TY - JOUR
T1 - Maternal characteristics as indications for routine induction of labor
T2 - A nationwide retrospective cohort study
AU - Goodarzi, Bahareh
AU - Seijmonsbergen-Schermers, Anna
AU - van Rijn, Maaike
AU - Shah, Neel
AU - Franx, Arie
AU - de Jonge, Ank
N1 - Funding Information: The authors received no funding for this work Publisher Copyright: © 2022 The Authors. Birth published by Wiley Periodicals LLC.
PY - 2022/9
Y1 - 2022/9
N2 - BACKGROUND: Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality.METHODS: We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses.RESULTS: The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included.CONCLUSIONS: Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.
AB - BACKGROUND: Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality.METHODS: We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses.RESULTS: The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included.CONCLUSIONS: Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.
KW - age
KW - decision-making
KW - ethnicity
KW - induction of labor
KW - maternal characteristics
KW - parity
KW - risk
KW - risk selection
KW - socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85125364753&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/birt.12628
DO - https://doi.org/10.1111/birt.12628
M3 - Article
C2 - 35229355
SN - 0730-7659
VL - 49
SP - 569
EP - 581
JO - Birth-Issues in Perinatal Care
JF - Birth-Issues in Perinatal Care
IS - 3
ER -