Trends in provider-initiated versus spontaneous preterm deliveries, 2004-2013.

TitleTrends in provider-initiated versus spontaneous preterm deliveries, 2004-2013.
Publication TypeJournal Article
Year of Publication2017
AuthorsAda ML, Hacker MR, Golen TH, Haviland MJ, Shainker SA, Burris HH
JournalJ Perinatol
Date Published2017 11
KeywordsAdult, African Americans, European Continental Ancestry Group, Female, Gestational Age, Healthcare Disparities, Humans, Incidence, Infant, Newborn, Male, Obstetric Labor, Premature, Odds Ratio, Pregnancy, Premature Birth, Retrospective Studies, Risk Factors

OBJECTIVE: The objectives of this study were as follows: (i) to estimate the proportion of preterm deliveries at a tertiary perinatal center that were provider-initiated versus spontaneous before and after a 2009 policy to reduce elective early-term deliveries, and (ii)to evaluate whether shifts in type of preterm delivery varied by race/ethnicity.

METHOD: We performed a retrospective cohort study of preterm deliveries over a 10-year period, 2004 to 2013, including detailed review of 929 of 5566 preterm deliveries, to designate each delivery as provider-initiated or spontaneous. We dichotomized the time period into early (2004 to 2009) and late (2010 to 2013). We used log-binomial regression to calculate adjusted risk ratios.

RESULT: Of the 46‚ÄČ981 deliveries, 5566 (11.8%) were preterm, with a significant reduction in the overall incidence of preterm delivery from 12.3 to 11.2% (P=0.0003). Among the 929 preterm deliveries analyzed, there was a reduction in the proportion of provider-initiated deliveries from 48.3 to 41.8% that was not statistically significant. The proportion of provider-initiated preterm deliveries among Black, but not White, women declined from 50.8 to 39.7% (adjusted relative risk: 0.66; 95% confidence interval (CI): 0.45 to 0.97). This coincided with a larger reduction in overall preterm deliveries among Black women (16.2 to 12.8%) vs White women (12.3 to 11.2%) (P interaction=0.038). By 2013, the incidence of preterm deliveries had decreased for both Black (12.1%) and White women (11.4%), and the difference was no longer statistically significant (P=0.7).

CONCLUSION: We found a reduction in preterm deliveries after a policy targeted at reducing elective early-term deliveries in 2009 that coincided with reductions in the proportion of provider-initiated preterm deliveries, especially among Black women.

Alternate JournalJ Perinatol
PubMed ID28749488
PubMed Central IDPMC5687992
Grant ListK23 ES022242 / ES / NIEHS NIH HHS / United States
UL1 TR001102 / TR / NCATS NIH HHS / United States