Received: AugAccepted: JPublished: July 20, 2023Ĭopyright: © 2023 Muller et al. (2023) Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation, and parity: A national cohort study in England. Key limitations included absence of additional confounding factors such as smoking, BMI, and the indication for induction in the HES datasets, which may mean some higher risk pregnancies were included.Ĭitation: Muller P, Karia AM, Webster K, Carroll F, Dunn G, Frémeaux A, et al. There was no statistically significant evidence that risk differences varied according to ethnicity ( p = 0.19). This risk difference varied according to socioeconomic background from 0.38% (−0.08%, 0.83%) in the least deprived to −0.48% (−0.76%, −0.20%) in the most deprived national quintile ( p-value for interaction = 0.01) and by parity with risk difference of −0.54% (−0.80%, −0.27%) in nulliparous women and −0.15% (−0.35%, 0.04%) in multiparous women ( p-value for interaction = 0.02). After adjustment, a lower risk of adverse perinatal outcomes was found in the IOL group (risk difference −0.28% 95% CI −0.43%, −0.12% p = 0.001). Approximately 3.3% of births in the IOL group (1 555/47 352) and 3.6% in the expectant management group (16 525/453 720) had an adverse perinatal outcome. Of the 1 567 004 women with singleton pregnancies, 501 072 women with low-risk pregnancies and with sufficient data quality were included in the analysis. Interaction tests examined risk differences according to ethnicity, socioeconomic background, and parity. Binomial regression models estimated risk differences (with 95% confidence intervals (CIs)) between the IOL group and the expectant management group, adjusting for ethnicity, socioeconomic background, maternal age, parity, year of birth, and birthweight centile. Adverse perinatal outcome was defined as stillbirth, neonatal death, or neonatal morbidity, the latter identified using the English composite neonatal outcome indicator (E-NAOI). Women with premature rupture of membranes, placental abruption, hypertensive disorders of pregnancy, amniotic fluid abnormalities, or antepartum stillbirth were excluded only from the IOL group. Women with a low-risk pregnancy were identified by excluding pregnancies with preexisting comorbidities, previous cesarean section, breech presentation, placenta previa, gestational diabetes, or a baby with congenital abnormalities. Using the Hospital Episode Statistics (HES) dataset, maternal and neonatal data (demographic, diagnoses, procedures, labour, and birth details) were linked, with neonatal mortality data from the Office for National Statistics (ONS). All English National Health Service (NHS) hospital births between January 2018 and March 2021 were examined.
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