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Pushing for 39 weeks: Are pregnancies getting longer?

Pushing for 39 weeks: Are pregnancies getting longer?. Michelle J.K. Osterman , M.H.S. Joyce A. Martin , M.P.H . National Center for Health Statistics. Extending Our Reach Through Partnerships June 2-6, 2013 Phoenix , Arizona. Why?. Better outcomes with longer gestation .

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Pushing for 39 weeks: Are pregnancies getting longer?

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  1. Pushing for 39 weeks: Are pregnancies getting longer? Michelle J.K. Osterman, M.H.S. Joyce A. Martin, M.P.H. National Center for Health Statistics Extending Our Reach Through PartnershipsJune 2-6, 2013 Phoenix, Arizona

  2. Why? • Better outcomes with longer gestation 39 or more weeks Early term 38 weeks 36 weeks 37 weeks 35 weeks Late preterm Under 39 weeks 34 weeks

  3. Outline • Outcomes by gestational age • Late preterm (34-36 weeks) • 36 weeks • Early term births (37-38 weeks) • Labor and Delivery Management by gestational age • Induction of Labor • Cesarean delivery

  4. Methods • Birth certificate data • 1990-2010 final • 2011 preliminary • Focus on births under 39 weeks • Gestational age based on date of last menstrual period • Singletons only

  5. Methods • Includes all births • Medically-indicated • Nonmedically-indicated • Definitions • Induction of labor = artificial initiation of labor prior to the onset of spontaneous labor • Cesarean delivery = surgical extraction of the fetus, placenta, and membranes through abdominal incision

  6. Gestational age

  7. Births by gestational age: United States, 1990-2011 39 or more weeks Under 39 weeks NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  8. Births by gestational age: United States, 1990-2011 39 or more weeks Under 39 weeks 37% -11% NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  9. Gestational age groups • Under 39 weeks • Less than 34 weeks = Early preterm • 34-36 weeks = Late preterm • 37-38 weeks = Early term • 39 or more weeks

  10. Births by gestational age: United States, 1990 and 2006 2006 1990 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  11. Births by gestational age: United States, 1990, 2006 and 2011 2006 2011 1990 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  12. Births by gestational age: United States, 2006 and 2011 Late preterm Early term NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  13. Births by gestational age: United States, 2006 and 2011 Late preterm Early term NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  14. Births by gestational age: United States, 2006 and 2011 Late preterm Early term NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  15. Births by gestational age: United States, 2006 and 2011 Late preterm Early term NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  16. Births under 39 weeks • 2006-2011 decrease • 36 weeks (late preterm) • 37 weeks (early term) • 38 weeks (early term) • Combine weeks 36-38

  17. WA MT ND OR MN MA ID SD WY CT NJ DE NE OH DE IL UT CO WV CA VA KS DC MO KY TN OK AR SC AL GA TX FL Change in percentage of births occurring at 36-38 weeks: 2006 and 2011 ME VT NH WI NY RI MI PA IA NE IN MD NC AZ NM AK LA Decrease HI NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  18. Change in percentage of births occurring at 36-38 weeks: 2006 and 2011 MS Decrease No change NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  19. Induction of Labor

  20. Induction of labor: United States, 1990-2011 All gestational ages NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  21. Induction of labor by gestational age: United States, 1990-2011 39 or more weeks Under 39 weeks NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  22. Induction of labor by gestational age: United States, 1990-2011 39 or more weeks Under 39 weeks -7% NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  23. Induction of labor by gestational age: United States, 1990 and 2006 2006 1990 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  24. Induction of labor by gestational age: United States, 1990, 2006 and 2011 2006 2011 1990 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  25. Births under 39 weeks • 2006-2011 decrease • 36 weeks (late preterm) • 37 weeks (early term) • 38 weeks (early term) • Combine weeks 36-38

  26. Change in induction of labor at 36-38 weeks: 2006 and 2011 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  27. WA MT ND OR MN ID MA SD CT WY NJ DE NE OH DE IL UT CO WV CA VA KS DC MO KY TN OK AR SC AL GA TX FL Change in induction of labor at 36-38 weeks: 2006 and 2011 Decrease NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  28. Change in induction of labor at 36-38 weeks: 2006 and 2011 ME VT WI NH RI PA IA NE MD NM MS Decrease No change NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  29. Change in induction of labor at 36-38 weeks: 2006 and 2011 NY MI IN NC AZ AK LA Decrease HI No change Increase NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  30. Cesarean delivery

  31. Cesarean delivery:United States, 1990-2011 All gestational ages NOTES: Singletons only. 2011 data are preliminary. Source: CDC/NCHS, National Vital Statistics System

  32. Cesarean delivery by gestational age:United States, 1990-2011 Under 39 weeks 39 or more weeks NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  33. Cesarean delivery by gestational age:United States, 1990-2011 Under 39 weeks 39 or more weeks -2% NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  34. Cesarean delivery by gestational age: United States, 1996 and 2009 2009 1996 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  35. Cesarean delivery by gestational age: United States, 1996, 2009 and 2011 2009 2011 1996 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  36. Change in cesarean delivery at 37 weeks: 2006 and 2011 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  37. Change in cesarean delivery at 37 weeks: 2006 and 2011 MA DE CO TX Decrease NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  38. WA MT ND OR MN ID SD RI WY CT NJ NE OH DE IL UT CA VA KS MO KY TN OK AR SC AL GA FL Change in cesarean delivery at 37 weeks: 2006 and 2011 ME VT NH WI NY MI PA IA NE IN NC AZ NM MS AK LA Decrease No change NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  39. Change in cesarean delivery at 37 weeks: 2006 and 2011 MD WV DC Decrease HI No change Increase NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  40. Change in cesarean delivery at 38 weeks: 2006 and 2011 NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  41. WA OR MN MA CT NJ NE OH DE IL UT CA MO OK SC GA FL Change in cesarean delivery at 38 weeks: 2006 and 2011 NH NY MI PA DE NE IN CO NC AZ AK TX Decrease HI NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  42. MT ND ID SD WY DE VA KS KY TN AR AL Change in cesarean delivery at 38 weeks: 2006 and 2011 ME VT WI RI IA MD WV DC NM MS LA Decrease No change NOTES: Singletons only. Source: CDC/NCHS, National Vital Statistics System

  43. Summary

  44. Summary • Overall rates • Induction of labor increased from 1990-2006 • Cesarean delivery increased from 1996-2009 • Among births under 39 weeks • 1990-2006 • Percentage of births increased • Most of increase occurred at late preterm and early term • Rate of induction of labor increased • Most of increase occurred at 36-38 weeks • 1996-2009 • Rate of cesarean delivery increased • Most of increase occurred at 37-38 weeks

  45. Summary • Among births under 39 weeks • 2006-2011 • Percentage of births declined 11% • Most of decline occurred at 36, 37, and 38 weeks • Percent of 36-38-week births was down in 49 states and DC • Induction of labor rate declined 7% • All of decline at 36-38 weeks • Rates at 36-38 weeks declined in 32 states and DC; increased in 8 states

  46. Summary • Among births under 39 weeks • 2009-2011 • Rate of cesarean delivery declined 2% • Decline mainly occurred at 37 and 38 weeks • Rates at 37 weeks declined in 4 states; increased in 2 states and DC • Rates at 38 weeks declined in 29 states; unchanged in 21 states and DC

  47. Limitations • Induction of labor • Gestational age • No distinction for medical indication • Medical items not comprehensive • Current data quality concerns • E.g., fetal intolerance of labor

  48. Conclusions • Induction of labor and cesarean delivery are declining for births under 39 weeks. • Percentage of births under 39 weeks declining • Decline in births under 39 weeks is more wide-spread than declines in induction of labor and cesarean delivery • Pregnancies are getting longer!

  49. Thank you!

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