Risk factors for not delivering in a level III unit before 32 weeks of gestation: results from a population-based study in Paris and surrounding districts in 2003
Jennifer Zeitlin
(1)
,
Cletus D. Gwanfogbe
,
Dominique Delmas
(2)
,
Hugo Pilkington
(3)
,
Pierre-Henri Jarreau
(4, 5)
,
Jean-Louis Chabernaud
,
Gérard Bréart
(1, 6)
,
Emile Papiernik
(7)
1
UMR_S 953 -
Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants
2 LNC - Lipides - Nutrition - Cancer (U866)
3 LADYSS - Laboratoire Dynamiques Sociales et Recomposition des Espaces
4 PremUp Foundation
5 Service de réanimation néonatale Port-Royal
6 ISP - Institut de santé publique
7 Maternité Port-Royal [CHU Cochin]
2 LNC - Lipides - Nutrition - Cancer (U866)
3 LADYSS - Laboratoire Dynamiques Sociales et Recomposition des Espaces
4 PremUp Foundation
5 Service de réanimation néonatale Port-Royal
6 ISP - Institut de santé publique
7 Maternité Port-Royal [CHU Cochin]
Jennifer Zeitlin
- Fonction : Auteur
- PersonId : 756756
- ORCID : 0000-0002-9568-2969
- IdRef : 174867816
Cletus D. Gwanfogbe
- Fonction : Auteur
Hugo Pilkington
- Fonction : Auteur
- PersonId : 764532
- ORCID : 0000-0002-8245-2806
- IdRef : 084712740
Pierre-Henri Jarreau
- Fonction : Auteur
Jean-Louis Chabernaud
- Fonction : Auteur
Résumé
Delivery of very preterm babies in maternity units with on-site neonatal intensive care (level III units) is associated with lower mortality and morbidity. This analysis explores risk factors for not delivering in a level III unit, using data from a population-based study of very preterm births in Paris and surrounding districts in 2003. The sample for analysis included resident women with a fetus alive at the onset of labour between 24 and 31 weeks of gestation (n = 641). Characteristics of women delivering in and those not in level III units were compared using logistic regression. Further analysis was carried out for the subgroup of women not already scheduled to deliver in a level III unit. Twenty-nine per cent of women did not deliver in level III units; in the subgroup scheduled to deliver in level I or II units, 43% were not transferred. Women were less likely to deliver in a level III unit if they had a singleton pregnancy, a gestation of <26 weeks or at 31 weeks, experienced antenatal haemorrhaging, lived in socially deprived neighbourhoods or at a greater distance from the nearest level III. Women scheduled to deliver in a maternity unit with a special care nursery were also less likely to deliver in a level III unit. In contrast, preterm rupture of membranes and fetal growth restriction increased the likelihood of a level III delivery. These results underline the importance of controlling for clinical characteristics when analysing perinatal outcome by place of delivery and show how socioe-conomic factors, known to impact on the risk of having a preterm birth, can also affect access to appropriate care.
Domaines
GéographieFormat du dépôt | Notice |
---|---|
Type de dépôt | Article dans une revue |
Titre |
en
Risk factors for not delivering in a level III unit before 32 weeks of gestation: results from a population-based study in Paris and surrounding districts in 2003
|
Résumé |
en
Delivery of very preterm babies in maternity units with on-site neonatal intensive care (level III units) is associated with lower mortality and morbidity. This analysis explores risk factors for not delivering in a level III unit, using data from a population-based study of very preterm births in Paris and surrounding districts in 2003. The sample for analysis included resident women with a fetus alive at the onset of labour between 24 and 31 weeks of gestation (n = 641). Characteristics of women delivering in and those not in level III units were compared using logistic regression. Further analysis was carried out for the subgroup of women not already scheduled to deliver in a level III unit. Twenty-nine per cent of women did not deliver in level III units; in the subgroup scheduled to deliver in level I or II units, 43% were not transferred. Women were less likely to deliver in a level III unit if they had a singleton pregnancy, a gestation of <26 weeks or at 31 weeks, experienced antenatal haemorrhaging, lived in socially deprived neighbourhoods or at a greater distance from the nearest level III. Women scheduled to deliver in a maternity unit with a special care nursery were also less likely to deliver in a level III unit. In contrast, preterm rupture of membranes and fetal growth restriction increased the likelihood of a level III delivery. These results underline the importance of controlling for clinical characteristics when analysing perinatal outcome by place of delivery and show how socioe-conomic factors, known to impact on the risk of having a preterm birth, can also affect access to appropriate care.
|
Auteur(s) |
Jennifer Zeitlin
1
, Cletus D. Gwanfogbe
, Dominique Delmas
2
, Hugo Pilkington
3
, Pierre-Henri Jarreau
4, 5
, Jean-Louis Chabernaud
, Gérard Bréart
1, 6
, Emile Papiernik
7
1
UMR_S 953 -
Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants
( 81504 )
- HÔPITAL SAINT VINCENT DE PAUL - BATIMENT LELONG
82 AVENUE DENFERT ROCHEREAU
75014 PARIS
- France
2
LNC -
Lipides - Nutrition - Cancer (U866)
( 27738 )
- Université de Bourgogne - Faculte de medecine - 7, boulevard Jeanne d'Arc - BP 87900 - 21079 Dijon Cedex
- France
3
LADYSS -
Laboratoire Dynamiques Sociales et Recomposition des Espaces
( 1096 )
- Université Paris Ouest Nanterre La Défense Bâtiment T 200 avenue de la République 92001 Nanterre cedex
- France
4
PremUp Foundation
( 253049 )
- Fondation de Coopération Scientifique sur la Grossesse et la Prématurité - Maternité de Port Royal - 53 avenue de l'Observatoire - 75014 Paris
- France
5
Service de réanimation néonatale Port-Royal
( 100147 )
- Paris
- France
6
ISP -
Institut de santé publique
( 150378 )
- France
7
Maternité Port-Royal [CHU Cochin]
( 495459 )
- 123 Boulevard de Port-Royal, 75014 Paris.
- France
|
Langue du document |
Anglais
|
Vulgarisation |
Non
|
Comité de lecture |
Oui
|
Audience |
Internationale
|
Date de publication |
2008-03-04
|
Volume |
22
|
Numéro |
2
|
Page/Identifiant |
126-135
|
Commentaire |
ACL (facteur d'impact)
|
Nom de la revue |
|
Domaine(s) |
|
Mots-clés |
en
Very preterm birth, Access to care, Level III maternity unit, Place of delivery, Social inequalities
|
DOI | 10.1111/j.1365-3016.2007.00921.x |
Pubmed Id | 18298686 |
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