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    Does postterm pregnancy increase risk of neonatal morbidity?


    Israeli investigators say that the results of their recent retrospective study indicate that post-term pregnancy increases the likelihood of neonatal morbidity even in low-risk singleton gestations. The conclusion about the association appears in a new report in Archives of Disease in Childhood-Fetal and Neonatal Edition.

    Related: ACOG guidance for late-term and postterm pregnancy

    Conducted in a tertiary university-affiliated medical center, the study was designed to determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns. Over a 5-year period, the investigators analyzed data from all newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks’ gestation. Pregnancies that involved multiple gestations or were complicated by maternal hypertensive disorder, diabetes or cholestasis; placental abruption or intrapartum fever; small for gestational age; or major congenital or chromosomal anomalies were excluded.

    The outcomes of interest to the authors were neonatal intensive care unit (NICU) admission, hospital length of stay, 5-minute Apgar score, birth trauma, and respiratory, neurological, metabolic and infectious morbidities and neonatal mortality. Adverse outcome rates were compared among 3 groups based on gestational age at birth: post-term (≥42+0 weeks), late term (41+0 to 41+6 weeks) and full term (39+0 to 40+6 weeks).

    A total of 23,524 neonates were studied, of whom 18,145 (77.1%) were born full term, 4632 (19.7%) were born late term, and 747 (3.2%) were born post-term. Rates of cesarean delivery and of operative vaginal delivery were significantly higher in the women with the post-term vs late-term deliveries (8.9% vs 5.6%; P<0.001 and 9.6% vs 7.4%, P=0.024, respectively). In the post-term group versus the full-term group, risks were increased of NICU admission (OR 2.0, 95% confidence interval [CI] 1.4-2.8), respiratory morbidity (OR 2.2, 95% CI 1.3-3.8) and infectious morbidity (OR 1.88, 95% CI 1.32-2.69). Similar increases were seen in comparisons of post-term pregnancy vs late-term pregnancy (OR 2.0, 95% CI 1.4-2.9 for NICU admission, OR 2.7, 95% CI 1.5-5.0 for respiratory morbidity, OR 1.8, 95% CI 1.2-2.7 for infectious morbidity, and OR 2.6, 95% CI 1.2-5.4 for hypoglycemia). Post-term delivery was not associated with neonatal mortality.

    NEXT: Impact of maternal fish consumption on their child

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.


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