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

Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama. The Biostatistics Center, The George Washington University, Washington, District of Columbia. Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. Department of Obstetrics and Gynecology, Columbia University, New York, New York. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas. Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio. Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania. Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.

American journal of perinatology. 2018;(7):624-631
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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.

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