Paediatric and perinatal epidemiology · 2026
The Methodological Pitfalls Complicating the Analysis of Early Term Births.
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Berman Ye'elah E, Newnham John P, Doherty Dorota A, Ward Sarah V
Аннотация
BACKGROUND: Evaluating the success of policies aiming to reduce early term birth (37+0-38+6 weeks' gestation) is analytically challenging.
OBJECTIVES: Determine the best method of reporting temporal changes of early term birth rates.
METHODS: We analysed 54,646 singleton births at Western Australia's main tertiary hospital (2009-2019). Using interrupted time series, segmented and nominal regression, we assessed how varying gestational age outcomes, denominator, or statistical method affected conclusions regarding temporal changes (pre and post-Initiative implementation) in the timing of birth.
RESULTS: Interrupted time series showed yearly rates of birth at 37+0-38+6 weeks increased pre-Initiative, with no instant level change or change in the slope post-Initiative, regardless of denominator: all births (slope change -0.0, 95% CI -0.5, 0.5); births > 36+6 weeks (slope change: -0.4, 95% CI -1.0, 0.2), and no change to the number of early term births averted. Conversely, when examining births < 39+0 weeks, pre-Initiative rates increased by 0.9% (95% CI 0.5, 1.3) per year, then stabilised post-Initiative (slope change: -0.8, 95% CI -1.4, -0.3), with no change to the number of births < 39+0 weeks averted. Nominal logistic regression showed that pre-Initiative, the rise in the early term birth rate was driven by a reduction in births at ≥ 39+0 weeks, and post-Initiative by a reduction in preterm birth. Using segmented quantile regression, lengthening of gestational age at birth in days was observed more so at the lower percentiles, compared to the estimated counterfactual.
CONCLUSION: Examining early term birth rates in isolation can mask changes in birth timing in the presence of a changing preterm or ≥ 39+0 birth rate. Researchers should examine all births < 39+0 weeks rather than just early term births, or use nominal logistic regression. For gestational age in days as the outcome, segmented quantile regression can be used.
OBJECTIVES: Determine the best method of reporting temporal changes of early term birth rates.
METHODS: We analysed 54,646 singleton births at Western Australia's main tertiary hospital (2009-2019). Using interrupted time series, segmented and nominal regression, we assessed how varying gestational age outcomes, denominator, or statistical method affected conclusions regarding temporal changes (pre and post-Initiative implementation) in the timing of birth.
RESULTS: Interrupted time series showed yearly rates of birth at 37+0-38+6 weeks increased pre-Initiative, with no instant level change or change in the slope post-Initiative, regardless of denominator: all births (slope change -0.0, 95% CI -0.5, 0.5); births > 36+6 weeks (slope change: -0.4, 95% CI -1.0, 0.2), and no change to the number of early term births averted. Conversely, when examining births < 39+0 weeks, pre-Initiative rates increased by 0.9% (95% CI 0.5, 1.3) per year, then stabilised post-Initiative (slope change: -0.8, 95% CI -1.4, -0.3), with no change to the number of births < 39+0 weeks averted. Nominal logistic regression showed that pre-Initiative, the rise in the early term birth rate was driven by a reduction in births at ≥ 39+0 weeks, and post-Initiative by a reduction in preterm birth. Using segmented quantile regression, lengthening of gestational age at birth in days was observed more so at the lower percentiles, compared to the estimated counterfactual.
CONCLUSION: Examining early term birth rates in isolation can mask changes in birth timing in the presence of a changing preterm or ≥ 39+0 birth rate. Researchers should examine all births < 39+0 weeks rather than just early term births, or use nominal logistic regression. For gestational age in days as the outcome, segmented quantile regression can be used.