title: Asphyxia, Neurologic Morbidity, and Perinatal Mortality in Early-Term and Postterm Birth.
abstract: Neonatal outcomes vary by gestational age. We evaluated the association of early-term, full-term, and postterm birth with asphyxia, neurologic morbidity, and perinatal mortality.
  
  
  
  Our register-based study used retrospective data on 214 465 early-term (37(+0)-38(+6) gestational weeks), 859 827 full-term (39(+0)-41(+6)), and 55 189 postterm (≥42(+0)) live-born singletons during 1989-2008 in Finland. Asphyxia parameters were umbilical cord pH and Apgar score at 1 and 5 minutes. Neurologic morbidity outcome measures were cerebral palsy (CP), epilepsy, intellectual disability, and sensorineural defects diagnosed by the age of 4 years. Newborns with major congenital anomalies were excluded from perinatal deaths.
  
  
  
  Multivariate analysis showed that, compared with full-term pregnancies, early-term birth increased the risk for low Apgar score (<4) at 1 and 5 minutes (odds ratio 1.03, 95% confidence interval 1.03-1.04 and 1.24, 1.04-1.49, respectively), CP (1.40, 1.27-1.55), epilepsy (1.14, 1.06-1.23), intellectual disability (1.39, 1.27-1.53), sensorineural defects (1.24, 1.17-1.31), and perinatal mortality (2.40, 2.14-2.69), but risk for low umbilical artery pH ≤7.10 was decreased (0.83, 0.79-0.87). Postterm birth increased the risk for low Apgar score (<4) at 1 minute (1.26, 1.26-1.26) and 5 minutes (1.80, 1.43-2.34), low umbilical artery pH ≤7.10 (1.26, 1.19-1.34), and intellectual disability (1.19, 1.00-1.43), whereas risks for CP (1.03, 0.84-1.26), epilepsy (1.00, 0.87-1.15), sensorineural defects (0.96, 0.86-1.07), and perinatal mortality (0.91, 0.69-1.22) were not increased.
  
  
  
  Early-term birth was associated with low Apgar score, increased neurologic morbidity, and perinatal mortality. Asphyxia and intellectual disability were more common among postterm births, but general neurologic morbidity and perinatal mortality were not increased.
authors.affiliation: Department of Obstetrics and Gynecology, and laura.seikku@hus.fi.
authors.forename: Laura
authors.initials: L
authors.lastname: Seikku
authors.affiliation: Information Department, National Institute for Health and Welfare, Helsinki, Finland; and Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland;
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland;
authors.forename: Petri
authors.initials: P
authors.lastname: Rahkonen
authors.affiliation: Department of Obstetrics and Gynecology, and.
authors.forename: Vedran
authors.initials: V
authors.lastname: Stefanovic
authors.affiliation: Department of Obstetrics and Gynecology, and.
authors.forename: Minna
authors.initials: M
authors.lastname: Tikkanen
authors.affiliation: Department of Obstetrics and Gynecology, and.
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.affiliation: Department of Obstetrics and Gynecology, and.
authors.forename: Leena
authors.initials: L
authors.lastname: Rahkonen
mesh_terms: D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000209:etiology*; D004827:Epilepsy / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology*; D007234:Infant, Premature / Q000523:psychology; D008607:Intellectual Disability / Q000209:etiology*; D015999:Multivariate Analysis; D065886:Neurodevelopmental Disorders / Q000209:etiology*; D054238:Perinatal Mortality; D012189:Retrospective Studies; D012307:Risk Factors