Research published in JAMA Pediatrics shows despite a rise in stillbirths, overall infant death rates did not increase in the two years immediately following the adoption of the 39-week rule, a recommendation to limit the number of elective inductions, or cases in which labor is initiated prior to 39 completed weeks of gestation.
The study, conducted by researchers at Oregon Health & Science University in Portland, Oregon, demonstrated an increase in stillbirths balanced by a decrease in infant deaths, resulting in an overall stable mortality rate. The work includes an analysis, accounting for changes over time, which suggests that up to 34% of the reduction in infant deaths may be attributed to the 39-week rule.
“These findings suggest that broad adoption of the 39-week rule significantly changed the timeline of births and increased gestational age of the infants overall. Further, death rates immediately before and after birth remained stable. This is a step in the right direction toward improving healthy birth outcomes, however, there is still a lot of work to be done,” says principal investigator Rachel Pilliod, M.D., an assistant professor of obstetrics and gynecology (maternal fetal medicine) in the OHSU School of Medicine.
Study data indicate a nearly 7% increase in labor inductions after 39-weeks in 2011 and 2012, compared with the years prior to the implementation of the 39-week rule. According to Pilliod, while this demonstrates a strong rate of policy adoption, care must be taken to ensure this policy is adopted as intended and only applies to low-risk women.
“It is imperative that additional research and clinical work is done to better identify the risk factors associated with stillbirth and to improve methods of surveillance to identify those most at risk for adverse fetal events,” Pilliod says.