LAUSR

Supplem 543 Childhood neurodevelopment after spontaneous versus indicated preterm birth Emily E. Nuss, Jessica Spiegelman, Amy L. Turitz, Cynthia Gyamfi-Bannerman Columbia University Irving Medical Center, New York, NY OBJECTIVE: An association between preterm delivery (PTD) and neurodevelopmental deficits is known, but how specific etiologies of PTD influence neurodevelopment is not. Therefore, we assessed whether neurologic outcomes differ by indicated (IPTD) or spontaneous preterm delivery (SPTD). STUDY DESIGN: Secondary analysis of a multicenter trial assessing magnesium for neuroprotection in women at risk for PTD from 24 to 31 weeks. We included women with live, nonanomalous, singleton gestations who delivered preterm; we excluded those without 2-year follow-up for reasons other than perinatal demise. The primary exposure was type of PTD: 1) spontaneous if the subject presented with preterm labor or ruptured membranes or 2) indicated if the subject was delivered preterm iatrogenically. The primary outcome was death or an abnormal Bayley II scores at age 2, defined as a mental developmental index (MDI) or psychomotor developmental index (PDI) 2 standard deviations (SD) below the mean. Secondary outcomes included MDI and PDI 1 SD and neonatal morbidities associated with prematurity. Bivariate analyses of baseline characteristics by exposure were conducted. We fit a logistic regression model to adjust for confounders. RESULTS: Of 1,678 subjects 1,631 (97.2%) underwent SPTD and 47 (2.8%) underwent IPTD. Baseline maternal demographics and gestational age at delivery were similar between groups (29.6 wks 7.8 v. 28.8 wks 2.5, p1⁄40.07) (Table 1). A PDI 2 SD or death occurred in 340 (20.9%) SPTD subjects and 17 (36.2%) IPTD subjects (p1⁄40.01). When adjusting for confounders, there remained an increased probability of PDI 2 SD or death in IPTD subjects (p1⁄40.02) (Table 2). Though not statistically significant, IPTD was also associated with higher odds of MDI 2 SD, PDI 1 SD, and MDI 1 SD (1.76, 1.59, 1.45, respectively). Limiting the analysis to small for gestational age (SGA) infants, there was no difference in neurologic outcomes. However, after adjusting for SGA, the PDI remained abnormal in the indicated group (aOR 1.98, 95% CI 1.01, 3.88). CONCLUSION: In this cohort of pregnancies who delivered preterm, indicated delivery was associated with worse psychomotor development than spontaneous delivery. Other outcomes appeared poor, but our numbers were limited. This finding should be confirmed in a larger cohort of women undergoing medically indicated preterm deliveries.