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Objective Late preterm and early term deliveries are common in pregnancies complicated by diabetes due to higher rates of obstetric complications including increased stillbirth risk. However, early delivery is associated with multiple neonatal adverse outcomes, which may be further increased by maternal diabetes. We examined whether there is an additive effect on adverse neonatal outcomes in the setting of maternal diabetes in the late preterm and early term periods. Study Design This was a retrospective cohort study of women with a singleton, nonanomalous pregnancy delivering at a single academic medical center in the late preterm (34 0/7 –36 6/7 weeks) or early term (37 0/7 –38 6/7 weeks) period between 2010 and 2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or gestational diabetes (GDM). Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent. Results A total of 8,072 pregnancies were included with T1DM, T2DM, and GDM complicating 1.8, 5.6, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups including higher rates of non-Hispanic Black race, chronic hypertension, and higher body mass index in women with T2DM. The probability of severe composite adverse neonatal outcome was significantly increased in women with T1DM in the late preterm (aOR: 4.4; CI: 2.4–8.1) and early term (aOR: 1.6; CI: 1.1–2.3) periods, largely driven by the need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery but highest in women with T1DM. Conclusion Pregnancies complicated by diabetes, particularly T1DM, have higher rates of neonatal adverse outcomes independent of gestational age at delivery, which is an important consideration when late preterm or early term delivery is planned. Key Points Diabetes in pregnancy increases risk of early delivery. Adverse neonatal outcomes are higher with diabetes, especially T1DM. Adverse neonatal outcomes are independent of gestational age. [ABSTRACT FROM AUTHOR]

Objective  The aim of this study is to model the association between gestational age at birth and early child development through 3 years of age. Study Design  Development of 5,868 children in Upstate KIDS (New York State; 2008–2014) was assessed at 7 time points using the Ages and Stages Questionnaire (ASQ). The ASQ was implemented using gestational age corrected dates of birth at 4, 8, 12, 18, 24, 30, and 36 months. Whether children were eligible for developmental services from the Early Intervention Program was determined through linkage. Gestational age was based on vital records. Statistical models adjusted for covariates including sociodemographic factors, maternal smoking, and plurality. Results  Compared with gestational age of 39 weeks, adjusted odds ratios (aOR) and 95% confidence intervals of failing the ASQ for children delivered at <32, 32–34, 35–36, 37, 38, and 40 weeks of gestational age were 5.32 (3.42–8.28), 2.43 (1.60–3.69), 1.38 (1.00–1.90), 1.37 (0.98–1.90), 1.29 (0.99–1.67), 0.73 (0.55–0.96), and 0.51 (0.32–0.82). Similar risks of being eligible for Early Intervention Program services were observed (aOR: 4.19, 2.10, 1.29, 1.20, 1.01, 1.00 [ref], 0.92, and 0.78 respectively for <32, 32–34, 37, 38, 39 [ref], 40, and 41 weeks). Conclusion  Gestational age was inversely associated with developmental delays for all gestational ages. Evidence from our study is potentially informative for low-risk deliveries at 39 weeks, but it is notable that deliveries at 40 weeks exhibited further lower risk. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate the effect of the prophylactic continuous positive airway pressure (CPAP) administration in the delivery room to newborns who were delivered by elective cesarean section (CS). Study Design Inborn infants with gestational age between 340/7 to 386/7 and born by elective CS were prospectively randomized to receive either prophylactic CPAP for 20 minutes via face mask or standardized care without CPAP in the delivery room. Primary outcomes were the incidence of transient tachypnea of the newborn (TTN) and neonatal intensive care unit (NICU) admission due to respiratory distress. Results A total of 259 infants with a mean gestational age of 37.7 ± 0.8 weeks and birth weight of 3,244 ± 477 g were included. A total of 134 infants received prophylactic CPAP and 125 received control standard care. The rate of NICU admission was significantly lower in prophylactic CPAP group (p = 0.045). Although the rate of TTN was lower in the prophylactic CPAP group, the difference was not statistically significant (p = 0.059). The rate of NICU admission due to respiratory distress was significantly higher in late-preterm cohort than early-term cohort (p < 0.0001). Conclusion Prophylactic CPAP administration decreases the rate of NICU admission without any side effect in late-preterm and early-term infants delivered by elective CS. [ABSTRACT FROM AUTHOR]

Objective To quantify the variation in induction of labor (IOL) over the days of the week for gravid women in the United States. Study Design Women who delivered singletons between 24 and 42 weeks' gestation were identified using birth certificate data from 2007 to 2010. Women with pregnancy-associated hypertension, fetal anomalies, previous cesarean delivery, or incomplete records were excluded. The primary outcome was IOL. Women were stratified into four gestational age groups: < 34, 34 to 36, 37 to 38, and ≥ 39 weeks. Frequencies of IOL were determined according to day of the week. Multivariable logistic regression estimated the association between weekend delivery and IOL, adjusting for maternal characteristics and year of delivery. Results There were 11.6 million eligible women. For each gestational age stratum, the frequency of IOL was increased on weekdays compared with weekends (8.0 vs. 7.4%, 16.5 vs. 13.2%, 25.0 vs. 14.8%, and 33.2 vs. 19.3% at < 34, 34-36, 37-38, and ≥ 39 weeks, respectively; p < 0.01 for all). Multivariable analyses demonstrated that weekend IOL was inversely related to gestational age (odds ratios: 0.93, 0.77, 0.52, and 0.48, respectively; p < 0.001 for all). Conclusion The frequency of IOL varies according to the day of the week, with the odds of weekend IOL lowest at greater gestational ages. [ABSTRACT FROM AUTHOR]