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Neonatal and Maternal Composite Adverse Outcomes among Low-Risk Nulliparous Women Compared with Multiparous Women at 39-41 Weeks of Gestation


Chauhan, Suneet P.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M., Jr.; Caritis, Steve N.; & Prasad, Mona, et al. (2020). Neonatal and Maternal Composite Adverse Outcomes among Low-Risk Nulliparous Women Compared with Multiparous Women at 39-41 Weeks of Gestation. Obstetrics & Gynecology, 136(3), 450-457. PMCID: PMC7483669


OBJECTIVE: To estimate whether the frequency of adverse maternal and neonatal outcomes differs between low-risk nulliparous and multiparous women at 39-41 weeks of gestation.
METHODS: This is a secondary analysis of an observational obstetrics cohort of maternal-neonatal dyads at 25 hospitals. Low-risk women with nonanomalous singletons who delivered between 39 0/7 and 41 6/7 weeks of gestation were included. The composite neonatal adverse outcome included 5-minute Apgar score less than five, ventilator support or cardiopulmonary resuscitation, seizure, hypoxic ischemic encephalopathy, sepsis, bronchopulmonary dysplasia, persistent pulmonary hypertension, necrotizing enterocolitis, birth injury or perinatal death. The composite maternal adverse outcome included infection, third- or fourth-degree perineal laceration, thromboembolism, transfusion of blood products, or maternal death. Small for gestational age (SGA), large for gestational age (LGA), and shoulder dystocia requiring maneuvers were also evaluated. Multivariable regression was used to estimate adjusted relative risks (aRRs) and adjusted odds ratios (aORs) with 95% CIs.
RESULTS: Of the 115,502 women in the overall cohort, 39,870 (34.5%) met eligibility criteria for this analysis; 18,245 (45.8%) were nulliparous. The risk of the composite neonatal adverse outcome (1.5% vs 1.0%, aRR 1.80, 95% CI 1.48-2.19), composite maternal adverse outcome (15.1% vs 3.3%, aRR 5.04, 95% CI 4.62-5.49), and SGA (8.9% vs 5.8%, aOR 1.45, 95% CI 1.33-1.57) was significantly higher in nulliparous than multiparous patients. The risk of LGA (aOR 0.65, 95% CI 0.60-0.71) and shoulder dystocia with maneuvers (aRR 0.68, 95% CI 0.60-0.77) was significantly lower in nulliparous rather than multiparous patients.
CONCLUSION: The risk of composite adverse outcomes and SGA among low-risk nulliparous women at 39-41 weeks of gestation is significantly higher than among multiparous counterparts. However, nulliparous women had a lower risk of shoulder dystocia with maneuvers and LGA.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

Obstetrics & Gynecology


Chauhan, Suneet P.
Rice, Madeline Murguia
Grobman, William A.
Bailit, Jennifer L.
Reddy, Uma M.
Wapner, Ronald J.
Varner, Michael W.
Thorp, John M., Jr.
Caritis, Steve N.
Prasad, Mona
Tita, Alan T. N.
Saade, George R.
Sorokin, Yoram
Rouse, Dwight J.
Tolosa, Jorge E., for Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network



Data Set/Study

APEX (Assessment of Perinatal Excellence)


United States of America