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.
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.
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DOI：
10.1001/jama.2016.9635
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发表时间：
2016-07-26
期刊：
影响因子：
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通讯作者：
Kramer MR
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文献类型：
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作者：
Richards JL;Kramer MS;Deb-Rinker P;Rouleau J;Mortensen L;Gissler M;Morken NH;Skjærven R;Cnattingius S;Johansson S;Delnord M;Dolan SM;Morisaki N;Tough S;Zeitlin J;Kramer MR
在没有母体或胎儿干预指征的情况下，敦促临床医生延迟使用产科干预（例如，引产、剖宫产）至39周或更晚。描述6个高收入国家晚期早产和早产率的近期趋势，并评估与使用临床医生发起的产科干预措施的相关性。对加拿大、丹麦、芬兰、挪威、瑞典和美国从2006年到最近一年（范围从2010年到2015年）的单胎活产进行回顾性分析。在分娩过程中使用临床医生发起的产科干预（引产或产前剖宫产）。每年特定国家的晚期早产（34-36周）和早期（37-38周）出生率。研究人群包括2006-2014年出生的2415432名加拿大人（4.8%晚早产; 25.3%早产）; 2006-2010年丹麦出生305 947人（3.6%晚期早产; 18.8%早期早产）; 2006-2015年芬兰出生571 937人（3.3%晚期早产; 16.8%早期早产）; 2006-2013年挪威出生468 954例（3.8%晚期早产; 17.2%早期早产）; 2006-2012年瑞典出生737 754例（3.6%晚期早产; 18.7%早期）; 2006-2014年美国出生25788558例（6.0%晚期早产; 26.9%早期）。挪威（3.9%至3.5%）和美国（6.8%至5.7%）的晚期早产率有所下降。挪威（17.6%至16.8%）、瑞典（19.4%至18.5%）和美国（30.2%至24.4%）的早产率有所下降。在美国，早期足月出生率从2006年的33.0%下降到2014年的21.1%，其中有临床医生发起的产科干预，从2006年的29.7%下降到2014年的27.1%，其中没有临床医生发起的产科干预。在加拿大（28.0%至37.9%）、丹麦（22.2%至25.0%）和芬兰（25.1%至38.5%）的晚期早产中，以及在丹麦（38.4%至43.8%）和芬兰（29.8%至40.1%）的早产中，临床医生启动的产科干预率增加。在2006年至2014年期间，美国的晚期早产和早期出生率下降，并且观察到早期出生率与临床医生发起的产科干预措施减少之间存在关联。挪威的晚期早产也有所减少，挪威和瑞典的早产也有所减少。在一些国家，临床医生发起的产科干预措施有所增加，但未发现与晚期早产或早产率相关。
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. 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%). 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.