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; 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

doi:10.1055/s-0037-1608787

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, 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

^*Corresponding author for this work

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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.

Original language	English (US)
Pages (from-to)	624-631
Number of pages	8
Journal	American journal of perinatology
Volume	35
Issue number	7
DOIs	https://doi.org/10.1055/s-0037-1608787
State	Published - Jun 1 2018

Funding

The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD34208, HD27869, HD40485, HD40560, HD40544, HD34116, HD40512, HD21410, HD40545, HD40500, HD27915, HD34136, HD27860, HD53118, HD53097, HD27917, and HD36801]; the National Heart, Lung, and Blood Institute; and the National Center for Research Resources [M01 RR00080, UL1 RR024153, UL1 RR024989], and its contents do not necessarily represent the official view of NICHD, NHLBI, NCRR, or NIH.

Keywords

indicated preterm birth
preeclampsia
pregnancy outcomes
spontaneous preterm birth

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1055/s-0037-1608787

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Tita, A. T., Doherty, L., Roberts, J. M., Myatt, L., Leveno, K. J., Varner, M. W., Wapner, R. J., Thorp, J. M., Mercer, B. M., Peaceman, A., Ramin, S. M., Carpenter, M. W., Iams, J., Sciscione, A., Harper, M., Tolosa, J. E., Saade, G. R., & Sorokin, Y. (2018). Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial. American journal of perinatology, 35(7), 624-631. https://doi.org/10.1055/s-0037-1608787

@article{47d045efabb24f288b16d52b48728815,

title = "Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial",

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.",

keywords = "indicated preterm birth, preeclampsia, pregnancy outcomes, spontaneous preterm birth",

author = "Tita, {Alan T.} and Lindsay Doherty and Roberts, {Jim M.} and Leslie Myatt and Leveno, {Kenneth J.} and Varner, {Michael W.} and Wapner, {Ronald J.} and Thorp, {John M.} and Mercer, {Brian M.} and Alan Peaceman and Ramin, {Susan M.} and Carpenter, {Marshall W.} and Jay Iams and Anthony Sciscione and Margaret Harper and Tolosa, {Jorge E.} and Saade, {George R.} and Yoram Sorokin",

note = "Publisher Copyright: {\textcopyright} 2018 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY.",

year = "2018",

month = jun,

day = "1",

doi = "10.1055/s-0037-1608787",

language = "English (US)",

volume = "35",

pages = "624--631",

journal = "American journal of perinatology",

issn = "0735-1631",

publisher = "Thieme Medical Publishers, Inc.",

number = "7",

}

Tita, AT, Doherty, L, Roberts, JM, Myatt, L, Leveno, KJ, Varner, MW, Wapner, RJ, Thorp, JM, Mercer, BM, Peaceman, A, Ramin, SM, Carpenter, MW, Iams, J, Sciscione, A, Harper, M, Tolosa, JE, Saade, GR & Sorokin, Y 2018, 'Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial', American journal of perinatology, vol. 35, no. 7, pp. 624-631. https://doi.org/10.1055/s-0037-1608787

TY - JOUR

T1 - Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas

T2 - A Secondary Analysis of a Randomized Trial

AU - Tita, Alan T.

AU - Doherty, Lindsay

AU - Roberts, Jim M.

AU - Myatt, Leslie

AU - Leveno, Kenneth J.

AU - Varner, Michael W.

AU - Wapner, Ronald J.

AU - Thorp, John M.

AU - Mercer, Brian M.

AU - Peaceman, Alan

AU - Ramin, Susan M.

AU - Carpenter, Marshall W.

AU - Iams, Jay

AU - Sciscione, Anthony

AU - Harper, Margaret

AU - Tolosa, Jorge E.

AU - Saade, George R.

AU - Sorokin, Yoram

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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.

KW - indicated preterm birth

KW - preeclampsia

KW - pregnancy outcomes

KW - spontaneous preterm birth

UR - http://www.scopus.com/inward/record.url?scp=85036570731&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85036570731&partnerID=8YFLogxK

U2 - 10.1055/s-0037-1608787

DO - 10.1055/s-0037-1608787

M3 - Article

C2 - 29190847

AN - SCOPUS:85036570731

SN - 0735-1631

VL - 35

SP - 624

EP - 631

JO - American journal of perinatology

JF - American journal of perinatology

IS - 7

ER -

Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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