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To determine the relationship between planned home birth and neonatal mortality using a large population-based linked birth-death registry.
Study Design
This is a population based retrospective cohort study of all births between 37 and 42 weeks gestation using the National Health Center for Vital Statistics 2005 Linked Birth/Infant Death Cohort Data Set. The primary outcome was neonatal mortality and the primary predictor was planned home birth. The referent group for the regression model was births that occurred in a hospital. Initial univariate analysis was performed using Chi-square or Fishers exact tests for categorical variables and the t-test or Mann-Whitney U test for continuous variables. A multiple logistic regression model was performed using predictor variables that were either chosen a priori or were found to alter the primary OR by 10-15%. Goodness of fit was assessed using the Hosmer-Lemeshow test. All analyses were performed using STATA 11.0.
Results
There were 4,145,887 births included in the final analysis with 27,968 cases of infant mortality (6.69 cases per 1000 births) with 3,192,544 births and 7,620 neonatal deaths occurring between 37 and 42 weeks gestation. The following variables were included as covariates in the final regression model: age, race, marital status, education, prenatal care, tobacco use, composite medical comorbidities. The unadjusted odds ratio (OR) for neonatal mortality among individuals having a planned home birth was 1.37 (95% CI 0.89, 2.10). The adjusted OR for neonatal mortality among individuals having a planned home birth was 2.32 (95% CI 1.33, 4.06) after controlling for the aforementioned covariates. The Hosmer-Lemeshow test was nonsignificant indicating goodness of fit.
Conclusion
The odds of neonatal mortality are significantly increased among those individuals having a planned home birth compared to those individuals giving birth in the hospital.
