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. 2017 Jul;102(4):F286-F290.
doi: 10.1136/archdischild-2015-308553. Epub 2015 Dec 8.

Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies

Nehama Linder  1   2 , Liran Hiersch  2   3 , Elana Fridman  1 , Gil Klinger  2   4 , Daniel Lubin  1 , Franck Kouadio  1 , Nir Melamed  3
Affiliations

Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies

Nehama Linder et al. Arch Dis Child Fetal Neonatal Ed. 2017 Jul.

Abstract

Objective: To determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns.

Design: Retrospective cohort.

Setting: Tertiary university-affiliated medical centre.

Patients: All newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks' gestation over a 5-year period.

Exclusion criteria: multiple gestation, maternal hypertensive disorder, diabetes or cholestasis, placental abruption or intrapartum fever (>38°C), small for gestational age (<10th centile) and major congenital or chromosomal anomalies.

Interventions: None.

Outcome measures: Admission to the neonatal intensive care unit (NICU), hospital length of stay, 5-min Apgar score, birth trauma, respiratory, neurological, metabolic and infectious morbidities and neonatal mortality. The adverse outcome rate was compared among three groups based on gestational age at birth: post-term (≥42+0 weeks), late term (41+0 to 41+6 weeks) and full term (39+0 to 40+6 weeks).

Results: Of the 23 524 eligible neonates, 747 (3.2%) were born post-term, 4632 (19.7%) late term and 18 145 (77.1%) full term. Women in the post-term group versus the late-term group had a significantly higher rate of caesarean section (8.9% vs 5.6%, p<0.001) and operative vaginal delivery (9.6% vs 7.4%, p=0.024). Post-term pregnancy versus full-term pregnancy was associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.8), respiratory morbidity (OR 2.2, 95% CI 1.3 to 3.8) and infectious morbidity (OR 1.88, 95% CI 1.32 to 2.69). Post-term pregnancy versus late-term pregnancy was similarly associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.9), respiratory morbidity (OR 2.7, 95% CI 1.5 to 5.0) and infectious morbidity (OR 1.8, 95% CI 1.2 to 2.7) and with hypoglycaemia (OR 2.6, 95% CI 1.2 to 5.4). Post-term delivery was not associated with neonatal mortality.

Conclusions: Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies.

Keywords: Neonatal complications; post-term; singleton.

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