Are temporal trends in late preterm and early term birth rates in 6 high-income countries associated with use of clinician-initiated obstetric interventions?
These population-based retrospective analyses of singleton live births found declining late preterm birth rates in Norway and the United States and declining early term birth rates in Norway, Sweden, and the United States. Obstetric interventions increased in some countries but decreased in the United States, where an association was observed with decreasing early term birth rates.
Decreasing US early term birth rates were associated with decreasing rates of clinician-initiated obstetric interventions; obstetric interventions increased in some other countries but with no association with late preterm or early term birth rates.
Clinicians have been urged to delay the use of obstetric interventions (eg, labor induction, cesarean delivery) until 39 weeks or later in the absence of maternal or fetal indications for intervention.
To describe recent trends in late preterm and early term birth rates in 6 high-income countries and assess association with use of clinician-initiated obstetric interventions.
Retrospective analysis of singleton live births from 2006 to the latest available year (ranging from 2010 to 2015) in Canada, Denmark, Finland, Norway, Sweden, and the United States.
Use of clinician-initiated obstetric intervention (either labor induction or prelabor cesarean delivery) during delivery.
Main Outcomes and Measures
Annual country-specific late preterm (34-36 weeks) and early term (37-38 weeks) birth rates.
The study population included 2 415 432 Canadian births in 2006-2014 (4.8% late preterm; 25.3% early term); 305 947 Danish births in 2006-2010 (3.6% late preterm; 18.8% early term); 571 937 Finnish births in 2006-2015 (3.3% late preterm; 16.8% early term); 468 954 Norwegian births in 2006-2013 (3.8% late preterm; 17.2% early term); 737 754 Swedish births in 2006-2012 (3.6% late preterm; 18.7% early term); and 25 788 558 US births in 2006-2014 (6.0% late preterm; 26.9% early term). Late preterm birth rates decreased in Norway (3.9% to 3.5%) and the United States (6.8% to 5.7%). Early term birth rates decreased in Norway (17.6% to 16.8%), Sweden (19.4% to 18.5%), and the United States (30.2% to 24.4%). In the United States, early term birth rates decreased from 33.0% in 2006 to 21.1% in 2014 among births with clinician-initiated obstetric intervention, and from 29.7% in 2006 to 27.1% in 2014 among births without clinician-initiated obstetric intervention. Rates of clinician-initiated obstetric intervention increased among late preterm births in Canada (28.0% to 37.9%), Denmark (22.2% to 25.0%), and Finland (25.1% to 38.5%), and among early term births in Denmark (38.4% to 43.8%) and Finland (29.8% to 40.1%).
Conclusions and Relevance
Between 2006 and 2014, late preterm and early term birth rates decreased in the United States, and an association was observed between early term birth rates and decreasing clinician-initiated obstetric interventions. Late preterm births also decreased in Norway, and early term births decreased in Norway and Sweden. Clinician-initiated obstetric interventions increased in some countries but no association was found with rates of late preterm or early term birth.
Richards JL, Kramer MS, Deb-Rinker P, Rouleau J, Mortensen L, Gissler M, Morken N, Skjærven R, Cnattingius S, Johansson S, Delnord M, Dolan SM, Morisaki N, Tough S, Zeitlin J, Kramer MR. Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-Income Countries in North America and Europe and Association With Clinician-Initiated Obstetric Interventions. JAMA. 2016;316(4):410-419. doi:10.1001/jama.2016.9635