Grand Rounds

Is Labor Independently Associated with Reduced Neonatal Respiratory Complications?

BACKGROUND AND PURPOSE:

Plunkett et al. (Obstetrics & Gynecology, 2019) sought to determine whether Labor is independently associated with reduced odds of respiratory morbidity

Secondary analysis of the Assessment of Perinatal Excellence obstetric cohort over a 3-year period
Participants
- Singleton, liveborn nonanomalous neonate
- GA between 36 to 40 weeks
- Exclusion: Antenatal corticosteroids | Amniocentesis for fetal lung maturity
Data analysis
- Multivariable logistic regression to adjust for covariates
- Following variables were specifically assessed: Diabetes mellitus | Labor| Gestational age
Primary outcome: Neonatal respiratory morbidity
- RDS | Ventilator support | CPAP | Neonatal death

63,187 women underwent labor | 10,629 did not undergo labor
There was a significant interaction between labor and gestational age
- 36-39 weeks: Labor was associated with lower odds of neonatal respiratory morbidity compared with no labor (P=.01)
- Adjusted odds ratio (OR) ranged from 0.43 at 36 weeks to 0.69 at 39 weeks
- Labor did not have an impact on the primary outcome at 40 weeks
There was no significant interaction between labor and (1) diabetes or (2) gestational age

Odds of neonatal respiratory complications between 36 and 39 weeks are reduced in women undergoing labor
- Benefit was most pronounced at 36 weeks and independent of diabetes status

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