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Study Indicates That Cesarean Delivery May Not Be More Protective for Small, Premature Newborns
In a study to be presented today at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in Dallas, Texas, researchers will report findings that suggest that delivery by cesarean section may not be protective compared to vaginal deliveries for babies who are small for their gestational age (those weighing less than the 10th percentile at birth based on national growth curves) born more than six weeks before their due date.
“We found that infants delivered vaginally were not at a significantly increased risk for any neonatal complications. In fact, infants delivered by cesarean had significantly higher odds of breathing problems after birth,” said Erika F. Werner, MD, with Johns Hopkins University, Gynecology and Obstetrics in Baltimore, Md., and one of the study’s authors. “This indicates that cesarean isn’t superior to vaginal deliveries for this high risk population.”
For the study, entitled Method of Delivery and Neonatal Outcomes in Preterm, Small for Gestational Age Infants, Werner and her colleagues studied birth data of this high risk population that was collected in New York between 1995 and 2003.
The results indicate that delivery by cesarean section was not associated with decreased odds of any neonatal complications and was associated with significantly higher odds of respiratory distress syndrome in small for gestational age preterm newborns.
In addition to Werner, the study was conducted by David Savitz, Brown University, Departments of Epidemiology and Obstetrics and Gynecology, Providence, R.I.; Teresa Janevic, Yale University, Global Health Initiative, New Haven, Conn.; Stephen F. Thung and Edmund F. Funai, Ohio State University College of Medicine, Columbus, Ohio; and Heather Lipkind, Yale University, Ob/Gyn & Reproductive Science, New Haven, Conn.
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A copy of the abstract is available at http://www.smfmnewsroom.org/annual-meeting/2011-meeting-abstracts/. For interviews please contact Vicki Bendure at Vicki@bendurepr.com, 540-687-3360 (office) or 202-374-9259 (cell), or Jacqueline Boggess at jacqueline@bendurepr.com, 540-687-5399 (office) or 202-738-3054 (cell).
The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by providing continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed. For more information, visit www.smfm.org or www.facebook.com/SocietyforMaternalFetalMedicine.
Abstract 13:
Method of delivery and neonatal outcomes in preterm, small for gestational age infants
Erika F. Werner 1, David Savitz 2, Teresa Janevic 3, Stephen F. Thung 4, Edmund F. Funai 4, Heather Lipkind 4
1 Johns Hopkins University, Gynecology and Obstetrics, Baltimore, MD, 2 Brown University, Departments of Epidemiology and Obstetrics and Gynecology, Providence, RI, 3 Yale University, Global Health Initiative, New Haven, CT, 4 Yale University, Ob/Gyn & Reprod Science, New Haven, CT
OBJECTIVE: Cesarean delivery (CD) has been proposed as an obstetric strategy to improve neonatal outcomes for premature fetuses with intrauterine growth restriction (IUGR). The relative rarity of this clinical situation has made prospective randomized studies challenging and has even limited retrospective cohort studies. This study was undertaken to compare neonatal outcomes by method of delivery in preterm (34 week), small for gestational age (SGA) infants in a large diverse cohort.
STUDY DESIGN: Birth data for 1995 to 2003 from New York City were linked to hospital discharge data. Data were limited to singleton, live born, vertex neonates delivered between 25 and 34 weeks. Births complicated by known congenital anomalies, birth weight 500 grams and those requiring forceps or vacuum assistance were excluded. Deliveries were also excluded if there was a maternal history of prior CD. SGA was used as a surrogate for IUGR. Any diagnosis of intraventricular hemorrhage (IVH), seizure, sepsis, subdural hemorrhage, respiratory distress syndrome (RDS), or five minute Apgar 7 was considered a significant neonatal morbidity. Associations between method of delivery and neonatal morbidities were estimated using logistic regression.
RESULTS: 2560 SGA neonates meeting the study criteria were identified; 46% were delivered vaginally and 54% were delivered by CD. There was no significant difference in IVH, subdural hemorrhage, seizure or sepsis between the CD and vaginal delivery (VD) groups. CD compared to VD was associated with increased odds of RDS. The increased odds persisted after controlling for maternal age, ethnicity, education, primary payor, pre-pregnancy weight, gestational age at delivery, diabetes and hypertension. CD compared to VD was associated with increased odds of five minute Apgar 7 using unadjusted odds (odds ratio: 1.4; 95% CI 1.1-1.9), but this difference dissipated after adjusting for confounding factors.
CONCLUSION: CD was not associated with decreased odds of any neonatal complications and was associated with significantly higher odds of RDS in SGA preterm neonates.
