NICU admission was compared between groups in both univariate and multivariate analysis.
Of 2693 late preterm deliveries, 32.3% (872/2693) were iatrogenic; 56.7% were delivered for NEB indications. Women with NEB deliveries were older (30.0 vs 28.6 years, P = .001), and more likely to be pregnant with twins (18.8% vs 7.9%, P < .001), have private insurance (80.3% vs 59.0%, P < .001), or have a second complicating factor (27.5% vs 10.1%, P < .001). A total of 56% of EB deliveries resulted in NICU admissions. After controlling for confounders, early gestational age (34 vs 36 weeks: odds ratio, 19.34; 95% confidence interval, 4.28–87.5) and mode of delivery (cesarean: odds ratio, 1.88; 95% confidence interval, 1.15–3.05) were most strongly associated with NICU admission.
Over half of nonspontaneous late preterm births were NEB. EB guidelines are needed.
The morbidity associated with late preterm birth, defined as birth from 34 0/7-36 6/7 weeks, has recently become the topic of much debate and literature.1, 2, 3 and 4 We now understand that late preterm birth is associated with significantly higher rates of respiratory morbidity, but also results in other morbidities such as intraventricular hemorrhage, necrotizing enterocolitis, neonatal intensive care unit (NICU) admission, and sepsis, when compared to infants born at term. McIntire and Leveno1 compared the different types of morbidities associated with late preterm birth to birth at 39 weeks, the gestational age with the lowest morbidity in their cohort of 21,771 deliveries over an 18-year period. They found that ventilator use, transient tachypnea of the newborn, sepsis, phototherapy for hyperbilirubinemia, and intraventricular hemorrhage were all significantly higher in late preterm infants compared to term. Similarly, Yoder et al2 reviewed the epidemiology of respiratory disease in late preterm infants. They found that respiratory morbidity from all causes was higher at 34 weeks (22%), 35 weeks (8.5%), and 36 weeks (3.9%) when compared to 39 and 40 weeks (0.7% and 0.8%, respectively, P < .001). These findings were corroborated recently by the Safe Labor Consortium. 3 Currently, the standard of care is not to administer antenatal corticosteroids to women at risk for late preterm delivery due to a lack of data showing benefit at these later gestational ages.
Mortality is known to be higher as well. Tomashek et al4 and McIntire and Leveno1 both showed that infant mortality was up to 3 times higher after late preterm birth compared to birth at term. Reddy et al5 found that neonatal mortality and infant mortality were 9.5- and 5.4-fold higher following birth at 34 weeks compared to 39 weeks. The increased morbidity and mortality associated with late preterm birth when compared to term is concerning and raises the question as to whether the indications for these births are justified.
Additionally, long-term outcomes have been found to be poorer in late preterm infants compared to term. Tagle et al6 found that IQ scores were lower at 6 years of age in children of women with a late preterm birth compared with similar term children. Another study of preschool and kindergarten children born late preterm compared with term children showed that the late preterm children were more likely to have developmental delay and suspension and retention in kindergarten.7 Finally, Moster et al8 found that adults born late preterm in Norway were 2.7 times more likely to have cerebral palsy and 1.6 times more likely to have mental retardation. These data further question the need to deliver these infants in the late preterm period.
Nonspontaneous late preterm birth: etiology and outcomes
American Journal of Obstetrics and Gynecology
Volume 205, Issue 5, November 2011, Pages 456.e1–456.e6
Even this article pays no attention to the psychological consequences of such profound maternal rejection (babies initiate their own births, presumably not before they’re ready to be born) and the known connections to life-long alienation, depression and violence. And then there’s the society-wide impacts of such abuse and loss of intelligence on a mass scale. This is a seriously orwellian form of social control. Children are people too. Why is this not seen as a human rights issue?
This is pure evil.