Burden of elective early-term births in rural Appalachia

South Med J. 2014 Oct;107(10):624-9. doi: 10.14423/SMJ.0000000000000176.


Objectives: Infants delivered at ≥ 37 weeks' gestation are considered full term, but research has demonstrated those born at 37 to 38 weeks (early term) have a higher risk for poor birth outcomes than deliveries at 39 to 41 weeks (full term). Despite this, many deliveries occur electively (scheduled, no medical indication) before 39 weeks. This study examined the risks of elective early-term delivery in a disadvantaged, rural sample and compared these results with national findings.

Methods: Data were available for 638 rural women, recruited prenatally from three counties in rural southern Appalachia, who delivered electively at ≥ 37 weeks.

Results: Compared with electively delivered full-term infants, those delivered electively at early term were 7.7 times more likely to be low birth weight, 4.4 times more likely to have a neonatal intensive care unit admission, and 2.5 times more likely to develop jaundice. Those living furthest from the hospital were most likely to deliver electively at <39 weeks. Although rates of elective deliveries <39 weeks were no higher than national rates, adjusted odds ratios (aOR) of associated admission to a neonatal intensive care unit doubled (aOR 4.4 vs aOR 2.2).

Conclusions: Results demonstrate that initiatives targeting early-term elective deliveries are needed in rural, disadvantaged regions.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Appalachian Region
  • Cesarean Section / adverse effects*
  • Cesarean Section / statistics & numerical data
  • Cost of Illness*
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / statistics & numerical data
  • Female
  • Gestational Age
  • Health Services Accessibility
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Intensive Care, Neonatal / statistics & numerical data
  • Jaundice, Neonatal / epidemiology
  • Jaundice, Neonatal / etiology
  • Labor, Induced / adverse effects*
  • Labor, Induced / statistics & numerical data
  • Pregnancy
  • Rural Health
  • Term Birth*