Infant Outcomes After Elective Early-Term Delivery Compared With Expectant Management

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Epidemiology

Background:

• Elective early-term deliveries before 39 weeks gestation are common.
• The risks of neonatal morbidity and infant mortality associated with these deliveries require careful evaluation.

Purpose of the Study:

• To compare neonatal morbidity and infant mortality risks between elective early-term deliveries (37-38 weeks gestation) and expectant management (delivery at 39-40 weeks gestation).

Main Methods:

• Population-based retrospective cohort study of 675,302 singleton infants born between 37-44 weeks gestation in Florida (2005-2009).
• Infants categorized by delivery timing and reason: elective induction, elective cesarean, and expectant management.
• Primary outcomes included neonatal respiratory morbidity, sepsis, feeding difficulties, NICU admission, and infant mortality.

Main Results:

• Elective induction at 37-38 weeks showed no increased odds of respiratory morbidity, sepsis, or NICU admission compared to expectant management, but had slightly higher odds of feeding difficulty.
• Elective cesarean delivery at 37-38 weeks was associated with 13-66% increased odds of adverse outcomes.
• Infant mortality rates were similar across early induction, early cesarean, and expectant management groups.

Conclusions:

• Elective early-term deliveries, particularly inductions, do not appear to significantly increase major neonatal morbidities or infant mortality compared to expectant management.
• Elective cesarean deliveries before 39 weeks gestation are linked to higher adverse outcomes.
• Avoidance of all elective early-term deliveries is not supported; individual pregnancy circumstances are critical.