Authors: Balchin, I¹; Whittaker, JC²; Lamont, RF³; Steer, PJ⁴

Source: BJOG: An International Journal of Obstetrics & Gynaecology, Volume 116, Number 9, August 2009 , pp. 1218-1224(7)

Publisher: Wiley-Blackwell

Abstract:

Objectives 

To investigate the effect of excluding cases with unrecorded best estimate of gestational age at birth on pregnancy outcome reporting and to determine the reasons for unrecorded gestational age data. Design 

Prospective study. Setting 

Fifteen maternity units in North West London. Population 

497 105 women who booked for antenatal care from 1988 to 1998. Method 

Multiple logistic regression analysis. Main outcome measures 

Preterm birth rate of, and the factors associated with, cases with unrecorded best estimate of gestational age at birth. Results 

Of the 53 981 cases with an unrecorded best estimate of gestational age at birth, by using additional data, it was possible to compute a new best estimate of gestational age in 80%. In this latter group, the preterm birth rate was 42% (95% CI 41.5-42.6). The corrected, overall preterm birth rate in North West London (9.8%, 9.7-9.9) was higher than the original estimate (7.6%, 7.5-7.7), which included only cases with recorded data on gestational age at birth. The most significant factors associated with an unrecorded gestational age were no ultrasound scan (OR 49, P < 0.001), and preterm birth <31 weeks (OR 30, P < 0.001). Conclusions 

The incidence of preterm birth are likely to be under-reported in studies where only cases with readily available gestational age data are included. In routinely collected maternity data, human omission is an important contributing factor for an unrecorded best estimate of gestational age at birth. This is associated with the urgent transfer of babies to the neonatal intensive care unit.

Keywords: Exclusion bias; gestational age; preterm birth

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1471-0528.2009.02184.x

Affiliations: 1: University College London Institute for Women's Health, London, UK 2: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK 3: Department of Obstetrics and Gynaecology, Imperial College Faculty of Medicine, Northwick Park Hospital, Middlesex, UK 4: Academic Department of Obstetrics and Gynaecology, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK

Publication date: 2009-08-01

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