TY - JOUR
T1 - The risk of stillbirth and infant death by each additional week of expectant management stratified by maternal age
AU - Page, Jessica M.
AU - Snowden, Jonathan M.
AU - Cheng, Yvonne W.
AU - Doss, Amy E.
AU - Rosenstein, Melissa G.
AU - Caughey, Aaron B.
N1 - Funding Information:
Y.W. C. is supported by the University of California, San Francisco, Women’s Reproductive Health Research Career Development Award and grant K12 HD001262 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health .
PY - 2013/10
Y1 - 2013/10
N2 - Objective The objective of the study was to examine fetal/infant mortality by gestational age at term stratified by maternal age. Study Design A retrospective cohort study was conducted using 2005 US national birth certificate data. For each week of term gestation, the risk of mortality associated with delivery was compared with composite mortality risk of expectant management. The expectant management measure included stillbirth and infant death. This expectant management risk was calculated to estimate the composite mortality risk with remaining pregnant an additional week by combining the risk of stillbirth during the additional week of pregnancy and infant death risk following delivery at the next week. Maternal age was stratified by 35 years or more compared with women younger than 35 years as well as subgroup analyses of younger than 20, 20-34, 35-39, or 40 years old or older. Results The fetal/infant mortality risk of expectant management is greater than the risk of infant death at 39 weeks' gestation in women 35 years old or older (15.2 vs 10.9 of 10,000, P <.05). In women younger than 35 years old, the risk of expectant management also exceeded that of infant death at 39 weeks (21.3 vs 18.8 of 10,000, P <.05). For women younger than 35 years old, the overall expectant management risk is influenced by higher infant death risk and does not rise significantly until 41 weeks compared with women 35 years old or older in which it increased at 40 weeks. Conclusion Risk varies by maternal age, and delivery at 39 weeks minimizes fetal/infant mortality for both groups, although the magnitude of the risk reduction is greater in older women.
AB - Objective The objective of the study was to examine fetal/infant mortality by gestational age at term stratified by maternal age. Study Design A retrospective cohort study was conducted using 2005 US national birth certificate data. For each week of term gestation, the risk of mortality associated with delivery was compared with composite mortality risk of expectant management. The expectant management measure included stillbirth and infant death. This expectant management risk was calculated to estimate the composite mortality risk with remaining pregnant an additional week by combining the risk of stillbirth during the additional week of pregnancy and infant death risk following delivery at the next week. Maternal age was stratified by 35 years or more compared with women younger than 35 years as well as subgroup analyses of younger than 20, 20-34, 35-39, or 40 years old or older. Results The fetal/infant mortality risk of expectant management is greater than the risk of infant death at 39 weeks' gestation in women 35 years old or older (15.2 vs 10.9 of 10,000, P <.05). In women younger than 35 years old, the risk of expectant management also exceeded that of infant death at 39 weeks (21.3 vs 18.8 of 10,000, P <.05). For women younger than 35 years old, the overall expectant management risk is influenced by higher infant death risk and does not rise significantly until 41 weeks compared with women 35 years old or older in which it increased at 40 weeks. Conclusion Risk varies by maternal age, and delivery at 39 weeks minimizes fetal/infant mortality for both groups, although the magnitude of the risk reduction is greater in older women.
KW - expectant management
KW - fetal/infant mortality
KW - infant death
KW - maternal age
KW - stillbirth
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U2 - 10.1016/j.ajog.2013.05.045
DO - 10.1016/j.ajog.2013.05.045
M3 - Article
C2 - 23707677
AN - SCOPUS:84884671044
SN - 0002-9378
VL - 209
SP - 375.e1-375.e7
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 4
ER -