Abstract
Objective
Prematurity is known to be associated with high rates of endocrine complications. We aimed to determine whether early term delivery (37-38+6 weeks’ gestation) impacts on long term pediatric endocrine and metabolic morbidity.
Study Design
A population-based prospective cohort analysis was performed including all term singleton deliveries occurring between 1991-2013 at a single tertiary medical center. Fetuses with congenital malformations and multiple pregnancies were excluded. Gestational age upon delivery was sub-divided into: early, full (39 - 40+6 weeks’ gestation), late (41 - 41+6 weeks’ gestation) and post term (≥42 weeks). Morbidity up to the age of 18 years involving the endocrine system was evaluated. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. A Cox hazards regression model was used to control for confounders.
Results
During the study period 225,260 term deliveries met the inclusion criteria. Of them, 24% (n=54,073) occurred at early term. Hospitalizations up to the age of 18 years, involving endocrine-metabolic morbidities were significantly more common in the early term group as compared with full and late term delivery groups (Table). Specifically, diabetes mellitus and over-weight were significantly more common among the early term group (p<0.05). The survival curve demonstrated significantly higher cumulative incidence of endocrine morbidity in the early term group (Figure, log rank p<0.001). In the Cox regression model, while controlling for multiple confounders such as maternal diabetes, hypertension, labor induction, and Apgar score, early term delivery exhibited an independent association with long-term childhood endocrine or metabolic morbidity (adjusted HR = 1.3, CI 1.1-1.5, p=0.02) and more so beyond the age of 5 years (adjusted HR =1.4, CI 1.2-1.7, p<0.001).
Conclusion
Deliveries occurring at early term are associated with higher rates of long term pediatric endocrine and metabolic morbidities compared with full and late term deliveries.
Prematurity is known to be associated with high rates of endocrine complications. We aimed to determine whether early term delivery (37-38+6 weeks’ gestation) impacts on long term pediatric endocrine and metabolic morbidity.
Study Design
A population-based prospective cohort analysis was performed including all term singleton deliveries occurring between 1991-2013 at a single tertiary medical center. Fetuses with congenital malformations and multiple pregnancies were excluded. Gestational age upon delivery was sub-divided into: early, full (39 - 40+6 weeks’ gestation), late (41 - 41+6 weeks’ gestation) and post term (≥42 weeks). Morbidity up to the age of 18 years involving the endocrine system was evaluated. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. A Cox hazards regression model was used to control for confounders.
Results
During the study period 225,260 term deliveries met the inclusion criteria. Of them, 24% (n=54,073) occurred at early term. Hospitalizations up to the age of 18 years, involving endocrine-metabolic morbidities were significantly more common in the early term group as compared with full and late term delivery groups (Table). Specifically, diabetes mellitus and over-weight were significantly more common among the early term group (p<0.05). The survival curve demonstrated significantly higher cumulative incidence of endocrine morbidity in the early term group (Figure, log rank p<0.001). In the Cox regression model, while controlling for multiple confounders such as maternal diabetes, hypertension, labor induction, and Apgar score, early term delivery exhibited an independent association with long-term childhood endocrine or metabolic morbidity (adjusted HR = 1.3, CI 1.1-1.5, p=0.02) and more so beyond the age of 5 years (adjusted HR =1.4, CI 1.2-1.7, p<0.001).
Conclusion
Deliveries occurring at early term are associated with higher rates of long term pediatric endocrine and metabolic morbidities compared with full and late term deliveries.
| Original language | Danish |
|---|---|
| Pages (from-to) | S352-S352 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 216 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2017 |