(897) Trends in and factors associated with early term deliveries without indication

Objective: Since 2009, ACOG and SMFM have recommended against induction or cesarean at 37-38 weeks without indication. Reducing nonmedically indicated early term deliveries has also been a priority over the past decade for state Medicaid programs seeking to improve neonatal outcomes. The purpose of this analysis is to describe current trends in and factors associated with these deliveries.

Study Design: We conducted a repeated cross-sectional analysis of 18.8 million delivery hospitalizations in the National Inpatient Sample from October 2015-December 2020 at ≥20 weeks gestation. We identified those hospitalizations with a medical indication for early delivery as defined by ACOG/SMFM criteria or which occurred to patients who presented in spontaneous labor at 37-38 weeks gestation. We then described temporal trends in 37-38 week delivery without such indication, reporting average annual percent change (AAPC). Using survey-adjusted logistic regression, we calculated adjusted odds ratios (aOR) for the association between demographic and hospital factors and unindicated early term delivery.

Results: Of 5.1 million 37-38 week deliveries, 2.3 million had no associated indication. The percentage of unindicated early term deliveries was higher among Medicaid-paid births as compared to those with private insurance for every year in our study interval, decreasing from 14.1% to 12.6% of Medicaid-paid births over 2015-2020 for an AAPC of -2.9% [95% confidence interval (CI) (-3.3%, -2.4%)] as compared to 12.3% to 10.3% of privately-insured births for an AAPC of -3.5% [95% CI (-4.6%, -2.5%)]. Deliveries to Black [aOR 1.15 95% CI 1.13, 1.16] and Hispanic [aOR 1.25 95% CI 1.23, 1.26] patients, deliveries paid for by Medicaid [aOR 1.10 95% CI 1.09, 1.11], and deliveries in the South [aOR 1.24 95% CI 1.21, 1.26] were more likely to be unindicated and at early term. 

Conclusion: While early elective deliveries are decreasing nationally, these deliveries remain common. Disparities in these deliveries by race and payer have persisted despite nearly a decade of target Medicaid quality improvement initiatives.