Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial
Alan T Tita, Lindsay Doherty, Jim M Roberts, Leslie Myatt, Kenneth J Leveno, Michael W Varner, Ronald J Wapner, John M Thorp Jr, Brian M Mercer, Alan Peaceman, Susan M Ramin, Marshall W Carpenter, Jay Iams, Anthony Sciscione, Margaret Harper, Jorge E Tolosa, George R Saade, Yoram Sorokin, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Alan T Tita, Lindsay Doherty, Jim M Roberts, Leslie Myatt, Kenneth J Leveno, Michael W Varner, Ronald J Wapner, John M Thorp Jr, Brian M Mercer, Alan Peaceman, Susan M Ramin, Marshall W Carpenter, Jay Iams, Anthony Sciscione, Margaret Harper, Jorge E Tolosa, George R Saade, Yoram Sorokin, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Abstract
Objective: To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB).
Methods: A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity.
Results: Of 9,867 women, 10.4% (N = 1,038) were PTBs; 32.7% (n = 340) IPTBs and 67.3% (n = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB-4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4-11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1-3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times).
Conclusion: Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.
Conflict of interest statement
None.
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Source: PubMed