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#Grand Rounds

Is Labor Independently Associated with Reduced Neonatal Respiratory Complications?

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BACKGROUND AND PURPOSE:

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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Association of Labor With Neonatal Respiratory Outcomes at 36-40 Weeks of Gestation

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