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      Term pregnancy: a period of heterogeneous risk for infant mortality

      research-article
      , MD, MPH 1 , , MHS 2 , , M.S. 2 , , MPH, MS 2 , , PhD 3 , , PhD 1
      Obstetrics and gynecology

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          Abstract

          Objective

          Term pregnancy (37–41 weeks of gestation) is generally regarded as a uniform period for pregnancy outcome. The purpose of this study was to estimate the trend of maternal racial/ethnic differences in mortality for early term (37 0/7 – 38 6/7 weeks of gestation) compared to full term births (39 0/7 – 41 6/7 weeks of gestation).

          Methods

          We analyzed 46,329,018 singleton live births using the National Center for Health Statistics (NCHS) U.S. period-linked birth/infant death data from 1995 to 2006. Infant mortality rates (IMR), neonatal mortality rates (NMR), and postneonatal mortality rates (PNMR) were calculated according to gestational age, race/ethnicity, and cause of death.

          Results

          Overall, IMR has decreased for early term and full term births between 1995 and 2006. At 37 weeks of gestation, Hispanics had the greatest decline in IMR, 35.4% (4.8/1000 to 3.1/1000), followed by 22.4% for whites (4.9/1000 to 3.8/1000),whereas blacks had the smallest decline, 6.8% (5.9/1000 to 5.5/1000), due to a stagnant NMR. When 37 weeks is compared to 40 weeks of gestation, NMR is increased : Hispanics: RR= 2.6 (95% CI 2.0–3.3); whites: RR= 2.6 (95% CI 2.2–3.1); and blacks: RR= 2.9 (2.2–3.8). There is still excess NMR at 38 weeks of gestation. At both early and full term gestations, NMR is 40% higher and PNMR is 80% higher for blacks whereas Hispanics have a reduced PNMR when compared to whites.

          Conclusion

          Early term births are associated with higher NMR, PNMR, and IMR compared to full term births, with concerning racial/ethnic disparity in rates and trends.

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          Author and article information

          Journal
          0401101
          6204
          Obstet Gynecol
          Obstet Gynecol
          Obstetrics and gynecology
          0029-7844
          1873-233X
          12 April 2017
          June 2011
          27 June 2017
          : 117
          : 6
          : 1279-1287
          Affiliations
          [1 ] Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
          [2 ]March of Dimes, White Plains, NY
          [3 ]U.S. Food and Drug Administration, Silver Spring, MD
          Author notes
          Corresponding author: Uma M.Reddy, MD, MPH, 6100 Executive Blvd. Rm 4B03F, Bethesda, MD 20892-7510, Phone: 301-496-5575, Facsimile: 301-496-3790, reddyu@ 123456mail.nih.gov
          Article
          PMC5485902 PMC5485902 5485902 nihpa665001
          10.1097/AOG.0b013e3182179e28
          5485902
          21606738
          2ff596c2-fec9-4947-a746-741cb2a4f5cf
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