Gestational age at term and readmission after discharge from the maternity hospital

Background

Unplanned newborn readmissions after discharge from a maternity hospital contribute to neonatal morbidity and healthcare costs. Our prior research in low-risk term newborns showed higher readmission rates <7 days among infants born at 37, 38 and 39 weeks’ gestational age (GA) than at ≥ 40 weeks. This study aimed to verify this finding using a more strictly defined low-risk population and to describe the causes of earlier-term readmissions.

Methods

We used linked delivery, birth, and postnatal hospitalization data from the French National Health Data System from 2014-2024. The initial population included singleton liveborn term infants without congenital anomalies or neonatal unit admission who were discharged with their mothers (7,000,431; 84.7% of all births). We also defined a restricted low-risk population without maternal, fetal, or neonatal complications based on ICD-10 codes, as specified in a Joint Commission quality indicator. Relative risks (RRs) of readmission <7 days after discharge were estimated by GA using a modified Poisson model, accounting for clustering within hospitals and adjusting for socioeconomic covariables (maternal age, insurance status, area-based deprivation). Principal readmission diagnoses were compared by GA.

Results

The overall readmission rate was 1.34% and increased with decreasing GA. The rate was 1.31% in the restricted low-risk sample, which excluded 28% of infants born at 37 weeks and 7% at 40 weeks; GA patterns remained similar. RRs (95% CI) were 2.58(2.49–2.68) at 37 weeks, 1.61(1.57–1.66) at 38 weeks, 1.23(1.20–1.25) at 39 weeks, and 0.96(0.94–0.98) at 41 weeks, compared with infants born at 40 weeks. Jaundice and digestive and feeding problems were the main contributors to higher readmission rates at earlier GAs.

Conclusions

These differences among low-risk term infants raise questions in the context of changing labor induction practices worldwide, which have led to increases in births at earlier-term gestations.

Key messages

• The overall readmission rate was 1.34% and increased with decreasing GA. The rate was 1.31% in the restricted low-risk sample, which excluded 28% of infants born at 37 weeks and 7% at 40 weeks.

• These differences among low-risk term infants raise questions in the context of changing labor induction practices worldwide, which have led to increases in births at earlier-term gestations.