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571: Are term deliveries occuring at earlier gestational ages at community versus university hospitals?
Poster Session IV
Academic Issues, etc
571 Are term deliveries occuring at earlier gestational ages at community versus university hospitals? Candice Snyder1, Katherine Wolfe1, Ryan Loftin1, Sammy Tabbah1, David Lewis1, Emily DeFranco1 1
University of Cincinnati, Cincinnati, Ohio
OBJECTIVE: Strict guidelines regarding optimal gestational age (⬎39 wks)
for scheduled deliveries have been set forth by ACOG. We hypothesize that despite an increase in medical comorbidities in patients delivered at university hospitals (Univ), patients at community hospitals (Comm) are delivering more often at 37 and 38 wks, and also that induction and cesarean (C/S) rates are higher at term in Comm versus Univ hospitals. STUDY DESIGN: A population-based retrospective cohort study of births from 2006-2008 was performed using Ohio Department of Health’s birth certificate database. Primary outcomes were term week of gestation ⬍39 wks, labor induction, and C/S, which were compared by hospital type. Adjusting for medical comorbidities, malpresentation, and prior cesarean, logistic regression assessed association between hospital type and outcomes. RESULTS: Births occurred less often in 37th wk [13 vs 11%, aOR 0.9 (0.8,0.9)] but slightly more often in 38th wk [24 vs 25%, aOR 1.1(1.04, 1.1)] and ⬎39 wks in Univ vs Comm (24 vs 25%, aOR 1.1, CI 1.04, 1.1). Inductions occurred more commonly at all term gestations in Comm vs. Univ settings. Surprisingly, despite the increased induction rate at Comm, the C/S rates are the same at each week of term gestation between hospital types. CONCLUSION: There is minimal difference between Univ and Comm regarding rate of delivery at various weeks of term gestation. Patients are 70-80% more likely to undergo labor induction at Comm prior to the optimal GA of ⱖ39 wks, despite the inherently higher risk population at Univ often necessitating earlier delivery. (N)
Univ 30637
Comm 213827
aOR (CI)
Induction (%)
..........................................................................................................................................................................................
37 weeks 18.9 26.5 1.7 (1.5,1.8) .......................................................................................................................................................................................... 38 weeks 21.1 31.4 1.8 (1.7,1.9) .......................................................................................................................................................................................... 39-42 weeks 24.6 38.5 2.0 (1.9,2.0) .......................................................................................................................................................................................... Cesarean (%) .......................................................................................................................................................................................... 37 weeks 31.5 31.7 1.0 (0.9,1.1) .......................................................................................................................................................................................... 38 weeks 31.6 31.9 1.0 (0.9,1.1) .......................................................................................................................................................................................... 39-42 weeks 26.1 25.7 1.0 (1.0,1.1) .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.436
572 Trends in cesarean delivery at preterm gestations: effects on perinatal mortality Cande Ananth1, Anthony Vintzileos2 1
UMDNJ-Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, New Jersey, 2Winthrop-University Hospital, Department of Obstetrics and Gynecology, Mineola, New York
OBJECTIVE: The recent increase in cesarean delivery rates and indicated preterm births in the United States have remained a cause for concern. In fact, some investigators have linked the increasing preterm birth rate to the increase in cesarean deliveries. However, the extent to which a temporal increase in preterm cesarean delivery is associated with gestational age-specific changes in perinatal survival remains poorly understood. STUDY DESIGN: We utilized data on singleton stillbirths and live births in the United States (1990-2004) delivered between 24-36 weeks gestation. We examined gestational age-specific changes in cesarean delivery over a 15 year period (i.e., 1990 and 2004), and the contribution of these trends to gestational age-specific changes in preterm stillbirth, neonatal and perinatal mortality. These trends as well as the incre-
S212
www.AJOG.org mental impact of preterm cesarean on mortality were estimated from logistic regression models after adjustment for confounding factors. RESULTS: The 10.3% increase in preterm births between 1990 (9.8%) and 2004 (10.8%) was solely confined to the 34-36 weeks group. Between 1990 and 2004, cesarean delivery rates increased by 48%, 32% and 29% at 24-27, 28-33 and 34-36 weeks, respectively. The largest incremental impact of cesarean was associated with a reduction in stillbirth rates, leading to a reduction in perinatal deaths by 11%, 5% and 0.6% at 24-27, 28-33 and 34-36 weeks, respectively. This occurred despite incremental increases in neonatal deaths by 5% and 3% in the 28-33 and 34-36 weeks groups. CONCLUSION: In preterm gestations, increasing rates of cesarean delivery are associated with improved perinatal survival. This association was evident in all preterm gestational age groups, largely because of dramatic incremental declines in stillbirths. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.437
573 Evaluating the influence of early gestational age and low birthweight on the development of autism spectrum disorders by gender in the 1991-2001 California Birth Cohort Gaea Moore1, Guibo Xing1, Lloyd Smith1, William Gilbert2 1 University of California, Davis, Sacramento, California, 2Sutter Medical Center Sacramento, OB/GYN, Sacramento, California
OBJECTIVE: To determine whether gestational age (GA) ⬍28w or
birthweight (BW) ⬍1500g influence the risk for autism spectrum disorders (ASD), and whether this risk differs by gender. STUDY DESIGN: Retrospective cohort population based study. Records of 20,206 children with ASD (Childhood autism, 299.0; Asperger’s disorder, 299.8; Pervasive developmental disorder [PDD], 299.9; and “Other” autism developmental delay [DD]) from the California Department of Developmental Services were linked with their hospital birth records from 1991-2001, and compared to all children without ASD born in California during the same period (n⫽6,028,353). RESULTS: Asperger’s was associated with BW ⬍1500g in boys (OR 3.8, 95%CI 1.7-8.9) but not in girls (OR 3.6, 0.5-28.7), and not affected in either sex by GA ⬍28w (boys 1.5, 0.2-10.7; girls 6.3, 0.8-48.2). “Other DD” was associated with BW ⬍1500g in girls (1.9, 1.5-2.4) but not in boys (1.1,1.0-1.3), and with GA ⬍28w in girls (1.9, 1.4-2.7) but not in boys (1.1, 0.9-1.3). Childhood autism was not associated in either sex with BW ⬍1500g (boys OR 1.0, 95%CI 0.6-1.8; girls 1.5, 0.5-4.0) or GA ⬍28w (boys OR 1.6, 0.9-3.0; girls 1.5, 0.4-6.1). PDD was not associated in either sex with BW ⬍1500g (boys OR 1.5, 0.5-4.0; girls 1.6, 0.2-12.2) or GA ⬍28w (boys OR 0.9, 0.1-6.6; girls NA). CONCLUSION: The differential influence of low BW and early gestational age on autism subtypes by gender supports etiologic heterogeneity within the autism spectrum. Since ASD as a whole carries a high male/female ratio, identification of an increased risk for “OtherAutism DD” in girls born at low BW or early GA may further autism screening in this population. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.438
574 Low level prenatal alcohol exposure increases the rate of spontaneous abortion Robert Sokol1, Lisa Chiodo2, Virginia Delaney-Black1, John Hannigan1 1
Wayne State University, Detroit, Michigan, 2Wayne State University, Pediatrics, Detroit, Michigan
OBJECTIVE: Although a relation has been identified between heavy lev-
els of maternal; alcohol consumption during pregnancy and spontaneous abortion, a recent review identified no evidence of effects for low-moderate levels of exposure. We examined the impact of moderate levels of prenatal alcohol exposure on rate of spontaneous abortion in a prospective cohort. STUDY DESIGN: Maternal pregnancy alcohol consumption was assessed in African American women (n⫽431). At each prenatal visit, women were queried about alcohol intake during the prior 2 weeks. From this interview, three alcohol-drinking measures were obtained: ounces of absolute alcohol per day (AAD: mean ⫽ 0.32; SD⫽0.6), ounces of absolute
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Academic Issues, etc
571 Are term deliveries occuring at earlier gestational ages at community versus university hospitals? Candice Snyder1, Katherine Wolfe1, Ryan Loftin1, Sammy Tabbah1, David Lewis1, Emily DeFranco1 1
University of Cincinnati, Cincinnati, Ohio
OBJECTIVE: Strict guidelines regarding optimal gestational age (⬎39 wks)
for scheduled deliveries have been set forth by ACOG. We hypothesize that despite an increase in medical comorbidities in patients delivered at university hospitals (Univ), patients at community hospitals (Comm) are delivering more often at 37 and 38 wks, and also that induction and cesarean (C/S) rates are higher at term in Comm versus Univ hospitals. STUDY DESIGN: A population-based retrospective cohort study of births from 2006-2008 was performed using Ohio Department of Health’s birth certificate database. Primary outcomes were term week of gestation ⬍39 wks, labor induction, and C/S, which were compared by hospital type. Adjusting for medical comorbidities, malpresentation, and prior cesarean, logistic regression assessed association between hospital type and outcomes. RESULTS: Births occurred less often in 37th wk [13 vs 11%, aOR 0.9 (0.8,0.9)] but slightly more often in 38th wk [24 vs 25%, aOR 1.1(1.04, 1.1)] and ⬎39 wks in Univ vs Comm (24 vs 25%, aOR 1.1, CI 1.04, 1.1). Inductions occurred more commonly at all term gestations in Comm vs. Univ settings. Surprisingly, despite the increased induction rate at Comm, the C/S rates are the same at each week of term gestation between hospital types. CONCLUSION: There is minimal difference between Univ and Comm regarding rate of delivery at various weeks of term gestation. Patients are 70-80% more likely to undergo labor induction at Comm prior to the optimal GA of ⱖ39 wks, despite the inherently higher risk population at Univ often necessitating earlier delivery. (N)
Univ 30637
Comm 213827
aOR (CI)
Induction (%)
..........................................................................................................................................................................................
37 weeks 18.9 26.5 1.7 (1.5,1.8) .......................................................................................................................................................................................... 38 weeks 21.1 31.4 1.8 (1.7,1.9) .......................................................................................................................................................................................... 39-42 weeks 24.6 38.5 2.0 (1.9,2.0) .......................................................................................................................................................................................... Cesarean (%) .......................................................................................................................................................................................... 37 weeks 31.5 31.7 1.0 (0.9,1.1) .......................................................................................................................................................................................... 38 weeks 31.6 31.9 1.0 (0.9,1.1) .......................................................................................................................................................................................... 39-42 weeks 26.1 25.7 1.0 (1.0,1.1) .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.436
572 Trends in cesarean delivery at preterm gestations: effects on perinatal mortality Cande Ananth1, Anthony Vintzileos2 1
UMDNJ-Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, New Jersey, 2Winthrop-University Hospital, Department of Obstetrics and Gynecology, Mineola, New York
OBJECTIVE: The recent increase in cesarean delivery rates and indicated preterm births in the United States have remained a cause for concern. In fact, some investigators have linked the increasing preterm birth rate to the increase in cesarean deliveries. However, the extent to which a temporal increase in preterm cesarean delivery is associated with gestational age-specific changes in perinatal survival remains poorly understood. STUDY DESIGN: We utilized data on singleton stillbirths and live births in the United States (1990-2004) delivered between 24-36 weeks gestation. We examined gestational age-specific changes in cesarean delivery over a 15 year period (i.e., 1990 and 2004), and the contribution of these trends to gestational age-specific changes in preterm stillbirth, neonatal and perinatal mortality. These trends as well as the incre-
S212
www.AJOG.org mental impact of preterm cesarean on mortality were estimated from logistic regression models after adjustment for confounding factors. RESULTS: The 10.3% increase in preterm births between 1990 (9.8%) and 2004 (10.8%) was solely confined to the 34-36 weeks group. Between 1990 and 2004, cesarean delivery rates increased by 48%, 32% and 29% at 24-27, 28-33 and 34-36 weeks, respectively. The largest incremental impact of cesarean was associated with a reduction in stillbirth rates, leading to a reduction in perinatal deaths by 11%, 5% and 0.6% at 24-27, 28-33 and 34-36 weeks, respectively. This occurred despite incremental increases in neonatal deaths by 5% and 3% in the 28-33 and 34-36 weeks groups. CONCLUSION: In preterm gestations, increasing rates of cesarean delivery are associated with improved perinatal survival. This association was evident in all preterm gestational age groups, largely because of dramatic incremental declines in stillbirths. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.437
573 Evaluating the influence of early gestational age and low birthweight on the development of autism spectrum disorders by gender in the 1991-2001 California Birth Cohort Gaea Moore1, Guibo Xing1, Lloyd Smith1, William Gilbert2 1 University of California, Davis, Sacramento, California, 2Sutter Medical Center Sacramento, OB/GYN, Sacramento, California
OBJECTIVE: To determine whether gestational age (GA) ⬍28w or
birthweight (BW) ⬍1500g influence the risk for autism spectrum disorders (ASD), and whether this risk differs by gender. STUDY DESIGN: Retrospective cohort population based study. Records of 20,206 children with ASD (Childhood autism, 299.0; Asperger’s disorder, 299.8; Pervasive developmental disorder [PDD], 299.9; and “Other” autism developmental delay [DD]) from the California Department of Developmental Services were linked with their hospital birth records from 1991-2001, and compared to all children without ASD born in California during the same period (n⫽6,028,353). RESULTS: Asperger’s was associated with BW ⬍1500g in boys (OR 3.8, 95%CI 1.7-8.9) but not in girls (OR 3.6, 0.5-28.7), and not affected in either sex by GA ⬍28w (boys 1.5, 0.2-10.7; girls 6.3, 0.8-48.2). “Other DD” was associated with BW ⬍1500g in girls (1.9, 1.5-2.4) but not in boys (1.1,1.0-1.3), and with GA ⬍28w in girls (1.9, 1.4-2.7) but not in boys (1.1, 0.9-1.3). Childhood autism was not associated in either sex with BW ⬍1500g (boys OR 1.0, 95%CI 0.6-1.8; girls 1.5, 0.5-4.0) or GA ⬍28w (boys OR 1.6, 0.9-3.0; girls 1.5, 0.4-6.1). PDD was not associated in either sex with BW ⬍1500g (boys OR 1.5, 0.5-4.0; girls 1.6, 0.2-12.2) or GA ⬍28w (boys OR 0.9, 0.1-6.6; girls NA). CONCLUSION: The differential influence of low BW and early gestational age on autism subtypes by gender supports etiologic heterogeneity within the autism spectrum. Since ASD as a whole carries a high male/female ratio, identification of an increased risk for “OtherAutism DD” in girls born at low BW or early GA may further autism screening in this population. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.438
574 Low level prenatal alcohol exposure increases the rate of spontaneous abortion Robert Sokol1, Lisa Chiodo2, Virginia Delaney-Black1, John Hannigan1 1
Wayne State University, Detroit, Michigan, 2Wayne State University, Pediatrics, Detroit, Michigan
OBJECTIVE: Although a relation has been identified between heavy lev-
els of maternal; alcohol consumption during pregnancy and spontaneous abortion, a recent review identified no evidence of effects for low-moderate levels of exposure. We examined the impact of moderate levels of prenatal alcohol exposure on rate of spontaneous abortion in a prospective cohort. STUDY DESIGN: Maternal pregnancy alcohol consumption was assessed in African American women (n⫽431). At each prenatal visit, women were queried about alcohol intake during the prior 2 weeks. From this interview, three alcohol-drinking measures were obtained: ounces of absolute alcohol per day (AAD: mean ⫽ 0.32; SD⫽0.6), ounces of absolute
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009