Center Variation in the Delivery of Indicated Late Preterm Births

Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births

Center Variation in the Delivery of Indicated Late Preterm Births

OBJECTIVE: Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births. STUDY DESIGN: Analysis of singleton late preterm and term births from a large U.S. retrospective obstetrical cohort. Births associated with spontaneous preterm labor, major congenital anomalies, chorioamnionitis, and emergency cesarean were excluded. We used modified Poisson fixed effects logistic regression with interaction terms to assess center variation of indicated late preterm births associated with four medical/obstetric comorbidities after adjusting for socio-demographics, co-morbidities, and hospital/provider characteristics. RESULTS: We identified 150,055 births from 16 hospitals; 9218 were indicated late preterm births. We found wide variation of indicated late preterm births across hospitals. The extent of center variation was greater for births associated with preterm premature rupture of membranes (RR across sites: 0.45 – 3.05), hypertensive disorders of pregnancy (RR across sites: 0.36 – 1.27), and placenta previa/abruption (RR across sites: 0.48 – 1.82). We found less center variation for births associated with diabetes (RR across sites: 0.65 – 1.39). CONCLUSION: Practice variation in the management of indicated late preterm deliveries might be a source of preventable late preterm birth

Maternal psychiatric disorders and risk of preterm birth

PURPOSE: To study the effect of maternal psychiatric disorders (depression, anxiety disorder, bipolar disease, schizophrenia, unspecified psychiatric disorder, and comorbid conditions) and odds of preterm birth. METHODS: The Consortium on Safe Labor (2002-2008), an observational cohort with 12 centers from across the U.S. included 223,394 singleton pregnancies with clinical data obtained from electronic medical records and maternal diagnoses of psychiatric disorders from maternal discharge summaries. Length of gestation was based on the best clinical estimate and categorized as birth <39, <37, <34 and <28 weeks’ gestation. The adjusted odds ratios (ORs) with 95% confidence intervals of birth were estimated by logistic regression with generalized estimating equations. RESULTS: Any maternal psychiatric disorder was associated with odds of birth <39 weeks’ gestation (OR=1.32, 95% confidence interval 1.28-1.37), <37 weeks’ gestation (OR=1.45, 1.38-1.52), <34 weeks’ gestation (OR=1.47, 1.35-1.59) and <28 weeks’ gestation (OR=1.57, 1.36-1.82). Specifically, odds of birth <37 weeks’ gestation were associated with maternal depression (OR=1.31, 1.23-1.40), anxiety disorder (OR=1.68, 1.41-2.01), depression with anxiety disorder (OR=2.31, 1.93-2.78), bipolar disease (OR=1.54, 1.22-1.94), bipolar disease with depression and=or anxiety disorder (OR=1.70, 1.30-2.22) and unspecified psychiatric disorder (OR=1.52, 1.41-1.64). CONCLUSIONS: Maternal psychiatric disorders, especially comorbid psychiatric conditions, were associated with increased likelihood of preterm birth