The rate of preterm birth in the United States is affected by the method of gestational age assignment

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Abstract

OBJECTIVE: The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth.

STUDY DESIGN: Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age.

RESULTS: The rate of preterm birth was 9.7% when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5% when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54% vs 42%; P <.001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity.

CONCLUSION: The preterm birth rate is 9.7% vs 11.5% and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume213
Issue number2
DOIs
StatePublished - Aug 1 2015

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Premature Birth
Gestational Age
Obstetrics
Birth Certificates
Morbidity
National Center for Health Statistics (U.S.)
Birth Rate
Developed Countries
Surface-Active Agents
Ventilation
Parturition

Keywords

  • obstetric estimate
  • pregnancy dating
  • preterm birth

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "The rate of preterm birth in the United States is affected by the method of gestational age assignment",
abstract = "OBJECTIVE: The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth.STUDY DESIGN: Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age.RESULTS: The rate of preterm birth was 9.7{\%} when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5{\%} when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54{\%} vs 42{\%}; P <.001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity.CONCLUSION: The preterm birth rate is 9.7{\%} vs 11.5{\%} and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes.",
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author = "Duryea, {Elaine L.} and McIntire, {Donald D.} and Leveno, {Kenneth J.}",
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AU - Leveno, Kenneth J.

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N2 - OBJECTIVE: The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth.STUDY DESIGN: Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age.RESULTS: The rate of preterm birth was 9.7% when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5% when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54% vs 42%; P <.001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity.CONCLUSION: The preterm birth rate is 9.7% vs 11.5% and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes.

AB - OBJECTIVE: The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth.STUDY DESIGN: Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age.RESULTS: The rate of preterm birth was 9.7% when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5% when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54% vs 42%; P <.001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity.CONCLUSION: The preterm birth rate is 9.7% vs 11.5% and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes.

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