Adverse Infant Outcomes Associated with Discordant Gestational Age Estimates

Nils Halvdan Morken, Rolv Skjærven, Jennifer L. Richards, Michael R. Kramer, Sven Cnattingius, Stefan Johansson, Mika Gissler, Siobhan M. Dolan, Jennifer Zeitlin, Michael S. Kramer

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Gestational age estimation by last menstrual period (LMP) vs. ultrasound (or best obstetric estimate in the US) may result in discrepant classification of preterm vs. term birth. We investigated whether such discrepancies are associated with adverse infant outcomes. Methods: We studied singleton livebirths in the Medical Birth Registries of Norway, Sweden and Finland and US live birth certificates from 1999 to the most recent year available. Risk ratios (RR) with 95% confidence intervals (CI) by discordant and concordant gestational age estimation for infant, neonatal and post-neonatal mortality, Apgar score <4 and <7 at 5 min, and neonatal intensive care unit (NICU) admission were estimated using generalised linear models, adjusting for maternal age, education, parity, year of birth, and infant sex. Results were presented stratified by country. Results: Compared to infants born at term by both methods, infants born preterm by ultrasound/best obstetric estimate but term by LMP had higher infant mortality risks (range of adjusted RRs 3.9 to 7.2) and modestly higher risks were obtained among infants born preterm by LMP but term by ultrasound/best obstetric estimate (range of adjusted RRs 1.6 to 1.9). Risk estimates for the other outcomes showed the same pattern. These findings were consistent across all four countries. Conclusions: Infants classified as preterm by ultrasound/best estimate, but term by LMP have consistently higher risks of adverse outcomes than those classified as preterm by LMP but term by ultrasound/best estimate. Compared with ultrasound/best estimate, use of LMP overestimates the proportion of births that are preterm.

Original languageEnglish (US)
JournalPaediatric and Perinatal Epidemiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Gestational Age
Obstetrics
Infant Mortality
Premature Infants
Parturition
Term Birth
Birth Certificates
Apgar Score
Neonatal Intensive Care Units
Premature Birth
Maternal Age
Live Birth
Finland
Norway
Parity
Sweden
Registries
Linear Models
Odds Ratio
Confidence Intervals

Keywords

  • Best obstetric estimate
  • Gestational age estimation
  • Infant outcome
  • Last menstrual period
  • Ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Epidemiology

Cite this

Morken, N. H., Skjærven, R., Richards, J. L., Kramer, M. R., Cnattingius, S., Johansson, S., ... Kramer, M. S. (Accepted/In press). Adverse Infant Outcomes Associated with Discordant Gestational Age Estimates. Paediatric and Perinatal Epidemiology. https://doi.org/10.1111/ppe.12311

Adverse Infant Outcomes Associated with Discordant Gestational Age Estimates. / Morken, Nils Halvdan; Skjærven, Rolv; Richards, Jennifer L.; Kramer, Michael R.; Cnattingius, Sven; Johansson, Stefan; Gissler, Mika; Dolan, Siobhan M.; Zeitlin, Jennifer; Kramer, Michael S.

In: Paediatric and Perinatal Epidemiology, 2016.

Research output: Contribution to journalArticle

Morken, NH, Skjærven, R, Richards, JL, Kramer, MR, Cnattingius, S, Johansson, S, Gissler, M, Dolan, SM, Zeitlin, J & Kramer, MS 2016, 'Adverse Infant Outcomes Associated with Discordant Gestational Age Estimates', Paediatric and Perinatal Epidemiology. https://doi.org/10.1111/ppe.12311
Morken, Nils Halvdan ; Skjærven, Rolv ; Richards, Jennifer L. ; Kramer, Michael R. ; Cnattingius, Sven ; Johansson, Stefan ; Gissler, Mika ; Dolan, Siobhan M. ; Zeitlin, Jennifer ; Kramer, Michael S. / Adverse Infant Outcomes Associated with Discordant Gestational Age Estimates. In: Paediatric and Perinatal Epidemiology. 2016.
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abstract = "Background: Gestational age estimation by last menstrual period (LMP) vs. ultrasound (or best obstetric estimate in the US) may result in discrepant classification of preterm vs. term birth. We investigated whether such discrepancies are associated with adverse infant outcomes. Methods: We studied singleton livebirths in the Medical Birth Registries of Norway, Sweden and Finland and US live birth certificates from 1999 to the most recent year available. Risk ratios (RR) with 95{\%} confidence intervals (CI) by discordant and concordant gestational age estimation for infant, neonatal and post-neonatal mortality, Apgar score <4 and <7 at 5 min, and neonatal intensive care unit (NICU) admission were estimated using generalised linear models, adjusting for maternal age, education, parity, year of birth, and infant sex. Results were presented stratified by country. Results: Compared to infants born at term by both methods, infants born preterm by ultrasound/best obstetric estimate but term by LMP had higher infant mortality risks (range of adjusted RRs 3.9 to 7.2) and modestly higher risks were obtained among infants born preterm by LMP but term by ultrasound/best obstetric estimate (range of adjusted RRs 1.6 to 1.9). Risk estimates for the other outcomes showed the same pattern. These findings were consistent across all four countries. Conclusions: Infants classified as preterm by ultrasound/best estimate, but term by LMP have consistently higher risks of adverse outcomes than those classified as preterm by LMP but term by ultrasound/best estimate. Compared with ultrasound/best estimate, use of LMP overestimates the proportion of births that are preterm.",
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AU - Morken, Nils Halvdan

AU - Skjærven, Rolv

AU - Richards, Jennifer L.

AU - Kramer, Michael R.

AU - Cnattingius, Sven

AU - Johansson, Stefan

AU - Gissler, Mika

AU - Dolan, Siobhan M.

AU - Zeitlin, Jennifer

AU - Kramer, Michael S.

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N2 - Background: Gestational age estimation by last menstrual period (LMP) vs. ultrasound (or best obstetric estimate in the US) may result in discrepant classification of preterm vs. term birth. We investigated whether such discrepancies are associated with adverse infant outcomes. Methods: We studied singleton livebirths in the Medical Birth Registries of Norway, Sweden and Finland and US live birth certificates from 1999 to the most recent year available. Risk ratios (RR) with 95% confidence intervals (CI) by discordant and concordant gestational age estimation for infant, neonatal and post-neonatal mortality, Apgar score <4 and <7 at 5 min, and neonatal intensive care unit (NICU) admission were estimated using generalised linear models, adjusting for maternal age, education, parity, year of birth, and infant sex. Results were presented stratified by country. Results: Compared to infants born at term by both methods, infants born preterm by ultrasound/best obstetric estimate but term by LMP had higher infant mortality risks (range of adjusted RRs 3.9 to 7.2) and modestly higher risks were obtained among infants born preterm by LMP but term by ultrasound/best obstetric estimate (range of adjusted RRs 1.6 to 1.9). Risk estimates for the other outcomes showed the same pattern. These findings were consistent across all four countries. Conclusions: Infants classified as preterm by ultrasound/best estimate, but term by LMP have consistently higher risks of adverse outcomes than those classified as preterm by LMP but term by ultrasound/best estimate. Compared with ultrasound/best estimate, use of LMP overestimates the proportion of births that are preterm.

AB - Background: Gestational age estimation by last menstrual period (LMP) vs. ultrasound (or best obstetric estimate in the US) may result in discrepant classification of preterm vs. term birth. We investigated whether such discrepancies are associated with adverse infant outcomes. Methods: We studied singleton livebirths in the Medical Birth Registries of Norway, Sweden and Finland and US live birth certificates from 1999 to the most recent year available. Risk ratios (RR) with 95% confidence intervals (CI) by discordant and concordant gestational age estimation for infant, neonatal and post-neonatal mortality, Apgar score <4 and <7 at 5 min, and neonatal intensive care unit (NICU) admission were estimated using generalised linear models, adjusting for maternal age, education, parity, year of birth, and infant sex. Results were presented stratified by country. Results: Compared to infants born at term by both methods, infants born preterm by ultrasound/best obstetric estimate but term by LMP had higher infant mortality risks (range of adjusted RRs 3.9 to 7.2) and modestly higher risks were obtained among infants born preterm by LMP but term by ultrasound/best obstetric estimate (range of adjusted RRs 1.6 to 1.9). Risk estimates for the other outcomes showed the same pattern. These findings were consistent across all four countries. Conclusions: Infants classified as preterm by ultrasound/best estimate, but term by LMP have consistently higher risks of adverse outcomes than those classified as preterm by LMP but term by ultrasound/best estimate. Compared with ultrasound/best estimate, use of LMP overestimates the proportion of births that are preterm.

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KW - Gestational age estimation

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KW - Last menstrual period

KW - Ultrasound

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