The effects of labor on infant mortality among small-for-gestational-age infants in the USA.
OBJECTIVE
To determine whether the presence of labor affects infant mortality among small-for-gestational-age (SGA) infants.


METHODS
Data were derived from the United States national linked birth/infant death data sets for 1995-97. Singleton SGA live births in cephalic presentation delivered at 24-42 weeks' gestation were included. Mortality rates for SGA infants exposed and unexposed to labor were compared, and relative risks (RR) were derived using multivariable logistic regression models, after adjusting for potential confounding factors.


RESULTS
Of 986 405 SGA infants, 87.4% were exposed to labor. Infants exposed to labor at 24-31 weeks had greater risks of dying during the early neonatal period (RR 1.79-1.86). Decreased risks of late and postneonatal death were observed at all gestational ages in the presence of labor.


CONCLUSIONS
Exposure to labor is associated with an increased risk of early neonatal death among SGA infants, especially at gestational ages below 32 weeks. Future randomized trials are warranted to determine the optimal obstetric management of these high-risk infants.
Kinzler
W L
WL
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Services, UMDNJ-Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, New Jersey 08903-0591, USA
Ananth
C V
CV
Smulian
J C
JC
Vintzileos
A M
AM
D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007743:Labor, Obstetric; D011247:Pregnancy; D012307:Risk Factors