Early term births in rural Appalachia

Purpose: Infants delivered at 37 weeks gestation or later have been considered full term, but recent research demonstrates those born at 37-38 weeks (early term) have higher risk for poor birth outcomes than deliveries at 39-41 weeks (full term). Despite this, a high percentage of deliveries still occur electively (scheduled with no medical indication) prior to 39 weeks. This study examined these risks in a disadvantaged, rural sample, particularly among those who electively delivered early term, and compared these results to national findings. Methods: Data were available for 1772 women, recruited prenatally, from three counties in rural, Southern Appalachia who delivered at 37+ weeks. Findings: Compared with full term infants, those delivered early term were significantly smaller, had longer hospital stays with higher rates of NICU admission and were more likely to develop jaundice. Similarly, among those with elective deliveries, compared with full term infants, those born early were 7.7 times more likely to be low birth weight, 4.4 times more likely to have a NICU admission, and 2.5 times more likely to develop jaundice. While the rate of elective deliveries <39 weeks in this sample was similar to the national rate, the associated adjusted odds of NICU admission was substantially higher (OR=4.4 vs OR=2.2). Finally, those living furthest from their delivery hospital were most likely to have elective deliveries prior to 39 weeks. Conclusions: Results demonstrate that recent efforts in large population centers to end elective early term deliveries are also needed in rural, disadvantaged regions.