The rate of preterm birth in the United States is affected by the method of gestational age assignment.
OBJECTIVE
The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth.


METHODS
Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age.


RESULTS
The rate of preterm birth was 9.7% when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5% when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54% vs 42%; P < .001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity.


CONCLUSIONS
The preterm birth rate is 9.7% vs 11.5% and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Elaine.Duryea@UTSouthwestern.edu.
Elaine L
EL
Duryea
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Donald D
DD
McIntire
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Kenneth J
KJ
Leveno
D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008598:Menstruation; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology*; D016216:Ultrasonography, Prenatal; D014481:United States; D055815:Young Adult
obstetric estimate; pregnancy dating; preterm birth