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Trends in Fetal and Infant Survival Following Preeclampsia
Olga Basso, PhD;
Svein Rasmussen, MD, PhD;
Clarice R. Weinberg, PhD;
Allen J. Wilcox, MD, PhD;
Lorentz M. Irgens, MD, PhD;
Rolv Skjaerven, PhD
JAMA. 2006;296:1357-1362.
Context Management of preeclampsia often culminates in induced delivery of a very preterm infant. While early termination protects the fetus from an intrauterine death, the newborn then faces increased risks associated with preterm delivery. This practice has increased in recent decades, but its net effect on fetal and infant survival has not been assessed.
Objective To assess the effect on fetal and infant survival of increased rates of early delivery of preeclamptic pregnancies.
Design, Setting, and Participants Population-based observational longitudinal study using registry data from 804 448 singleton first-born infants with Norwegian-born mothers and registered in the Medical Birth Registry of Norway between 1967 and 2003.
Main Outcome Measures Odds ratio (OR) of fetal and early childhood death in relation to preeclampsia.
Results Among preeclamptic pregnancies, inductions before 37 weeks increased from 8% in 1967-1978 to nearly 20% in 1991-2003. During this period, the adjusted OR for stillbirth decreased from 4.2 (95% confidence interval [CI], 3.8-4.7) to 1.3 (95% CI, 1.1-1.7) for preeclamptic compared with nonpreeclamptic pregnancies. During the same period, the OR for neonatal death after preeclamptic pregnancy remained relatively stable (1.7 in 1967-1978 vs 2.0 in 1991-2003). Later infant and childhood mortality also showed little change.
Conclusions Fetal survival in preeclamptic pregnancies has vastly improved over the past 35 years in Norway, presumably because of more aggressive clinical management. However, the relative risk of neonatal death following a preeclamptic pregnancy has not changed over time.
Author Affiliations: Epidemiology Branch (Drs Basso and Wilcox) and Biostatistics Branch (Dr Weinberg), National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC; Medical Birth Registry of Norway, Locus of Registry-Based Epidemiology, University of Bergen, and Norwegian Institute of Public Health, Bergen (Drs Rasmussen, Irgens, and Skjaerven); and Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, University of Bergen (Dr Rasmussen).
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