European Journal of Obstetrics & Gynecology and Reproductive Biology 179 (2014) 105109

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European Journal of Obstetrics & Gynecology and

Reproductive Biology
journal homepage: www.elsevier.com/locate/ejogrb

Maternal risk factors and obstetric complications in late preterm

prematurity
Cristina C. Trilla a, *, Maria C. Medina a , Gemma Ginovart b , Jocelyn Betancourt b ,
Josep A. Armengol a , Joaquim Calaf a
a
b

Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 13 October 2013
Received in revised form 18 May 2014
Accepted 22 May 2014

Objective: Late preterm prematurity has been related to poorer neonatal outcomes. However, research
has focused on the neonatal outcomes of late preterm infants, maternal characteristics of these births
have been less evaluated. The aim of the study was to compare maternal risk factors and obstetric
complications in late preterm births (LPTB) and term births. These factors were also assessed comparing
spontaneous LPTB with medically-indicated LPTB.
Study design: We conducted a retrospective cohort study with two groups. All singleton LPTB occurred at
our University Hospital between January 1, 2009 and December 31, 2010 were included in the rst cohort
(n = 171). A comparison cohort of term births was congured in a ratio 2:1 (n = 342). Well-dated
pregnancies without congenital malformations, congenital infections or chromosome abnormalities
were eligible. LPTB were classied into two groups, spontaneous LPTB and medically-indicated LPTB
following delivery indications. Statistical analysis of categorical variables was performed using either x2
or Fishers exact. Continuous variables were compared using the Students t-test.
Results: Women with LPTB had more medical conditions than women with term births (29% vs 15.7%;
P = 0.002). Prior preterm births (9.7% vs 2%; P < 0.001), prior adverse obstetric outcomes (6.9% vs 2.3%;
P < 0.001), and obstetric complications were also more frequent in LPTB than in term births. However, no
differences were found in maternal medical conditions when spontaneous LPTB and medically-indicated
LPTB were compared. Women with medically-indicated LPTB were older (33.69 vs 31.07; P = 0.003) and
mainly nulliparous (75.8% vs 49.4%; P = 0.002). Obstetric complications were more frequent in medicallyindicated LPTB than in spontaneous LPTB.
Conclusions: Maternal risk factors and obstetric complications are signicantly higher in LPTB than in
term births. These factors should be considered to identify women at risk for either spontaneous or
medically-indicated LPTB.
2014 Elsevier Ireland Ltd. All rights reserved.

Keywords:
Late preterm birth
Maternal risk factors
Obstetric complications
Prematurity

Introduction
Prematurity rates have increased in recent years mainly due to
an increase in late preterm births (LPTB) [13], dened as births
occurring between 34 0/7 and 36 6/7 weeks. This group currently
represents nearly 75% of preterm births (PTB). Several factors have
been suggested to contribute to the increase in prematurity rates.
One proposed explanation is that changes in maternal factors, such
as the rise of maternal age at pregnancy and assisted reproduction

* Corresponding author at: Hospital de la Santa Creu i Sant Pau, Department of

Obstetrics and Gynecology, C/Sant Quint 89, Barcelona 8025, Spain.
Tel.: +34 935537041.
E-mail address: trilla.cristina@gmail.com (C.C. Trilla).

techniques, may have increased the number of high-risk pregnancies, which are at higher risk of prematurity [2]. Another possible
explanation is that pregnancies at risk for an adverse perinatal
outcome are often delivered before term. This could be due to a
more comprehensive understanding of fetal adaptation mechanisms to threatening situations [4,5]. The enhancements in
obstetric surveillance and neonatal care have also been cited as
partially responsible for the increase in prematurity rates [2].
Late preterm prematurity has been related to poorer neonatal
outcome [69]. Teune et al. [9] performed a systematic review,
comparing neonatal morbidity in LPTB to term births. The
authors reported higher rates of respiratory distress syndrome,
intraventricular hemorrhage, necrotizing enterocolitis and neonatal death in late preterm infants. Long-term outcomes, such as
mortality in the rst year of life, neurological development and

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C.C. Trilla et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 179 (2014) 105109

school performance, were also worse in LPTB. These results have

increased concern among obstetric and pediatric communities
[10], and indications for delivery in LPTB have been investigated
[11,12].
Previous studies suggest that only a few LPTB are avoidable,
since these preterm births often occur following a maternal or
obstetric complication [13]. However, although extensive research
has been conducted on LPTB, few studies have evaluated the
maternal and obstetric factors specically associated with this
situation. Differences in maternal and obstetric characteristics
between spontaneous and indicated LPTB also remain unknown.
Better knowledge of the maternal risk factors involved in LPTB may
allow to identify patients at risk for LPTB. Better knowledge of the
obstetric complications associated with LPTB may help to
determine which situations would benet from conservative
management, without increasing maternal and perinatal risks by
continuing the pregnancy. We therefore conducted a retrospective
cohort study to evaluate maternal risk factors and obstetric
complications in singleton pregnancies delivered between 34 0/7
and 36 6/7 weeks at our institution. We assessed these factors by
comparing LPTB with term births, and spontaneous LPTB with
medically-indicated LPTB.
Material and methods
We performed a retrospective cohort study of all singleton LPTB
delivered at Hospital de la Santa Creu i Sant Pau in Barcelona, a
tertiary university hospital, between January 1, 2009 and December 31, 2010. A control cohort of term births (37 0/741 6/7 weeks)
was randomly congured in a 2:1 ratio. Approval for the study was
obtained from the ethics committee of the Institutional Review
Board at Hospital de la Santa Creu i Sant Pau, Barcelona.
Eligible cases were identied from the delivery room logbook,
and maternal and pregnancy data were reviewed. Well-dated and
well-controlled singleton pregnancies with a live fetus at hospital
admission were accepted for statistical analysis. Only pregnancies
with rst-trimester ultrasound assessment of gestational age were
considered well-dated. Exclusion criteria for both the study and
control groups were major anatomic malformations, chromosome
abnormalities and congenital infections.
Data were collected through retrospective chart review. We
recorded information on maternal age, parity, prior uterine

surgery, articial reproductive technique (ART), history of PTB,

and history of adverse obstetric outcome (dened as 3 or more
miscarriages, second trimester fetal loss, prior fetal major
malformation or prior chromosome abnormality). Presence of
maternal medical disorders was reviewed. We considered for
analysis hypertensive, endocrinological (thyroid disorders and
diabetes), autoimmune and prothrombotic disorders. Congenital
heart diseases and infectious conditions were also noted. Other
maternal medical disorders (e.g. neurological, psychiatric, rheumatic or respiratory conditions) were considered as others for
the analysis. This category included medical conditions that are
less likely to be linked to pregnancy-related complications. We
created a composite variable to measure maternal medical
disorders. This variable, composite maternal morbidity, was
dened as the presence of one or more medical disorders.
Pregnancy-related complications analyzed were hypertensive
disorders of pregnancy (gestational hypertension and preeclampsia), intrauterine growth restriction (IUGR), intrahepatic cholestasis of pregnancy, gestational diabetes, and bleeding in the second
half of pregnancy (abruptio placentae, placenta previa). Other
pregnancy-related complications (e.g. urinary tract infections,
ovarian hyperstimulation syndrome, alterations in the quantity of
amniotic uid, maternal anemia) were considered as others for
the analysis. We also recorded maternal antenatal care requirements (admission to the High Risk Obstetric Unit, antenatal
corticosteroid and tocolytic treatment). Finally, indication for
delivery and mode of delivery were noted. The study investigators
jointly resolved all uncertainties and discrepancies in the medical
charts.
For comparative purposes, LPTB were classied into two groups,
spontaneous LPTB and medically-indicated LPTB. We considered
LPTB was spontaneous when preterm premature rupture of
membranes (PPROM) or spontaneous preterm labor (SPTL)
occurred between 34 0/7 and 36 6/7 weeks, as in these cases
our current protocols recommend immediate delivery. Women
admitted to hospital for SPTL or PPROM in the late preterm period
were included in the spontaneous group even if they presented
other obstetric complications. We considered LPTB as medicallyindicated when delivery occurred following an obstetric or
maternal complication. As established in our institutional protocols, when PPROM occurred before 34 0/7 weeks, conservative
management was adopted after excluding chorioamnionitis

Fig. 1. Diagram of included and excluded patients. This gure shows the study prole. Causes for patient exclusion are also detailed.

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Table 1
Maternal clinical characteristics of the late preterm and term groups.
Maternal characteristic

Late preterm
(n = 145)

Term (n = 299)

P value

32.19  5.33
31.84  5.10
0.511
Maternal age, (years)a
Nulliparity, n (%)
88 (60.7)
187 (62.5)
0.755
Prior uterine surgery, n (%)
16 (11.1)
24 (8)
0.295
History of preterm birth, n (%)
14 (9.7)
6 (2)
<0.001*
History of adverse obstetric
7 (2.3)
0.031*
10 (6.9)
outcome, n (%)
13 (9)
Articial reproductive
16 (5.4)
0.156
technique, n (%)
47 (15.7)
0.002*
Composite maternal
42 (29)
morbidity, n (%)
Hypertensive disorder, n (%)
4 (2.8)
1 (0.3)
Endocrinological disease, n (%)
11 (7.6)
16 (5.4)
Prothrombotic condition, n (%)
11 (7.6)
5 (1.7)
Congenital heart disease, n (%)
2 (1.4)
1 (0.3)
Infectious condition, n (%)
2 (1.4)
4 (1.3)
Cervical conization, n (%)
1 (0.7)
2 (0.7)
Other, n (%)
16 (11.1)
18 (6)
*
a

Denotes signicant differences (P < 0.05).

Data are given as mean  SD.

criteria. If pregnancy reached 34 0/7 weeks, labor was induced and

prematurity was classied as medically-indicated.
A specic database was created, and a spreadsheet format was
used for statistical analysis. Statistical analysis was performed
using SPPS (version 17.0, SPSS Inc., Chicago IL). Associations
between categorical variables were evaluated using either x2 or
Fishers exact test where necessary. The MannWhitney U test was
used for ordinal variables. Continuous variables were compared
using the Student's t-test. Both the variables that were statistically
signicant in the univariate analysis, and the variables that were
considered clinically relevant, were further investigated using
multivariate logistic regression analysis. A P value < 0.05 was used
to dene statistical signicance.
Results
During the two-year study period, there were 3545 singleton live
births at our institution, 6.43% (n = 228) of which were singleton PTB.
Out of the 228 singleton PTB, 74.9% (n = 171) were singleton LPTB. A
control group of 342 term births was randomly congured. Of the
171 LPTB and 342 term births selected for the study, 84.8% (n = 145)
and 87.4% (n = 299), respectively, met selection criteria and were
eligible for analysis. Fig.1 shows the study sample selection process.
In the LPTB group, 19.3% (n = 28) infants were delivered at 34 (34 0/

107

734 6/7) weeks, 25.6% (n = 40) at 35 (35 0/735 6/7) weeks, and
53.1% (n = 77) at 36 (36 0/736 6/7) weeks.
Maternal clinical characteristics of LPTB and term births are
described in Table 1. No differences were found with regard to
maternal age, parity, ART or prior uterine surgery. History of PTB
and prior adverse obstetric outcome were more frequent in LPTB
than in full-term pregnancies (9.7% vs 2%; P < 0.001, and 6.9% vs
2.3%; P < 0.05, respectively). Composite maternal morbidity rate
was also signicantly higher in women with LPTB (29% vs 15.7%;
P < 0.01). Endocrinological disorders were the most frequent
medical disorders in both LPTB and term groups, followed by
prothrombotic conditions.
The obstetric characteristics of LPTB and term groups are
summarized in Table 2. Rates of all reviewed pregnancy-related
complications were signicantly higher in the LPTB group. IUGR
and intrahepatic cholestasis of pregnancy were the obstetric
complications most frequently observed in LPTB (15.2% and 10.3%,
respectively), whereas gestational diabetes was the most frequent
complication in term births (4.3%). Women who delivered at late
preterm period were more likely to require admission to the High
Risk Obstetric Unit, antenatal corticosteroid and tocolytic treatments. As regards the mode of delivery, more than 40% of late
preterm infants were delivered by caesarean section (42.8% vs
21.4%; P < 0.001).
Composite maternal morbidity, obstetric complications, history
of PTB, prior adverse obstetric outcome and ART were included in
the multivariate analysis. Only composite maternal morbidity (OR
1.86; 95% CI, 1.113.09), obstetric complications (OR 3.83; 95% CI,
2.446.04), and history of PTB (OR 5.08; 95% CI, 1.8014.31),
remained signicantly associated with LPTB (data not showed in
tables).
Of the 145 LPTB analyzed, 57% (n = 83) were spontaneous and
43% (n = 62) were medically-indicated. In the spontaneous group
13 neonates were born at 34 weeks, 27 at 35 weeks, and 43 at 36
weeks. In the medically-indicated group 15 neonates were
delivered at 34 weeks, 13 at 35 weeks, and 34 at 36 weeks.
Distribution by gestational age at delivery showed no differences
between groups (P = 0.207). Medically-indicated LPTB were mainly
due to an obstetric complication, and only two cases occurred
exclusively as a result of a maternal situation (one elective delivery
at 36 weeks in a woman with a high-risk prothrombotic condition,
and one elective delivery at 36 weeks in a woman with severe
gastroenteritis). Three pregnancies were complicated by PPROM
before 34 0/7 weeks (one case at 26 weeks, and two cases at 33
weeks). Conservative management was adopted after excluding
chorioamnionitis, and labour was induced at 34 weeks. These cases

Table 2
Obstetric characteristics of the late preterm and term groups.
Obstetric characteristic

Late preterm (n = 145)

Term (n = 299)

P value

Maternal admission to the High Risk Obstetric Unit, n (%)

Corticosteroid therapy, n (%)
Tocolytic therapy, n (%)

25 (17.4)
24 (16.7)
19 (13.1)

4 (1.3)
1 (0.3)
0 (0)

<0.001*
<0.001*
<0.001*

Obstetric complications
Hypertensive disease, n (%)
Intrauterine growth restriction, n (%)
Intrahepatic cholestasis of pregnancy, n (%)
Gestational diabetes, n (%)
Bleeding in the second half of pregnancy, n (%)
Other, n (%)

11 (7.6)
22 (15.2)
15 (10.3)
14 (9.7)
7 (4.8)
10 (6.9)

6 (2)
5 (1.7)
2 (0.7)
13 (4.3)
4 (1.3)
26 (8.7)

0.007*
<0.001*
<0.001*
0.035*
0.045*
0.582

Mode of delivery
Vaginal delivery, n (%)
Operative vaginal delivery, n (%)
Caesarean section, n (%)

83 (57.2)
18 (21.7)
62 (42.8)

235 (78.6)
77 (32.7)
64 (21.4)

<0.001*
<0.001*
<0.001*

Denotes signicant differences (P < 0.05)

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C.C. Trilla et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 179 (2014) 105109

were categorized as medically-indicated, in accordance with the

study protocol.
Differences in maternal and obstetric characteristics were
assessed comparing spontaneous LPTB with medically-indicated
LPTB (Table 3). Women with medically-indicated LPTB were more
likely to be older and nulliparous, but no differences were found
between the two groups in the composite maternal morbidity rate
(33.9% vs 25.3%; P = 0.273). As medically-indicated LPTB were
dened as deliveries occurring following an obstetric or maternal
complication, pregnancy-related complications were more frequent in this group. Table 4 illustrates these results. Maternal
antenatal care was equally required in both groups. Conversely,
caesarean rate was signicantly higher in medically-indicated
LPTB (74.2% vs 19.3%; P < 0.001). Composite maternal morbidity,
obstetric complications, maternal age, nulliparity, history of PTB,
ART were included in the multivariate analysis. The only variable
that was signicantly associated with medically-indicated LPTB
was the presence of an obstetric complication (OR 46.48; 95% CI,
17.16125.92) (data not showed in tables).
Comment

Table 3
Maternal clinical characteristics of the spontaneous and medically-indicated LPTB.
Spontaneous
LPTB (n = 83)

31.07  5.18
Maternal age, (years)a
Nulliparity, n (%)
41 (49.4)
Prior uterine surgery, n (%)
12 (14.5)
History of preterm birth, n
9 (10.8)
(%)
History of adverse obstetric
5 (6)
outcome, n (%)
Articial reproductive
7 (8.4)
technique, n (%)
21 (25.3)
Composite maternal
morbidity, n (%)
1 (1.2)
Hypertensive disorder, n (%)
Endocrinological disease, n
6 (7.2)
(%)
4 (4.8)
Prothrombotic condition, n
(%)
1 (1.2)
Congenital heart disease, n
(%)
2 (2.4)
Infectious condition, n (%)
Cervical conization, n (%)
0 (0)
Other, n (%)
10 (12)
*
a

Obstetric characteristic

Spontaneous
LPTB (n = 83)

Medicallyindicated LPTB
(n = 62)

Maternal admission at High

Risk Obstetric Unit, n (%)
Corticosteroid therapy, n (%)
Tocolytic therapy, n (%)

12 (14.6)

13 (21)

Denotes signicant differences (P < 0.05).

Data are given as mean  SD.

Medically- indicated P value

LPTB (n = 62)
33.69  5.19
47 (75.8)
4 (6.5)
5 (8.1)

0.003*
0.002*
0.181
0.777

5 (8.1)

0.582

6 (9.7)

21 (33.9)
3 (4.8)
4 (6.5)
7 (11.3)
1 (1.6)
0 (0)
1 (1.6)
6 (9.7)

0.273

13 (15.9)
13 (15.7)

Obstetric complications
0 (0)
Hypertensive disease, n (%)
Intrauterine growth restriction,
2 (2.4)
n (%)
Intrahepatic cholestasis of
1 (1.2)
pregnancy, n (%)
Gestational diabetes, n (%)
6 (7.2)
Bleeding in the second half of
2 (2.4)
pregnancy, n (%)
2 (2.4)
Other, n (%)
Mode of delivery
Vaginal delivery, n (%)
67 (80.7)
Caesarean section, n (%)
16 (19.3)
*

Our study showed that women with LPTB had more medical
disorders, mainly endocrinological and prothrombotic conditions.
However, no differences were observed when spontaneous and
medically-indicated LPTB were compared. We have also identied
other maternal risk factors highly associated with LPTB. According
to our data, the rate of prior PTB was up to 5-fold higher in LPTB,
corroborating ndings from previous studies assessing recurrence
of PTB [14]. However, no differences were noted in prior PTB rate
when we compared spontaneous and medically-indicated LPTB.
The rate of ART was similar in LPTB and term births. One possible
explanation for this nding is that we only included singleton
pregnancies, and risk of prematurity in pregnancies achieved
through ART is mainly associated with multiple pregnancies.
According to our results, prior PTB, history of adverse obstetric
outcome, and the presence of maternal medical conditions were
equally associated with spontaneous and medically-indicated
LPTB. This suggests these factors are not suitable to distinguish
women at risk for spontaneous LPTB from women at risk for
medically-indicated LPTB. As expected, the risk of developing

Maternal characteristics

Table 4
Obstetric characteristics of the spontaneous and indicated LPTB.
P value

0.377

11 (17.7)
6 (9.7)

0.823
0.330

11 (17.7)
20 (32.3)

<0.001*
<0.001*

14 (22.6)

<0.001*

8 (12.9)
5 (8.1)

0.270
0.138

8 (12.9)

0.019*
<0.001*

16 (25.8)
46 (74.2)

Denotes signicant differences (P < 0.05).

obstetric complications during pregnancy was increased in LPTB.

This increase was also observed in medically-indicated LPTB as
compared with spontaneous LPTB. IUGR and cholestasis were the
most frequent obstetric complications in LPTB, whereas these
complications were rare in term births. Our current protocols
recommend earlier delivery in many cases of IUGR and cholestasis.
This may explain the differences in obstetric complications
between LPTB and term births.
Multiple maternal factors have been related to PTB [15].
However, these factors have not been so well studied in the late
preterm period. We observed that prematurity risk factors also
have a signicant role in LPTB. Shapiro-Mendoza et al. [16] showed
that maternal medical conditions are associated with a higher risk
for neonatal morbidity. Our study adds to their conclusions that
maternal medical disorders can be helpful in identifying women at
risk for LPTB. Pregnancy-related complications have also been
associated with both spontaneous and medically-indicated LPTB
[6,12]. Our ndings are consistent with these results. Hypertensive
disorders of pregnancy have been reported as the most frequent
obstetric complication in LPTB [12], whereas in our study the most
frequent complication was IUGR. However, hypertensive disorders
and IUGR were together responsible for 42% of medically-indicated
LPTB. This supports the nding that placental disease and indicated
prematurity are intimately related.
Indications for delivery in LPTB have been previously investigated. In our study more than 40% of LPTB were medicallyindicated, which is a higher rate than those published by other
authors [12,17] (31.8% and 32.3%, respectively). This might be
explained by the fact that our center is a tertiary referral hospital
for high-risk pregnancies. As in our study, Gyam-Bannerman et al.
[12] classied LPTB as spontaneous or non-spontaneous according
to indication for delivery. They further categorized non-spontaneous LPTB as evidence-based or non-evidence based births, and
concluded that 56.3% of indicated deliveries were non-evidence
based. Our study did not aim to evaluate indications for delivery in
LPTB. We thus reported maternal and obstetric complications
without distinguishing between evidence and non-evidence based
deliveries. It is likely that some medically-indicated LPTB included
in our study were non-evidence based, and this might also explain
the high rate of indicated deliveries in the LPTB group.
To our knowledge, this is the rst study comparing maternal
clinical characteristics of spontaneous and medically-indicated
LPTB. We found that women with medically-indicated LPTB were

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signicantly older and more frequently nulliparous. Maternal age

and nulliparity have been recognized as risk factors for several
obstetric complications [18,19]. In Spain, maternal age at
pregnancy has increased over the past years (from 28.2 years in
1980 to 31.3 years in 2011), and this increase has been more
pronounced than in other European countries. However, maternal
age and nulliparity are conicting risk factors. These factors were
included in the multivariate analysis, and only obstetric complications remained signicantly associated with medically-indicated
LPTB. Thus, older and nulliparous pregnant women should be
considered at risk both for an obstetric complication and a
medically-indicated LPTB. We also evaluated antenatal care
requirements of LPTB. Obstetric complications were more frequent
in LPTB, and maternal antenatal care was subsequently more
necessary in this group. On the contrary, antenatal care requirements were similar in spontaneous and medically-indicated LPTB,
despite higher rates of obstetric complications in the indicated
group. Our results suggest that spontaneous and medicallyindicated LPTB should not be considered together when evaluating
LPTB.
The chart review of every patient included in our study allowed a
more accurate data assessment than abstraction from large databases. We only accepted deliveries with rst-trimester ultrasound
assessment of gestational age, which is more precise than dating
from the last menstrual period. Additionally, only pregnancies
delivered in the late preterm period were included, whereas other
studies evaluating late preterm prematurity also included 33-week
births. We believe 34 weeks is an important time reference to
evaluate causes and consequences of prematurity.
Our study has some limitations. Firstly, pregnancy-related
complications were assessed without considering the severity of
the condition, information of interest when assessing the obstetric
characteristics of LPTB. Secondly, our study was not adequately
powered to establish relationships between the presence of
maternal medical disorders and the occurrence of obstetric
complications. Another debatable aspect is the sample size of
the LPTB group for the comparison of spontaneous and medicallyindicated LPTB. We cannot conclude that these results would
persist with a larger sample, although we believe our ndings have
a clinical signicance.
The increase in LPTB is due to a rise in medically-indicated LPT
[20,21], a rise that has led to a decline in stillbirths and neonatal
deaths [22]. At the same time, however, research suggests that
neonatal morbidity is higher in late preterm infants than in term
infants [10,23,24], and these results have been conrmed in lowrisk spontaneous LPTB [25]. This excess of neonatal morbidity and
the increase in medically-indicated LPTB rates are therefore
controversial [26,27], and studies assessing whether LPTB are
avoidable have reached conicting conclusions [13,17,26]. This
suggests that risks and benets of medically-indicated preterm
deliveries must be individually assessed at every gestational age,
including the late preterm period.
Our results suggest that clinical and obstetric risk factors may
help identify women at risk for LPTB. Our study also provides
information on the maternal and obstetric differences between
spontaneous and medically-indicated LTPB. Although more data
are needed to address these differences, we believe it is important
to consider spontaneous and medically-indicated LPTB as two
different conditions, both clinically and in research. Clinical

109

practice guidelines should insist on maternal clinical characteristics for a thorough identication of patients at risk for LPTB.
Better assessment of both maternal and fetal risks of obstetric
complications at late preterm period is needed.
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