A recent study conducted by researchers from the Children’s Hospital of Philadelphia, covering millions of U.S. births over 15 years, shows that nearly one in 25 U.S. babies are born too soon i.e. earlier than medically justified, through elective cesarean sections and elective induced labor. The study illustrates how many mothers-to-be are opting for elective cesarean sections and induced labor that could pose an increased risk to the health of their future child.
“A growing body of research suggests that health outcomes are worse for infants born before 40 weeks gestation, compared to full-term births,” said Scott A. Lorch, M.D., M.S.C.E., a neonatologist at The Children’s Hospital of Philadelphia (CHOP), in a news release. “Unfortunately, many of these earlier births are ‘nonindicated,’ which means there is not a medical rationale to deliver the baby early. We analyzed the extent to which these infants are born too soon and without medical indication,” he further added.
The study appears in the July issue of Medical Care, published by the American Public Health Association. Lorch collaborated with lead author Katy B. Kozhimannil, Ph.D., MPA,the University of Minnesota School of Public Health. “Our study showed that early elective deliveries are making up between 3 and 4 percent of U.S. births each year.This may seem to be a small number, but with 4 million births a year in the U.S., each percentage point represents 40,000 babies,”said Kozhimannil.
Unlike previous studies based in specific institutions and healthcare systems, the current analysis was a population based study, covering all 7.3 million uncomplicated term births during 15 calendar years, 1995 to 2009, in three large states: California, Missouri and Pennsylvania. The retrospective study used hospital discharge data linked to state birth certificate records and included mothers and infants from diverse socioeconomic backgrounds. In addition to representing distinct geographic regions, said Lorch, the three states account for approximately 20 percent of all U.S. births. The 15-year span allowed the researchers to discern trends over time.
Over the full period, the early-term nonindicated birth rate was 3.18 percent (232,139 deliveries out of 7,293,363 total uncomplicated births). The rate peaked in 2006, in which 4 percent of uncomplicated births to term infants occurred before 39 weeks’ gestation without medical indication. By 2009, the risk of non-indicated birth before 39 weeks was 3.74 percent, 86 percent higher than in 1995, the start of the study period.
“Our study team found that nonindicated early births had adverse consequences for newborns and families,” added Lorch, who also noted that early-term, non-indicated cesarean sections more than doubled the chance of newborns needing ventiliation because of respiratory distress. Early-term non-indicated cesareans also typically lengthened an infant’s hospital stay.
Despite recommendations by professional organizations such as the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, the study team showed that nonindicated early deliveries have continued to rise. Lorch suggests that further research should focus on the reasons for these procedures, with greater private and public health efforts to lower the rate of nonindicated early-term births.
“While prior research has shown that early elective delivery policies can be highly effective within particular healthcare systems, there is a need to address this issue at the population level,” said Kozhimannil. “It is our hope that this study will add fuel to the ongoing efforts to educate pregnant women and influence clinical and policy environments to facilitate healthy, full-term deliveries whenever possible,” he further added.
Researchers hope to focus future studies on a more specific underlying need for these procedures.
