Changes in Gestational Age and Perinatal Mortality in US

MedicalResearch.com Interview with:

Dr. Cande V. Ananth, PhD, MPH Professor of Epidemiology and Vigil G. Damon Professor of Obstetrics and Gynecology Columbia University Medical Center

Dr. Ananth

Dr. Cande V. Ananth, PhD, MPH
Adjunct professor
Department of Health Policy and Management
Mailman School of Public Health
Columbia University, NY

MedicalResearch.com: What is the background for this study?

Response: Preterm delivery rates have declined between 2005 and 2014 in the US and in several European countries. Since reductions in preterm and early term deliveries, and perinatal mortality remain a global health priority, determining the relationship between gestational age distribution and perinatal mortality, remains a challenge. Efforts expended to a more complete understanding of the impact of new interventions, policies, and practices on reducing the burden of early deliveries, and in turn improvements in perinatal survival will be of tremendous benefit for clinical management and care of women during their pregnancy and the newborn.

MedicalResearch.com: Which of these results did you find most interesting or surprising?

Response: Increased perinatal mortality in some gestational age groups may be due to lower risk pregnancies being delivered preferentially at 39-40 weeks, leaving fetuses at higher risk for mortality at other gestations.

MedicalResearch.com: What are the clinical implications of these findings?

Response: This study of singleton births in the US shows that births at all gestational ages, except at 39-40 weeks, declined between 2007-2015. The overall decline in perinatal mortality rates was attributable to changes in gestational age distribution rather than gestational age-specific mortality. While the proportion of births at 34-36, 37-38, and 42-44 weeks’ gestation declined, perinatal mortality at these gestational ages increased.

MedicalResearch.com: What main message would you hope for physicians to take away from this report?

Response: A possibility for the increased perinatal mortality at 37-38 weeks could be that obstetricians may be more likely to defer to 39 weeks delivery for women at moderately increased risk for adverse perinatal outcomes. If so, one reason for the apparent increased perinatal mortality in some gestational age groups may be because pregnancies that previously would have unnecessarily been delivered earlier than 39-40 weeks were delivered at 39-40 weeks, leaving fetuses at higher risk for mortality at other gestations.

MedicalResearch.com: What other points, if any, would you like to make?

Response: A study of changes in spontaneous and iatrogenic deliveries, as well as the role maternal race-ethnicity plays in these trends may shed additional important insights to understand the prevailing trends in perinatal mortality.

MedicalResearch.com: Any disclosures? None.

Authors:

Cande V. Ananth, PhD, MPH,1,2
Robert L. Goldenberg, MD2
Alexander M. Friedman, MD, MPH2
Anthony M. Vintzileos, MD3

Author affiliations

  1. Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
  2. Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
  3. Department of Obstetrics and Gynecology, New York University-Winthrop University Hospital, Mineola, NY

Address for correspondence:
Cande V. Ananth, PhD, MPH
Department of Health Policy and Management
Mailman School of Public Health
Columbia University
722 West 168th Street, New York NY 10032
Email: cva2111@cumc.columbia.edu

Citation:

Ananth CV, Goldenberg RL, Friedman AM, Vintzileos AM. Association of Temporal Changes in Gestational Age With Perinatal Mortality in the United States, 2007-2015. JAMA Pediatr. Published online May 14, 2018. doi:10.1001/jamapediatrics.2018.0249

 

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