title: Perinatal outcomes and hospital costs in gastroschisis based on gestational age at delivery.
abstract: OBJECTIVE
  To investigate the association between gestational age at delivery and perinatal outcomes among gastroschisis-affected pregnancies that result in live birth.
  
  
  METHODS
  We conducted a retrospective cohort study using a linked maternal-infant database for more than 2.3 million liveborn neonates in Florida from 1998 to 2009. Cases were identified using a combination of International Classification of Diseases, 9th Edition, Clinical Modification, diagnosis and procedure codes indicative of gastroschisis. We restricted our analyses to singleton cases without another major birth defect or medical conditions that would justify early elective delivery. We categorized cases based on gestational age in weeks and compared perinatal outcomes.
  
  
  RESULTS
  Among 1,005 neonates with gastroschisis, 324 (32.3%) were isolated, singleton cases without an additional indication for early delivery. We observed decreased rates of adverse pregnancy outcomes among those neonates delivered in the early term period (37-38 weeks of gestation) compared with preterm (less than 34 weeks of gestation); specifically, jaundice (18.5% compared with 42.3%, P=.01) and respiratory distress syndrome (5.9% compared with 23.1%, P≤.01). As the gestational age at birth increased, we observed fewer mean number of days spent in the hospital (less than 34 weeks of gestation: 55.9, P<.01; 34-36 weeks of gestation: 51.9, P=.02; 37-38 weeks of gestation: 36.9 [reference]) and lower direct inpatient medical costs (in thousands, U.S. dollars; less than 34 weeks of gestation: 79, P=.01; 34-36 weeks of gestation: 71, P=.04; 37-38 weeks of gestation: 51 [reference]) per infant in the first year of life.
  
  
  CONCLUSIONS
  In pregnancies complicated by gastroschisis, and with no other known major indications, birth at early term or later term gestation, when compared with delivery before 37 weeks of gestation, is associated with improved perinatal outcomes and lower medical costs.
  
  
  METHODS
  II.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, the Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, and the Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida.
authors.forename: Mary Ashley
authors.initials: MA
authors.lastname: Cain
authors.forename: Jason L
authors.initials: JL
authors.lastname: Salemi
authors.forename: Jean
authors.initials: J
authors.lastname: Paul Tanner
authors.forename: Mulubrhan F
authors.initials: MF
authors.lastname: Mogos
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.forename: Valerie E
authors.initials: VE
authors.lastname: Whiteman
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D020139:Gastroschisis / Q000191:economics / Q000453:epidemiology; D005865:Gestational Age; D017721:Hospital Costs; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D013223:Statistics as Topic