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Cause of Preterm Birth as a Prognostic Factor for Mortality
Pierre Delorme1, François Goffinet, Pierre-Yves Ancel
1Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, the Department of Gynecology and Obstetrics, St. Joseph Hospital, the Department of Obstetrics and Gynecology, Hôtel Dieu Hospital, CIC P1419 Cochin Hotel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, the Department of Neonatal Pediatrics, Trousseau Hospital, Sorbonne Universités, and the Department of Obstetrics and Gynecology, Trousseau Hospital, Paris, the Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, University Hospital and the Department of Neonatal Pediatrics, University Hospital, Grenoble, the Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, Paul Sabatier University, and the Department of Obstetrics and Gynecology, University Hospital, Toulouse, the Department of Neonatal Pediatrics and Intensive Care, CHI, CRC, Créteil, the Department of Obstetrics and Gynecology, Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Jeanne de Flandre Hospital, Lille, the Department of Obstetrics and Gynecology, University Hospital, UMR 1280 Physiologie des adaptations nutritionnelles, Nantes, the Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Marseille, and the Department of Gynecology and Obstetrics, University Hospital, Caen, France; and the Department of Obstetrics and Gynecology, Princess Grace Hospital, Monaco.
Objective:
To investigate the association of the cause of preterm birth on in-hospital mortality of preterm neonates born from 24 to 34 weeks of gestation.
Methods:
L'Etude épidémiologique sur les petits âges gestationnels (EPIPAGE)-2 is a prospective, nationwide, population-based cohort of very preterm births. After dividing causes of preterm birth into six mutually exclusive groups, we analyzed the association of each cause with in-hospital deaths of preterm neonates born alive with adjustment for organizational, maternal, and obstetric factors.
Results:
The analysis included 3,138 singleton live births from 24 to 34 weeks of gestation with a newborn in-hospital mortality rate of 5.0% (95% confidence interval 4.5-5.7). Preterm labor was the most frequent cause of preterm birth (n=1,293 [43.5%]) followed by preterm premature rupture of membranes (n=765 [23.9%]), hypertensive disorders without suspected fetal growth restriction (n=397 [12.7%]), hypertensive disorders with suspected fetal growth restriction (n=408 [10.9%]), placental abruption after an uncomplicated pregnancy (n=92 [3.0%]), and suspected fetal growth restriction without hypertensive disorders (n=183 [5.9%]). Neonates born because of suspected fetal growth restriction with or without hypertensive disorders (adjusted odds ratio [OR] 3.0 [1.9-4.7] and adjusted OR 2.3 [1.1-4.6], respectively) had higher adjusted risks of in-hospital death than those born after preterm labor. Risks of in-hospital mortality for preterm births caused by preterm premature rupture of membranes (adjusted OR 1.3 [0.9-1.9]), hypertensive disorders without fetal growth restriction (adjusted OR 0.7 [0.4-1.4]), or placental abruption (adjusted OR 1.6 [0.7-3.7]) were similar to those born after preterm labor.
Conclusion:
Among neonates born alive before 34 weeks of gestation, only those born because of suspected fetal growth restriction have a higher mortality risk than those born after preterm labor.
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