Is indicated or spontaneous preterm delivery more advantageous for the fetus?

We performed a case-control study to determine whether fetuses delivered prematurely because of pregnancy complications (primarily pregnancy-associated hypertensive disease) had a different neonatal course than that of those born after either spontaneous preterm labor or after premature rupture of the membranes. Two case-control populations were matched by gestational age at delivery, fetal sex, and race. There was no perinatal survival advantage in babies delivered from "stressed" pregnancies. Selected neonatal morbidities were generally similar, but there was an increased incidence of necrotizing enterocolitis in babies born after preterm labor and a higher incidence of both necrotizing enterocolitis and neonatal sepsis after premature rupture of the membranes. We conclude that a "stressed" pregnancy confers a negligible survival advantage to the fetus.