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Trends in provider-initiated versus spontaneous preterm deliveries, 2004–2013

Journal of Perinatology volume 37, pages 1187–1191 (2017)Cite this article

Subjects

Abstract

Objective:

The objectives of this study were as follows: (i) to estimate the proportion of preterm deliveries at a tertiary perinatal center that were provider-initiated versus spontaneous before and after a 2009 policy to reduce elective early-term deliveries, and (ii)to evaluate whether shifts in type of preterm delivery varied by race/ethnicity.

Method:

We performed a retrospective cohort study of preterm deliveries over a 10-year period, 2004 to 2013, including detailed review of 929 of 5566 preterm deliveries, to designate each delivery as provider-initiated or spontaneous. We dichotomized the time period into early (2004 to 2009) and late (2010 to 2013). We used log-binomial regression to calculate adjusted risk ratios.

Result:

Of the 46 981 deliveries, 5566 (11.8%) were preterm, with a significant reduction in the overall incidence of preterm delivery from 12.3 to 11.2% (P=0.0003). Among the 929 preterm deliveries analyzed, there was a reduction in the proportion of provider-initiated deliveries from 48.3 to 41.8% that was not statistically significant. The proportion of provider-initiated preterm deliveries among Black, but not White, women declined from 50.8 to 39.7% (adjusted relative risk: 0.66; 95% confidence interval (CI): 0.45 to 0.97). This coincided with a larger reduction in overall preterm deliveries among Black women (16.2 to 12.8%) vs White women (12.3 to 11.2%) (P interaction=0.038). By 2013, the incidence of preterm deliveries had decreased for both Black (12.1%) and White women (11.4%), and the difference was no longer statistically significant (P=0.7).

Conclusion:

We found a reduction in preterm deliveries after a policy targeted at reducing elective early-term deliveries in 2009 that coincided with reductions in the proportion of provider-initiated preterm deliveries, especially among Black women.

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Acknowledgements

The We thank Laura Dodge, ScD, MPH, David Mediema and Anna Modest, MPH, for collecting data, and Tracey Pollard, RN for helping research assistant MA navigate the online medical records. Presented in oral format at the annual meeting of the New England Perinatal Society, Newport, RI, 13 to 15 March 2015, as well as Mini Grand Rounds of Beth Israel Deaconess Medical Center’s Research Assistant Learning Initiative, Boston, MA, 28 May 2015. Presented in poster format at the annual graduate research symposium of Boston University, Boston, MA, 31 March 2015, as well as the annual national conference of the Asian Pacific American Medical Student Association, Irvine, CA, 26 to 27 September 2015. Dr Heather Burris is funded by the NIH/NIEHS K23ES02224204. This work was conducted with support from Harvard Catalyst-The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers.

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Authors and Affiliations

  1. Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    M L Ada & H H Burris

  2. Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    M R Hacker, T H Golen, M J Haviland, S A Shainker & H H Burris

  3. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

    M R Hacker

  4. Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA

    H H Burris

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  1. M L Ada
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Correspondence to H H Burris.

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Ada, M., Hacker, M., Golen, T. et al. Trends in provider-initiated versus spontaneous preterm deliveries, 2004–2013. J Perinatol 37, 1187–1191 (2017). https://doi.org/10.1038/jp.2017.116

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