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Scientists probe the role of clinicians in rising rates of late preterm birth.

Chicago–Inappropriate interventions may be a substantial factor in the increase in late preterm births in the United States, with some physicians pursuing early delivery for a range of indications even when there is little evidence supporting such action, according to findings presented at the annual meeting of the Society for Maternal-Fetal Medicine (SMFM) in February. Researchers are also finding that outcomes for neonates are poorer when physicians use less stringent criteria for early delivery. Nearly 13% of US infants are born before they reach 37 weeks of gestation, according to the SMFM. That rate is much higher than in other developed nations. The rate of late preterm births, particularly those between 34 and 36 weeks, has grown from 6.8% of births in 1990 to 8.1% in 2006, according to the National Center for Health Statistics. Rates of late preterm birth have risen at all gestational ages, although the largest increases have occurred at 36 weeks, with births at 34 weeks increasing from 1.3% to 1.4%, births at 35 weeks increasing from 2.1% to 2.3%, and births at 36 weeks increasing from 3.4% to 4.4%. Preterm births cost the United States $26 billion annually, and substantially increase a child’s risk for death, cerebral palsy, cognitive impairment, or respiratory problems. Some of the factors that have been proposed as reasons for the trend may not be controllable—for example, greater maternal age or the increased use of artificial reproductive technology, which raises the risk for multiple births. However, scientists are taking a closer look at modifiable factors, such as aggressive interventions done without appropriate medical indications or performed for the convenience of the physician or patient. To do this, they are turning to large data sets of medical records to tease out the role that