Background
The ARRIVE trial demonstrated the benefit of induction of labor at 39 weeks gestation.
Obstetrics departments across the United States faced the challenge of adapting clinical
practice in light of these data while managing logistical constraints.
Objective
To determine if there were changes in obstetrical practices and perinatal outcomes
in the United States after the ARRIVE trial publication.
Study Design
This was a population-based retrospective cohort study of low-risk, nulliparous women
who initiated prenatal care by 12 weeks gestation with singleton, nonanomalous pregnancies
delivering at ≥39 weeks. Data were obtained from the US Natality database. The pre-ARRIVE
group were women who delivered between January 1, 2015 and December 31, 2017. The
post-ARRIVE group consisted of women who delivered between January 1, 2019 and December
31, 2019. Births that occurred in 2018 were excluded. Practice outcomes were rates
of induction of labor, timing of delivery, and cesarean delivery rate. Adverse maternal
outcomes were blood transfusion and admission to medical intensive care unit. Adverse
neonatal outcomes were need for assisted ventilation (immediate and >6 hours), 5-minute
APGAR score <3, neonatal intensive care unit admission, seizures, and surfactant use.
Univariate and multivariate analyses were performed. Trends were tested across the
time period represented by the pre-ARRIVE group using Cochran–Armitage trend test.
Results
There were 1,966,870 births in the pre-ARRIVE group and 609,322 in the post-ARRIVE
group. The groups differed in age, race, body mass index, marital status, infertility
treatment, and smoking history (P<.001). After adjusting for these differences, the post-ARRIVE group was more likely
to undergo induction (36.1% vs 30.2%; adjusted odds ratio, 1.36 [1.36–1.37]) and deliver
by 39+6 weeks of pregnancy (42.8% vs 39.9%; adjusted odds ratio, 1.14 [1.14–1.15]).
The post-ARRIVE group had a significantly lower rate of cesarean delivery than the
pre-ARRIVE group (27.3 % vs 27.9%; adjusted odds ratio, 0.94 [0.93–0.94]). Patients
in the post-ARRIVE group were more likely to receive a blood transfusion (0.4% vs
0.3%; adjusted odds ratio, 1.43 [1.36–1.50]) and be admitted to medical intensive
care unit (0.09% vs 0.08%; adjusted odds ratio, 1.20 [1.09–1.33]). Neonates in the
post-ARRIVE group were more likely to need assisted ventilation at birth (3.5% vs
2.8%; adjusted odds ratio, 1.28 [1.26–1.30]) and >6 hours (0.6% vs 0.5%; adjusted
odds ratio, 1.36 [1.31–1.41]). The neonates in the post-ARRIVE group were more likely
to have low 5-minute APGAR scores (0.4% vs 0.3%; adjusted odds ratio, 0.91 [0.86–0.95]).
Neonatal intensive care unit admission did not differ between the 2 groups (4.9% vs
4.9%; adjusted odds ratio, 1.01 [0.99–1.03]). There were no differences in neonatal
seizures (0.04% vs 0.04%; adjusted odds ratio, 0.97 [0.84–1.13]), and surfactant use
(0.08% vs 0.07%; adjusted odds ratio, 1.05 [0.94–1.17]) between the 2 groups.
Conclusion
There were more inductions of labor, more deliveries at 39 weeks’ gestation, and fewer
cesarean deliveries in the year after the ARRIVE trial publication. The small but
statistically significant increase in some adverse maternal and neonatal outcomes
should be explored to determine if they are related with concurrent changes in obstetrical
practices.
Key words
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Article Info
Publication History
Published online: February 05, 2022
Accepted:
February 1,
2022
Received in revised form:
February 1,
2022
Received:
December 10,
2021
Footnotes
The authors report no conflict of interest.
Cite this article as: Gilroy LC, Al-Kouatly HB, Minkoff HL, et al. Changes in obstetrical practices and pregnancy outcomes following the ARRIVE trial. Am J Obstet Gynecol 2022;226:716.e1-12.
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