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To assess the extent to which increased rates of labour induction and caesarean section have contributed to the recent rise in preterm birth.National birth cohort study.USA.Singleton live births, with primary analysis based on non-Hispanic white women.Ecological study based on the 50 states and the District of Columbia during two time periods 10 years apart: 1992-94 and 2002-04.Preterm birth (live birth37 completed weeks of gestation), based on an algorithm combining menstrual and clinical estimates of gestational age.The state-level ecological analysis among non-Hispanic white women showed that the change in preterm birth rate from 1992-94 to 2002-04 was significantly associated with the change in rate of labour induction (r = 0.50, 95% CI 0.26-0.68), but not with the change in rate of caesarean delivery (r = -0.06, 95% CI -0.33 to 0.22). Weaker but otherwise similar associations with labour induction were observed in Hispanic women and in non-Hispanic black women.Increasing use of labour induction is probably an important cause of the observed increased rate in preterm birth. |
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