Jay D Iams

The Ohio State University, Columbus, Ohio, United States

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Publications (177)1028.61 Total impact

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    ABSTRACT: To evaluate whether racial and ethnic disparities exist in obstetric care and adverse outcomes. We analyzed data from a cohort of women who delivered at 25 hospitals across the United States over a 3-year period. Race and ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, or Asian. Associations between race and ethnicity and severe postpartum hemorrhage, peripartum infection, and severe perineal laceration at spontaneous vaginal delivery as well as between race and ethnicity and obstetric care (eg, episiotomy) relevant to the adverse outcomes were estimated by univariable analysis and multivariable logistic regression. Of 115,502 studied women, 95% were classified by one of the race and ethnicity categories. Non-Hispanic white women were significantly less likely to experience severe postpartum hemorrhage (1.6% non-Hispanic white compared with 3.0% non-Hispanic black compared with 3.1% Hispanic compared with 2.2% Asian) and peripartum infection (4.1% non-Hispanic white compared with 4.9% non-Hispanic black compared with 6.4% Hispanic compared with 6.2% Asian) than others (P<.001 for both). Severe perineal laceration at spontaneous vaginal delivery was significantly more likely in Asian women (2.5% non-Hispanic white compared with 1.2% non-Hispanic black compared with 1.5% Hispanic compared with 5.5% Asian; P<.001). These disparities persisted in multivariable analysis. Many types of obstetric care examined also were significantly different according to race and ethnicity in both univariable and multivariable analysis. There were no significant interactions between race and ethnicity and hospital of delivery. Racial and ethnic disparities exist for multiple adverse obstetric outcomes and types of obstetric care and do not appear to be explained by differences in patient characteristics or by delivery hospital. II.
    Obstetrics and Gynecology 05/2015; 125(6):1. DOI:10.1097/AOG.0000000000000735 · 4.37 Impact Factor
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    ABSTRACT: The standard weekly dose of 17-alpha hydroxyprogesterone caproate (17OHP-C 250 mg/week) to reduce the risk of recurrent preterm birth was adopted without regard to patient characteristics. We examined the relationship between pre-pregnancy body mass index (BMI) and gestational age at birth after 17OHP-C prophylaxis. We hypothesized that rates of births before 32, 35, and 37 weeks of gestation would be increased in women with BMI ≥25. A retrospective cohort study was conducted from a de-identified database of women treated with 17OHP-C for prior spontaneous preterm birth. The frequency of recurrent preterm delivery before 32, 35, and 37 weeks of gestation was investigated for women with BMI <25 compared to women with BMI ≥25. The adjusted relative risk of preterm delivery was estimated through a modified Poisson regression approach. Of 390 women who met inclusion criteria, 60 (15.4%) delivered before 32 weeks, 89 (22.8%) before 35 weeks and 156 (40.0%) before 37 weeks. 174 women had a BMI <25 (mean (SD): 21.2 (2.5)) and 216 had a BMI ≥25 (mean (SD): 33.5 (6.7)). Risk of birth before 32 weeks was 1.7 times higher on average (aRR (95% CI): 1.7 (1.05-2.77)) in overweight women than in women with BMI <25, adjusting for age, race, smoking and short cervix. There was no difference in risk of preterm birth before 35 or 37 weeks. Among pregnant women receiving 17OHP-C prophylaxis for a prior preterm birth, recurrent preterm birth before 32 weeks was significantly more common in those women whose pre-pregnancy BMI was ≥25 kg/m(2) than in women with BMI below 25. This observation is consistent with others suggesting that dosing regimens of 17OHP-C may affect efficacy. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 04/2015; DOI:10.1016/j.ajog.2015.04.018 · 3.97 Impact Factor
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    ABSTRACT: Objective The aim of the study was to evaluate associations between fetal growth and weight at 2 years in infants born preterm using a customized approach for birth weight. Study Design This is a secondary analysis of a multicenter trial that included a 2-year follow-up of children born prematurely. Customized birth weight percentiles were calculated using the Gardosi model for a U.S. population, and the relation between customized percentile and weight and height at 2 years (adjusted for gender using z-score) was determined using regression analysis and by comparing z-scores for children with birth weight <10th versus ≥10th percentile. Results Weight z-score at 2 years was significantly lower in the <10th than in the ≥10th percentile group (median [interquartile range, IQR]: -0.66 [-1.58, -0.01] vs. -0.23 [-1.05, 0.55]; p < 0.001), and remained after adjusting for maternal education (p < 0.001). A similar relationship was noted for height z-score between groups (median [IQR]: -0.56 [-1.29, 0.19] vs. -0.24 [-0.99, 0.37]; p < 0.001). Positive relationships between customized birth weight percentile and weight and height at 2 years were noted (p < 0.001 for both), but were not strong (R (2) = 0.04 and 0.02, respectively). Conclusion Customized birth weight percentile is a minor determinant of weight at 2 years among children born preterm. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 03/2015; 32(06). DOI:10.1055/s-0035-1544947 · 1.60 Impact Factor
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    ABSTRACT: To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States. This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed. There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all). Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 03/2015; 125(3):1. DOI:10.1097/AOG.0000000000000680 · 4.37 Impact Factor
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    ABSTRACT: To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes. Cohort study of a random sample of deliveries performed at 25 hospitals over three years. Condition-specific protocols were collected from all hospitals and categorized independently by two authors. Data on maternal and neonatal outcomes, as well as data necessary for risk adjustment were collected. Risk-adjusted outcomes were compared according to whether the patient delivered in a hospital with condition-specific obstetric protocols at the time of delivery. Hemorrhage-specific protocols were not associated with a lower rate of postpartum hemorrhage or with fewer cases of EBL >1000cc. Similarly, in the presence of a shoulder dystocia protocol, there were no differences in the frequency of shoulder dystocia or number of shoulder dystocia maneuvers used. Conversely, preeclampsia-specific protocols were associated with fewer ICU admissions (OR 0.28, 95% CI 0.18-0.44) and fewer cases of severe maternal hypertension (OR 0.86, 95% CI 0.77-0.96). The presence of condition-specific obstetric protocols was not consistently shown to be associated with improved risk-adjusted outcomes. Our study would suggest that the presence or absence of a protocol does not matter and regulations to require protocols are not fruitful. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; DOI:10.1016/j.ajog.2015.01.055 · 3.97 Impact Factor
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    ABSTRACT: The primary aim of the "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" is to determine maternal characteristics, which include genetic, physiologic response to pregnancy, and environmental factors that predict adverse pregnancy outcomes. Nulliparous women in the first trimester of pregnancy were recruited into an observational cohort study. Participants were seen at 3 study visits during pregnancy and again at delivery. We collected data from in-clinic interviews, take-home surveys, clinical measurements, ultrasound studies, and chart abstractions. Maternal biospecimens (serum, plasma, urine, cervicovaginal fluid) at antepartum study visits and delivery specimens (placenta, umbilical cord, cord blood) were collected, processed, and stored. The primary outcome of the study was defined as pregnancy ending at <37+0 weeks' gestation. Key study hypotheses involve adverse pregnancy outcomes of spontaneous preterm birth, preeclampsia, and fetal growth restriction. We recruited 10,037 women to the study. Basic characteristics of the cohort at screening are reported. The "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" cohort study methods and procedures can help investigators when they plan future projects. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 01/2015; 212(4). DOI:10.1016/j.ajog.2015.01.019 · 3.97 Impact Factor
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    ABSTRACT: The preterm birth rate in the United States declined to 11.4% in 2013, the lowest level since 1997. Although the United States has one of the highest preterm birth rates in the developed world, we are improving this outcome and therefore improving the lives of thousands of infants. Demographic changes which may be responsible include a reduced teenage birth rate and fewer higher order multiples. Additionally, a public policy shift to prevent non-medically indicated births before 39 weeks, as well as smoking bans in several states have been associated with the reduced rate of preterm births. Lastly, interventions such as 17 hydroxyprogesterone caproate, vaginal progesterone, and the use of cerclage in selected populations, are probably also contributing to the reduction in preterm deliveries. However, a large portion of these births could still be prevented with greater access and implementation of our current interventions, reduction of modifiable risk factors for preterm birth, and expanded reporting of outcomes and risk factors to facilitate research for both prevention and treatment. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 12/2014; DOI:10.1016/j.ajog.2014.12.011 · 3.97 Impact Factor
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    ABSTRACT: To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis. © 2013 by the American Institute of Ultrasound in Medicine.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2014; 33(12):2187-92. DOI:10.7863/ultra.33.12.2187 · 1.53 Impact Factor
  • Jay D Iams
    American Journal of Obstetrics and Gynecology 11/2014; 211(5):443. DOI:10.1016/j.ajog.2014.07.030 · 3.97 Impact Factor
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    ABSTRACT: Objective This study aims to evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes (PPROM) between 24 and 31(6/7) weeks' gestation. Study Design This is a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Gravid women with a singleton pregnancy between 24 and 31(6/7) weeks' gestation with PPROM without evidence of labor were randomized to receive magnesium sulfate, administered intravenously as a 6-g bolus followed by a constant infusion of 2 g per hour up to 12 hours, or placebo. Maternal outcomes for this analysis were delivery in less than 48 hours and in less than 7 days from randomization. Neonatal outcomes included a composite of respiratory distress syndrome, interventricular hemorrhage grades 3 or 4, periventricular leukomalacia, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Results A total of 1,259 women were included. The rate of delivery < 48 hours was not different in the magnesium sulfate and the placebo groups (22.2 and 20.7%, p = 0.51). Delivery < 7 days was similar between groups (55.4 and 51.4%, p = 0.16). Median latency was also similar between groups (median [interquartile range], 6.0 days [range, 2.4-13.8 days] and 6.6 days [range, 2.4-15.1 days], p = 0.29). Composite neonatal outcomes did not differ between groups. Conclusion Magnesium sulfate administration given for neuroprotection in women with a singleton gestation with PPROM and without labor before 32 weeks does not impact latency.
    American Journal of Perinatology 09/2014; 32(04). DOI:10.1055/s-0034-1387930 · 1.60 Impact Factor
  • Jay D Iams
    American Journal of Obstetrics and Gynecology 09/2014; 211(3):271-4. DOI:10.1016/j.ajog.2014.07.002 · 3.97 Impact Factor
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    ABSTRACT: Objective To determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care. Study Design The Assessment of Perinatal EXcellence (APEX) cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and the obstetric care provided. Results 115,502 women were included in the study. For most outcomes, between 20 and 40% of hospital differences in outcomes were related to differences in patient populations. After controlling for patient-, provider- and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes, but these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, between 50 and 100% of the inter-hospital variation in outcomes was unexplained. Conclusion Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
    American journal of obstetrics and gynecology 08/2014; 211(2). DOI:10.1016/j.ajog.2014.03.017 · 3.97 Impact Factor
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    ABSTRACT: Objective To test whether elevated umbilical cord serum inflammatory cytokine levels predicted subsequent cerebral palsy (CP) or neurodevelopmental delay (NDD). Study Design Nested case-control analysis within a clinical trial of antenatal magnesium sulfate (MgSO4) before anticipated preterm birth (PTB) for prevention of CP, with evaluation of surviving children at the age of 2. NDD was defined as a Bayley psychomotor developmental index (PDI) and/or mental developmental index (MDI) < 70. Controls, defined as surviving children without CP and with Bayley PDI and MDI ≥ 85, were matched by race and gestational age. Cord serum was analyzed for interleukin-8 (IL-8) interleukin-1 beta (IL-1β), and tumor necrosis factor-α (TNF-α) levels. Elevated cytokine levels were defined as ≥ 75th percentile in placebo-exposed controls. Analyses compared case/control cytokine levels, adjusting for MgSO4 exposure, gestational age, race/ethnicity, and sociodemographic differences. Results Logistic regression analysis with 339 cases and 276 controls showed that elevated IL-8 and IL-1β were more common in cord blood serum from infants with subsequent low MDI as compared with controls. After adjusting for additional confounders, the significant differences were no longer evident. Cytokine levels (IL-8, IL-1β, and TNF-α) were not elevated with CP or low PDI. Conclusion Cord serum IL-8, IL-1β, and TNF-α levels in preterm infants are not associated with subsequent CP or NDD.
    American Journal of Perinatology 06/2014; 30(02). DOI:10.1055/s-0034-1376185 · 1.60 Impact Factor
  • Jay D Iams
    New England Journal of Medicine 05/2014; 370(19):1861. DOI:10.1056/NEJMc1402822 · 54.42 Impact Factor
  • Jay D Iams
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    ABSTRACT: Recognition of preterm birth as the major underlying cause of infant mortality in the United States has placed responsibility for prevention in the hands of obstetrician-gynecologists. The advent of effective methods to identify and treat women with increased risk is a major advance that will alter the focus of prenatal care. Adoption of research findings into clinical practice, never an easy task, will be particularly challenging for efforts to reduce the risk of preterm birth. Historical risk factors for preterm birth are numerous and variably defined. Measurement of the length of the cervix with ultrasonography requires unique personnel and facilities. Care algorithms exist but lack the detailed information that comes with experience. This review offers perspective and detail to aid health care practitioners in developing a prematurity prevention strategy appropriate to their practice population.
    Obstetrics and Gynecology 05/2014; DOI:10.1097/AOG.0000000000000276 · 4.37 Impact Factor
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    ABSTRACT: To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.Supplemental Digital Content is Available in the Text. This was a secondary analysis of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (more than three units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity; these were used to develop a prediction model for severe maternal morbidity. Among 115,502 women who delivered during the study period, 332 (2.9/1,000 births, 95% confidence interval 2.6-3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver operating characteristic curve of 0.80. Severe maternal morbidity occurs in approximately 2.9 per 1,000 births, is most commonly the result of postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 04/2014; 123(4):804-810. DOI:10.1097/AOG.0000000000000173 · 4.37 Impact Factor
  • Jay D Iams
    American journal of obstetrics and gynecology 02/2014; 210(2):97-8. DOI:10.1016/j.ajog.2013.10.013 · 3.97 Impact Factor
  • Jay D Iams
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    ABSTRACT: This article reviews risk factors for preterm delivery, with special attention to previous preterm birth and a short cervix. Strategies for minimizing the risk of preterm birth among high-risk women, including progesterone supplementation and cerclage, are discussed. ForewordThis Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.StageA woman presents for prenatal care in the first trimester of her third pregnancy. Her first child was born at 30 weeks of gestation after preterm labor. Her second pregnancy ended in delivery at 19 weeks of gestation. How would you recommend reducing the risk of preterm birth in this pregnancy? The Clinical Problem In the United States, the annual rate of preterm births (before 37 weeks of gestation) reached a peak of 12.8% in 2006 and was 11.7% in 2011.(1) The rate in the United States remains nearly twice the rate in European nations.(2) Premature birth in the ... Prevention of Preterm Parturition Despite advances in neonatal care, preterm birth remains a leading cause of infant death in the United States, especially among blacks. Systemic changes in reproductive health care to reduce the incidence of multifetal pregnancies and scheduled births before 39 weeks of gestation that lack a medical indication have been temporally associated with decreased preterm birth rates. Strategies to identify and treat medical risk factors in early pregnancy (e.g., genitourinary infection and poor nutrition) have not been effective in reducing preterm birth rates. Previous preterm birth and a short cervix (20 mm, as measured by transvaginal ultrasonography) are major risk factors for preterm birth. The use of progesterone supplementation in women with a previous preterm birth, a short cervix, or both was shown in randomized trials to reduce the frequency of preterm birth and is recommended for women with these risk factors. Cervical cerclage reduces the risk of recurrent preterm birth among women with a short cervix.
    New England Journal of Medicine 01/2014; 370(3):254-61. DOI:10.1056/NEJMcp1103640 · 54.42 Impact Factor
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    ABSTRACT: To evaluate whether progestin prophylaxis influenced the odds of recurrent spontaneous preterm birth among pregnant women with a previous preterm birth. A retrospective cohort study was performed evaluating outcomes of pregnant women with one or more previous preterm births who received prenatal care in a single academic prematurity clinic. Care algorithms were determined and revised by a single supervising physician. Progestin prophylaxis was adopted in 2004 with accelerated access to the first clinic visit adopted in 2008. Rates of preterm birth before 37, 35, and 32 weeks of gestation were compared over time. One thousand sixty-six women with a history of one or more spontaneous preterm births received care in the prematurity clinic and were delivered between January 1, 1998, and June 30, 2012. The gestational age at initiation of prenatal care declined significantly after adoption of an accelerated appointment process (median of 19.1 weeks before 2003, 16.2 weeks from 2004 to 2007, and 15.2 weeks from 2008 to 2012, P<.01), and progestin use increased from 50.8% in 2004-2007 to 80.3% after 2008 (P<.01). After adjustment for race, smoking, cerclage, and number of prior preterm deliveries, we noted a statistically significant decreased odds of spontaneous preterm birth in years 2008-2012 compared with 1998-2007 before 37 (adjusted odds ratio [OR] 0.75, 95% confidence interval [CI] 0.58-0.97) and 35 (adjusted OR 0.70, 95% CI (.52-0.94) weeks of gestation. Adoption of prophylactic progestin treatment was associated with a decreased odds of recurrent preterm birth before 37 or 35 weeks of gestation after adoption of an aggressive program to facilitate early initiation of progestin treatment. : II.
    Obstetrics and Gynecology 01/2014; 123(1):34-9. DOI:10.1097/AOG.0000000000000048 · 4.37 Impact Factor
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    ABSTRACT: Objective To compare maternal and neonatal outcomes in nulliparous women with non-medically indicated inductions at term versus those expectantly managed. Study Design Data were obtained from maternal and neonatal charts for all deliveries on randomly selected days across 25 US hospitals over a three-year period. A low-risk subset of nulliparas with vertex non-anomalous singleton gestations who delivered 38 0/7 to 41 6/7 weeks were selected. Maternal and neonatal outcomes for non medically indicated induction within each week were compared with women who did not undergo non medically indicated induction during that week. Multivariable analysis was used to adjust for hospital, maternal age, race/ethnicity, body mass index, cigarette use and insurance status. Results 31,169 women met criteria. Neonatal complications were either less frequent with non medically indicated induction or no different between groups. Non medically indicated induction was associated with less frequent peripartum infections (OR 0.39, 95%CI 0.16-0.98) at 38 weeks and less frequent third and fourth degree lacerations (OR 0.60, 95%CI 0.42-0.86) and less frequent peripartum infections (OR 0.66, 95% CI 0.49-0.90) at 39 weeks. Non medically indicated induction was associated with a longer admission-to-delivery time by approximately 3 to 4 hours and increased odds of cesarean delivery at 38 weeks (OR 1.50 95%CI 1.08-2.08) and 40 weeks (OR 1.30, 95%CI 1.15-1.46). Conclusion At 39 weeks, non medically indicated induction is associated with lower maternal and neonatal morbidity than women expectantly managed.
    American Journal of Obstetrics and Gynecology 01/2014; 212(1). DOI:10.1016/j.ajog.2014.06.054 · 3.97 Impact Factor

Publication Stats

6k Citations
1,028.61 Total Impact Points

Institutions

  • 1996–2015
    • The Ohio State University
      • Department of Obstetrics and Gynecology
      Columbus, Ohio, United States
  • 2003–2014
    • Columbia University
      New York, New York, United States
    • Society for Maternal-Fetal Medicine
      Columbus, Ohio, United States
  • 2004–2013
    • George Washington University
      • Department of Obstetrics and Gynecology
      Washington, Washington, D.C., United States
  • 2012
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
  • 2005–2012
    • Drexel University
      Filadelfia, Pennsylvania, United States
  • 2010
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • Wake Forest University
      Winston-Salem, North Carolina, United States
  • 2009–2010
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Maryland, United States
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
  • 2007
    • University of Alabama
      Tuscaloosa, Alabama, United States
  • 2000
    • Illinois State University
      Columbus, Ohio, United States
  • 1996–2000
    • National Institute of Child Health and Human Development
      Maryland, United States
  • 1998
    • University of Alabama at Birmingham
      • Department of Obstetrics and Gynecology
      Birmingham, AL, United States