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\begin{document}

\title{Gestational age at delivery, circumstances at parturition, and prenatal
risk factors affect outcomes of late preterm newborns: results from an
area-based, prospective cohort study.}



\author[1]{Francesca Monari}%
\author[1]{Giuseppe Chiossi}%
\author[2]{Giancarlo Gargano}%
\author[1]{Michela Ballarini}%
\author[3]{Dante Baronciani}%
\author[4]{Alessandra Coscia}%
\author[5]{Fabio Facchinetti}%
\affil[1]{Policlinico di Modena}%
\affil[2]{Arcispedale S Maria Nuova}%
\affil[3]{Affiliation not available}%
\affil[4]{Ospedale Sant'Anna}%
\affil[5]{Università degli Studi di Modena e Reggio Emilia}%


\vspace{-1em}



  
  \date{May 05, 2024}


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\selectlanguage{english}
\begin{abstract}
Objective: To identify pregnancies at risk for adverse outcomes in the
late preterm (LP) period, we investigated how gestational age (GA) at
delivery, circumstances at parturition, and specific prenatal risk
factors may affect neonatal outcomes. Study design: Prospective,
area-based cohort study of neonatal morbidity and mortality among
singleton infants born between 34+0 and 36+6 weeks, at 21 L\&D units in
Emilia Romagna county, Italy, during 2013-15. The primary neonatal
outcome was a composite of Apgar 5' [?] 3, umbilical-cord-blood arterial
pH \textless{} 7.0, RDS, TTN, hypoglycemia, sepsis, confirmed seizures,
stroke, IVH, cardiopulmonary resuscitation, invasive respiratory support
and hospitalization [?] 5 days. Multivariate logistic regression models
were used to respectively investigate the effects on study outcomes of
1) GA at delivery and circumstances at parturition 2) GA at delivery and
prenatal risk factors, after controlling for confounding Results: Among
1867 births, 302, 504 and 1061 infants were born at 34, 35 and 36 weeks,
respectively. There were no neonatal deaths. When studying circumstances
at parturition, an increased risk of composite neonatal outcome was
observed among 34 weeks births, 35 weeks deliveries, and indicated
deliveries. When studying prenatal risk factors, neonatal morbidity was
associated with delivery 34 weeks, birth at 35 weeks, pregestational
diabetes, pPROM, maternal BMI, bleeding and polyhidramnios; instead,
preeclampsia had a protective effect. Conclusion: LP with indicated
deliveries at 34 or 35 weeks, or with specific prenatal risk factors
have worse neonatal outcome when compared to 36. Such differences should
be considered when counseling patients and planning interventions.%
\end{abstract}%



\sloppy


\textbf{BACKGROUND}

Preterm birth is defined as delivery prior to 37 weeks' gestation.
Although infants born toward the end of this period were traditionally
assumed to be `low risk,' research has unequivocally demonstrated
increased rates of adverse neonatal outcomes associated with LP births
(34\textsuperscript{+0}--36\textsuperscript{+6} weeks). Compared with
term infants, LP infants are more frequently admitted to the neonatal
intensive care unit (NICU), and have longer hospital stay, due
respiratory morbidities, temperature instability, hypoglycaemia, and
hyperbilirubinaemia. Such population is also at higher mortality risk
and it is more susceptible to sepsis, necrotizing enterocolitis, and
neurological morbidities {[}1, 2, 3{]}.

The LP rate in Western countries represents 3.3-5.7\% of all births,
accounting for about two thirds of the entire preterm population
{[}4{]}. Despite the LP period is restricted to just 21 days of
intrauterine development, perinatal well-being may vary {[}5{]}. The
primary determinant of neonatal outcomes is gestational age at delivery;
however, race, fetal gender, and administration of antenatal
corticosteroids are also important factors affecting both survival and
intact survival {[}6{]}. Recent research suggests that also indication
for delivery significantly impacts neonatal outcomes {[}7, 8{]}: studies
on both preterm {[}7{]} as well as LP births {[}9{]} showed worse
outcomes among medically indicated as opposed to spontaneous preterm
deliveries. Furthermore, among births prior to 34 weeks, intrauterine
growth restriction (IUGR) was found to have increased neonatal risks
{[}10, 11{]} , while fetal or obstetric indications for delivery lead to
higher neonatal morbidity when compared to maternal indications
{[}12{]}. However, the role of specific maternal (such as hypertensive
disorders, diabetes mellitus) or fetal risk factors (such as IUGR,
amniotic fluid abnormalities) on neonatal outcomes is still a matter of
debate, when they are not directly responsible for LP deliveries.
Moreover, the outcomes of late LP premature rupture of membranes have
not been compared to other delivery indications.

With this study we sought to expand our understanding of how neonatal
risks in the LP period may vary according to the timing and the
indication for delivery, in order to personalize prenatal counseling, as
well as obstetric care for individual mothers and their newborns.
Therefore, we investigated a large prospective cohort of LP neonates to
determine:

1) if neonatal outcomes differ according to the specific gestational age
at delivery (34 vs 35 vs 36 weeks' births), as gestational age does not
affect management of pregnancies when delivery is anticipated between
34\textsuperscript{+0} and 36\textsuperscript{+6} weeks

2) if neonatal morbidity varies based on the circumstances at
parturition (spontaneous preterm labor (PTL), preterm premature rupture
of membranes (pPROM), or indicated delivery)

3) if complications at birth are affected by specific maternal, fetal
and obstetric conditions, even if they may not represent the indication
for delivery.

\textbf{MATERIALS AND METHODS}

We conducted a prospective, multicenter, area-based cohort study of all
the LP deliveries from December 1\textsuperscript{st} 2013 to December
1\textsuperscript{st} 2015 in Emilia Romagna, a region in Northern Italy
with nearly 4.5 million people organized in 9 counties.

The study steering committee (consisting in 2 obstetricians, 2
neonatologists and 1 epidemiologist) defined the information to collect
on pregnancies resulting in LP deliveries, and on neonates' hospital
course. Standardized chart abstraction forms were designed to obtain
anonymized data on mothers (i.e maternal demographics, maternal medical
and obstetrical complications, labor and delivery details) and their
newborns (i.e birthweight, gender, Apgar scores, admission to the NICU
or Intermediate/Step Down Unit, and length of stay, neonatal morbidities
and mortality). In Emilia Romagna, inpatient obstetric and pediatric
care was provided at that time by 28 hospitals within the National
Health System. Recruitment occurred only at the 21 hospitals with at
least 500 deliveries/year, equipped with NICUs or Intermediate/Step Down
Units, that could care for LP infants: one obstetrician and one
neonatologist/pediatrician from each study site approached mothers
delivering at 34\textsuperscript{+0}-36\textsuperscript{+6} weeks for
written informed consent, and respectively completed the maternal and
the neonatal data collection forms, as they interviewed the patients and
consulted the medical records. Five trained research associates visited
the study sites on a monthly basis to review the maternal and neonatal
data collection forms with the physicians that had filled them. At the
Data Managing Center (Modena Policlinico Hospital, University of Modena
and Reggio Emilia) research associates used optical character
recognition technology (Flexi Capture, Abbyy \selectlanguage{ngerman}®, Germany) to scan the
data collection sheets, extract pertinent data, and organize it in a
password protected database. If automated data extraction failed
(approximately 5\% of the times), research associates reviewed the forms
and manually entered the missing data in the database. Approval from the
Institution Review Board of the 9 Emilia Romagna Counties was obtained.
The study was financed by the Emilia Romagna County Grent (n 417149 \_
2014).

\textbf{Study population}

Women with a singleton viable pregnancy (antenatal stillbirth were
excluded) were classified according to the circumstances at delivery as
spontaneous PTL, pPROM or indicated delivery. The diagnosis of preterm
labor was based on clinical criteria of regular uterine contractions
accompanied by progressive changes in cervical dilation and effacement
{[}13{]}. As preterm labor occurred \selectlanguage{english}[?] 34 weeks, tocolytic therapy was
not administered. Women presenting with pPROM between
34\textsuperscript{+0} and 36\textsuperscript{+6} weeks' gestation, who
were not in labor within 24 hours after rupture of membranes and had no
indication for immediate delivery, were expectantly managed as detailed
in the PPROMEXIL trial {[}14{]}. Women in whom pPROM was diagnosed after
24\textsuperscript{+0} weeks, but who had not delivered by
34\textsuperscript{+0} weeks' gestation, could also be managed
expectantly. The diagnosis of membrane rupture was confirmed by
visualization of amniotic fluid passing from the cervical canal and
pooling in the vagina, a basic pH test of vaginal fluid, or arborization
(ferning) of dried vaginal fluid, which is identified under microscopic
evaluation. When needed, commercially available test for amniotic
proteins (Amnioquick (r) Biosynex) were utilized to confirm pPROM
according to local protocols. A course of therapy with a combination of
a beta lactam and a macrolide antibiotic was left at the discretion of
each study site even when pPROM occurred after 34 weeks, as a
preliminary inquiry had found such practice to be common. Rupture of
membranes was considered as the delivery indication only when
spontaneous labor occurred during expectant management, or if the
patient and/or her obstetrician opted for an elective delivery. Instead,
if onset of labor occurred within 24 hours of rupture of membranes,
spontaneous PTL was the delivery indication. We defined indicated births
as those occurring after labor induction or cesarean delivery without
labor due to maternal, fetal or obstetric complications.

No specific recommendations were given concerning administration of
antenatal corticosteroids, as the study was conducted prior to the
publication of the ALPS trial {[}15{]}.

The timing of delivery was determined in completed weeks of gestation
such that 34 weeks (for example) included deliveries at
34\textsuperscript{+0} -- 34\textsuperscript{+6} weeks. Gestational age
was based either on first trimester ultrasound scan or, in women with a
regular cycle, on the first day of the last menstrual period if the
expected date of delivery differed less than 7 days from that estimated
by ultrasound.

\textbf{Outcome measures}

The study outcomes were composite. Composite adverse neonatal outcome
included neonatal death, adverse respiratory outcomes (RDS,TTN ),
hypoglycemia, newborn sepsis, confirmed seizures, stroke, IVH,
cardiopulmonary resuscitation, mechanical ventilation,
umbilical-cord-blood arterial pH \textless{} 7.0 or base excess
\textless{} -12.5, a 5-minute Apgar score \selectlanguage{english}[?] 3, and prolonged
hospitalization (\selectlanguage{english}[?] 5 days). As indicated by previous studies, these
outcomes were chosen as they are associated with significant risks of
neonatal mortality or long-standing neonatal morbidities, including
hypoxic ischemic encephalopathy {[}16, 12{]}. Secondary outcomes
included neonatal resuscitation (metabolic acidosis and/or resuscitation
at birth), metabolic complications (hypoglycemia and/or difficulties
feeding), and respiratory support (both invasive and non-invasive).

Non reassuring fetal status was defined as catergory III {[}17{]} or
persistent category II fetal heart rate pattern with abnormal labor
progress {[}18{]}, non-reactive NST associated with recurrent
decelerations among non-laboring women {[}19{]}, absent or reverse
umbilical artery end diastolic flow in the setting of IUGR {[}20{]}.
Clinical chorioamnionitis included maternal fever in association with
uterine fundal tenderness, maternal tachycardia, fetal tachycardia,
purulent or foul amniotic fluid {[}21{]}. Mild metabolic acidosis was
defined as pH= 7.20 -- 7.30 and BE = -6 \selectlanguage{english}- -12, moderate acidosis
consisted in pH= 7 -- 7.19 and BE = -12 \selectlanguage{english}- -16, while severe acidosis was
pH \textless{} 7 and BE \textless{} -16. CPAP and oxygen administration
represented non-invasive respiratory support, as opposed to mechanical
ventilation, the invasive respiratory support. Neonatal sepsis was
defined as a clinical syndrome prompting antibiotic treatment, with or
without positive cultures. Cerebral lesions were suspected clinically,
screened by neonatal brain ultrasound, and confirmed on MRI. (For
details about specific definitions of outcomes please see Table S1) .

\textbf{Statistical analysis}

As we stratified neonatal outcomes according to timing of delivery, we
also compared how maternal characteristics, obstetric features, fetal
characteristics, and circumstances at parturition varied with each
completed week of gestation at the time of delivery. Categorical
variables were presented as n (\%) and tested with Chi square test or
Fisher's exact test as appropriate. Normally distributed continuous
variables were presented as mean +- SD and compared with One Way ANOVA.
Non-normally distributed continuous variables were presented as median
(IQR) and tested with One Way ANOVA on ranks. A level of statistical
significance of \emph{P} \selectlanguage{english}[?] 0.05 was considered

Multivariate logistic regression analysis was used to investigate if
gestational age and circumstances at delivery (spontaneous PTL, pPROM or
indicated delivery) independently affected the risk of adverse neonatal
outcomes. The following variables were tested as potential confounders:
maternal age, parity, history of spontaneous preterm birth, race, low
education, smoking, maternal BMI, excessive weight gain, utilization of
assisted reproductive technologies (ART), treatment with antenatal
corticosteroids, ASA, LMWH, or progesterone. Maternal medical disorders,
obstetric or fetal complications, type of labor other than spontaneous
(i.e induced or no labor), and route of delivery were not included in
the models as they were considered on the same causal pathway of
circumstances at delivery. Finally, a potential interaction between
gestational age at delivery and circumstances at delivery was
investigated.

Disorders of the mother or the fetus may affect neonatal outcomes, even
if they are not the primary indication for delivery. Therefore, we
tested the independent effect on adverse neonatal outcomes of maternal
medical conditions (diabetes mellitus, hypertensive disorders, liver
disorders), fetal characteristics (non-reassuring fetal status, IUGR,
prenatally diagnosed fetal anomalies or aneuploidies, and amniotic fluid
disorders), pregnancy complications (pPROM, spontaneous PTL,
chorioamnionitis, vaginal bleeding from placental abruption or abnormal
placentation), and gestational age at delivery using multivariate
logistic regression. Maternal age, parity, history of spontaneous
preterm birth, race, low education, smoking, maternal BMI, excessive
weight gain, utilization of ART, treatment with antenatal
corticosteroids, ASA, LMWH, or progesterone were tested as potential
confounders. Type of labor other than spontaneous (i.e induced or no
labor), and route of delivery were not included in the models as they
were considered on the same causal pathway of maternal, fetal, or
obstetrics complications.

The strength of the association between the covariates and the dependent
variable was estimated as area under the curve of a receiver operating
characteristic (ROC) curve plotted with the true-positive rate compared
with the false positive rate. Statistical analyses were performed using
Stata 15 (StataCorp, College Station, TX).

\textbf{RESULTS}

Among the 1897 LP births, 302 (16.2\%) occurred at 34 weeks', 504 (27\%)
at 35 weeks' and 1061 (56.8\%) at 36 weeks' gestation. Spontaneous
preterm labor accounted for 686 (36.7\%) deliveries, pPROM for 398
(21.3\%), while 783 (42\%) were indicated LP births.

Table 1 summarizes the maternal and obstetrics characteristics of the
study population presented by gestational age at delivery. Demographic
features, socioeconomic attributes, medical complications (hypertensive
and liver disorders, chorioamnionitis), prophylaxis with ASA or LMWH
were similar across different gestational age groups. Only 4 patients
developed pPROM \textless{} 34 weeks' gestation. Diabetes mellitus was
more common among mothers who delivered at 34 weeks' gestation (p
\textless{} 0.01), pPROM was more prevalent among pregnancies resulting
in 36 weeks deliveries (p = 0.03), while vaginal bleeding due to
abruption or abnormal placentation was less frequent among gestations
leading to 36 weeks as opposed to earlier births (p \textless{} 0.01).
Antenatal corticosteroids and progesterone prophylaxes progressively
decreased with gestational age (p \textless{} 0.01). The last (and for
605/634 the only course) of antenatal corticosteroids was administered
to 237 (37.4\%) patients \textless{} 34 weeks' gestation, while 397
(62.6\%) received the treatment later. Induction of labor was more
common later in pregnancy, as opposed to CDs performed prior to labor
onset (p \textless{} 0.01); the vaginal delivery rate increased with
gestational age at delivery (p \textless{} 0.01).

Thirty-four women (4\%) were diagnosed with pPROM prior to 34 weeks'
gestation, while 809 (96\%) later. The median interval from rupture of
membranes to delivery was 4 days (95\%CI 2 -5 days). Antibiotic
treatment was administered to 699 (83\%) women with pPROM; although
details about the duration of treatment were available for only 634
women, the vast majority (i.e. 610, 96\%) received a \selectlanguage{english}[?] 7 day-course.

Fetal characteristics are displayed in table 1. Non reassuring fetal
status, prenatally diagnosed fetal anomalies, and amniotic fluid
abnormalities were similar among study groups, while IUGR was
significantly less common when delivery occurred closer to term (p
\textless{} 0.01). Circumstances at parturition (spontaneous PTL, pPROM
or indicated deliveries) did not differ according to timing of delivery
(Table 2). Instead, most neonatal outcomes were affected by gestational
age (Table 3). No cases of neonatal deaths were detected in our study
population. The prevalence of metabolic acidosis and respiratory support
dropped with gestational age at delivery (p \textless{} 0.01), while 5'
Apgar score and cardiopulmonary resuscitation remained unaffected (Table
3). Later deliveries were associated with higher birthweights, higher
proportions of SGA infants, as well as lower rates of jaundice,
difficulty feeding, hypoglycemia and sepsis (p \textless{} 0.01).

The composite neonatal outcome was detected among 27.1\% (82/302) of the
34 weeks deliveries, 17.7\% (89/504) of the 35 weeks deliveries, and 8\%
(85/1061) of the 36 weeks births (p \textless{} 0.01). Similarly, the
composite outcomes respectively summarizing metabolic complications, and
respiratory support decreased when delivery occurred closer to term,
while the risk of metabolic acidosis and/or neonatal resuscitation was
unaffected by timing of delivery (Table 3).

Multivariate analysis showed that gestational age at delivery had the
most significant impact on the composite neonatal outcome, metabolic
complications, and the need for respiratory support. Table 4 summarizes
the multivariate logistic regression models investigating the role of
timing and circumstances at delivery. Neonatal morbidities decreased
with gestational age at delivery (p \textless{} 0.01), and were
associated with indicated births (p \textless{} 0.01); of note, outcomes
of pregnancies delivered due to pPROM were similar to spontaneous PTLs
(Table 4). Instead, timing of delivery did not affect neonatal
resuscitation, that appeared to be uniquely associated to deliveries
indicated by maternal, fetal or obstetric complications (p \textless{}
0.01). Table 5 illustrates the multivariate logistic regression models
assessing the impact of maternal medical conditions, fetal
characteristics, pregnancy complications, and gestational age at
delivery on neonatal morbidities. As gestational age increased, the
composite neonatal outcome, metabolic complications and the need for
respiratory support dropped (p \textless{} 0.01). Considering the same
outcome measures, pregestational diabetes was a significant risk factor
for neonatal morbidities (p =0.02, \textless{} 0.01, and \textless{}
0.01 respectively), while preeclampsia showed a protective effect (p
=0.03, \textless{} 0.01, and 0.04 respectively). Vaginal bleeding due to
abruption or abnormal placentation (p = 0.03), increasing maternal BMI
(p = 0.03, and 0.02 respectively), and polyhydramnios (p = 0.045, and
\textless{} 0.01 respectively) were significantly associated with both
the composite neonatal outcome and respiratory support, while pPROM (p
\textless{} 0.01) was solely associated with the composite neonatal
outcome. Non-reassuring fetal status was related to both metabolic
complications (p \textless{} 0.01), and respiratory support (p = 0.04);
instead, spontaneous PTL (p \textless{} 0.01) had a protective effect on
the risk of metabolic complications, as opposed to IUGR (p \textless{}
0.01). Gestational age at delivery did not affect the risk of metabolic
acidosis and/or neonatal resuscitation; the likelihood of such outcome
was associated with bleeding due to placental abruption or abnormal
placentation (p \textless{} 0.01), as well as with non-reassuring fetal
status (p \textless{} 0.01).

\textbf{CONCLUSIONS}

Although births at 34\textsuperscript{+0} -- 36\textsuperscript{+6} are
usually considered as a homogeneous population under the definition of
LP, this large prospective, observational study demonstrated significant
differences in neonatal outcomes based on gestational age at delivery.
We found that approximately one third of newborns at 34 weeks
experienced neonatal morbidities, when compared to \textless{} 10\% of
the 36 weeks births (Table 4). Moreover, after controlling for
confounding, adverse outcomes were 2-4 folds more common when delivery
took place at 34 instead of 36 weeks' gestation (Tables 5, 6). As also
shown by the Consortium on Safe Labor {[}22{]}, we identified a
continuum of neonatal morbidities that inversely correlated with timing
of delivery; therefore, when maternal, fetal or obstetric complications
develop between 34\textsuperscript{+0} and 36\textsuperscript{+6} weeks'
gestation, obstetricians need to carefully balance the risks and
benefits of birth at a specific gestational age with the consequences of
pregnancy continuation beyond that time point {[}23{]}.

As metabolic acidosis and the need for neonatal resuscitation reflect
the fetus' exposure to hypoxia and increased metabolic demands, we found
an association with pregnancy complications rather than gestational age
at delivery (Table 5, 6). De Almeida et al. {[}24{]} initially
demonstrated that LP babies were at substantially increased risk for
neonatal resuscitation when compared to term counterparts. Our
multivariate analyses confirmed among LP newborns known risk factors for
resuscitation at birth, such as delivery prompted by maternal or fetal
disorders (i.e. indicated deliveries, Table 5), vaginal bleeding from
placenta abruption/abnormal placentation, and non-reassuring fetal
status (Table 6) {[}25{]}. These findings may help develop strategies to
prepare for circumstances requiring advanced neonatal resuscitation
skills, and to organize in utero transfer to Tertiary Care Centers.

In our cohort, indicated deliveries were associated with worse immediate
neonatal outcomes when compared with spontaneous LP labor (Table 5), as
also indicated in previous reports {[}8, 9{]}. The process of labor
itself likely facilitates fetal lung maturation and improves clearance
of pulmonary fluid, reducing the risk of neonatal respiratory
morbidities and the need for resuscitation {[}26{]}, while the
underlying condition that prompted delivery may also account for poorer
outcomes. Interestingly, expectantly managed pPROM had outcomes similar
to spontaneous LP labor, suggesting that prompt induction of labor may
not represent the only option available when rupture of membranes
complicates LP gestations, as also stated in the PPROMEXIL {[}14{]} and
PPROMEXIL2 {[}27{]} trials.

Our study also showed that an adverse intrauterine environment may
significantly contribute to neonatal morbidity. The association between
infection, inflammation and adverse neonatal outcomes may be explained
by the ability of pro-inflammatory cytokines to produce the ``fetal
inflammatory response'' {[}28{]}. Intrauterine inflammation has been
demonstrated in pregnancies complicated by preeclampsia {[}29{]},
maternal obesity {[}30{]}, polyhydramnios {[}31{]}, rupture of
membranes, and chorioamnionitis {[}32{]}. Diabetes mellitus not only
creates a pro-inflammatory intrauterine environment {[}33{]}, but it
also accounts for the damaging effects of fetal hyperglycaemia and
hypoxia {[}34{]}. Accordingly, our multivariate analyses confirmed the
correlation between pregestational diabetes and increasing maternal BMI
with both the composite adverse neonatal outcome, and the need for
respiratory support, while polyhydramnios was linked to both the
composite adverse neonatal outcome and resuscitation at birth. We also
showed how pregestational diabetes relates to neonatal metabolic
complications, while pPROM was confirmed as a risk factor for the
composite of neonatal morbidities (Table 6). Surprisingly, preeclampsia
had a protective effect on neonatal complications (Table 6), suggesting
that the increased antepartum surveillance once preeclampsia is
diagnosed may counterbalance the risks associated with an adverse
intrauterine environment

Placental ischemia and hypoxia are characterized by impairment of
placental blood flow, which results in reduced delivery of oxygen and
nutrients to the fetus {[}35{]}. According to our multivariate analyses,
placental abruption or bleeding from abnormal placentation were
associated with the composite adverse neonatal outcome, with metabolic
acidosis and/or resuscitation at birth, and respiratory support as they
may compromise fetal supply of oxygen and nutrients to the fetus (Table
6). Similarly, increased metabolic demands may lead to non-reassuring
fetal status, that was also correlated with resuscitation at birth, the
composite metabolic outcome, and respiratory support (Table 6).
Insufficient intrauterine growth has been attributed to hypoxemia from
placental under perfusion {[}36, 37{]}, and it was found to have
increased neonatal risks among preterm births {[}10, 11{]}. Our
multivariate analyses confirmed such finding also in the LP population,
since IUGR babies had more metabolic complications (Table 6).

It has been speculated that spontaneous onset of preterm labor may be a
consequence of an earlier idiopathic activation of the normal labor
process in an attempt to protect the fetus. Therefore, labor may enable
the fetus to exit a potentially ``hostile'' in-utero environment
{[}38{]}. Accordingly, our multivariate analysis showed a protective
effect of spontaneous preterm labor on the risk of developing the
composite metabolic outcome, as opposed to other maternal, fetal or
obstetric complications.

Strengths of this study include the large sample size and multicenter
nature of the cohort: both characteristics increase the generalizability
of our findings. The prospective design of the survey, along with
predefinition of standardized chart abstraction forms completed by
Obstetricians and Pediatricians, and periodically audited by research
associates, limit misclassification bias and assures data validity. We
acknowledge also some limitations. The study did not classify neonatal
complications according to specific obstetric, maternal or fetal
indications for delivery. We deliberately chose to analyze together the
outcomes of all indicated deliveries, as some disease processes such as
hypertensive disorders, diabetes mellitus or intraamniotic infections
may affect both mothers and babies. Moreover, we focused on specific
disorders, rather than delivery indications, as those may be indirectly
responsible for LP deliveries; for example, IUGR may account for
non-reassuring fetal status that prompts emergent delivery, or also
preeclampsia may cause placental abruption that then leads to delivery.
Although inconsistencies in antenatal corticosteroids administration may
reflect different opinion leaders' viewpoints prior to the publication
of the ALPS trial, we considered bethamethasone treatment among the
potential confounders in our multivariate analyses.

In conclusion, gestational age at delivery, circumstances at
parturition, and specific maternal, fetal, as well as obstetric
complications have a significant impact on neonatal outcomes. Therefore,
the decision to deliver or not during LP period should be based on the
underlying conditions affecting the mother and/or the fetus, and a
careful assessment of the risks of preterm delivery versus the potential
benefits of expectant management should be performed. Our findings can
be helpful when counselling mothers at risk of LP delivery, and can be
used to plan interventions for their newborns.

\textbf{DISCLOSURE OF INTERESTS} : Each author declares to have no
conflicts of interest.

\textbf{CONTRIBUTION TO AUTHORSHIP:} each author contributed
significantly: FM and MB in writing paper and collecting data, GC in
statistical analysis and writing paper, GG, DB, AC in the conception of
the study and FF in scientific conception and principal investigator of
the study.

\textbf{DETAILS OF ETHICS APPROVAL:} The study was approved from the
Institution Review Board of the 9 Emilia Romagna Counties (n 24512 \_
25/9/2014)

\textbf{FOUNDING:} The study was financed by the Emilia Romagna County
Grent (n 417149 \_ 2014)

\emph{* \textbf{Late Preterm Emilia Romagna Group:} Vittorio Basevi
(Health facilities, Emilia-Romagna Region, Bologna, Italy), Frusca
Tiziana (Obstetrics and Gynaecology Unit, University of Parma, Parma,
Italy} )\emph{, Giuseppe Battagliarin (Health facilities, Emilia-Romagna
Region, Bologna, Italy) , Marinella Lenzi (Maternal and Pediatrics
Department, Maggiore Hospital, Bologna, Italy)., Gina Ancora (Neonatal
Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini,
Rimini, Italy} )\emph{, Luigi Corvaglia (Pediatric unit, Ospedale S.
Orsola- Malpighi di Bologna).}

\textbf{Acknowledgments:} we are indebted to all collegues and research
fellows for their contributions to data collection:

\emph{Group of Bologna: Maria Bisulli (Obstetric Unit), Nicola Rizzo
(Obstetric Unit), Elisa Moro (Obstetric Unit), Silvia Vandini (Neonatal
Unit) from Ospedale S. Orsola- Malpighi di Bologna; Francesco Giura
(Neonatal Unit), Fabrizio Sandri (Neonatal Unit), Paola Murano
(Obstetric Unit), Barbara Di Marcobernardino (Obstetric Unit), Giorgio
Scagliarini (Obstetric Unit) from Ospedale Maggiore of Bologna.}

\emph{Group of Romagna: Elena Baudassi (Neonatal Unit) from Ospedale
Infermi of Rimini}

\emph{Group of Parma and Piacenza : Federica Tamarri (Neonatal Unit),
Cinzia Magnani (Neonatal Unit), Alice Suprani (Obstetric Unit), from the
Department of Medicine and Surgery, University of Parma} ;

\emph{Bruno Mandelli (Obstetric Unit), Melissa Bellini (Pediatric Unit),
Luca Le Pera (Pediatric Unit) from the Ospedale of Piacenza; Maria Luisa
Bidetti (Pediatric Unit), Giuseppe Crovini (Obstetric Unit) from
Ospedale of Fidenza; Salvatore Anfuso (Obstetric Unit), Antonio
Albarelli (Obstetric Unit) from Ospedale of Borgotaro.}

\emph{Group of Modena: Petrella Elisabetta (Obstetric Unit), Isotta
Guidotti (Neonatal Unit), Fabrizio Ferrari (Neonatal Unit),
Mariamaddalena Carbone (Obstetric Unit), from Mother-Infant and Adult
Department of Medical and Surgical Sciences, University of Modena and
Reggio Emilia, Modena.}

\emph{Group of Reggio Emilia: Marina Palmieri (neonatal Unit), Flavio
Vanacore (Obstetric Unit) from Arcispedale Santa Maria Nuova, IRCCS,
Reggio Emilia, Lisa Melandri (Pediatric Unit) from Ospedale of
Montecchio and Ospedale of Scandiano, Marcella Palmisano (Obstetric
Unit) from Ospedale of Guastalla.}

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\end{enumerate}

\textbf{Legend:}

\textbf{LP:} late preterm

\textbf{RDS:} Respiratory Distress Syndrome,

\textbf{GA:} gestational age

\textbf{TTN:} transient tachypnea of neonate

\textbf{IVH:} Intraventricular Hemorrage

\textbf{PPROM:} preterm premature rupture of membranes

\textbf{NICU:} Neonatal Intensive Care Unit

\textbf{BMI:} Body mass index

\textbf{IUGR:} intrauterine growth restriction

\textbf{CNS:} Central nervous system

\textbf{SGA:} small for gestational age

\textbf{AGA:} adeguate for gestational age

\textbf{LGA:} large for gestational age

\textbf{ART:} assisted reproductive technologies

\textbf{ASA:} Cardioapirin

\textbf{LMWH:} Low molecular weight heparin

\textbf{CD:} caesarean delivery

\textbf{HTN:} hypertension

\textbf{IOM guidelines:} Institute of Medicine Weight Gain
Recommendations for Pregnancy

\textbf{PTB:} Preterm birth

\textbf{PTL:} preterm labour

\textbf{CPAP:} Continuous Positive Airway Pressure

\textbf{MRI:} Magnetic Resonance Imaging

\textbf{A1 GDM:} Gestational Diabetes under diet control

\textbf{A2 GDM:} Gestational Diabetes under drugs control (subcutaneous
insulin or medication)

\textbf{Table 1: Maternal and fetal characteristics}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{34 w (n: 302)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{35 w (n: 504)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{36 w (n: 1061)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Total (n: 1867)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Total (n: 1867)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{P}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Mean age}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32.8 \selectlanguage{ngerman}± 5.8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32.3 \selectlanguage{ngerman}± 5.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32.5 \selectlanguage{ngerman}± 5.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1867\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1867\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS+\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Primiparity}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
117 (38.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
193 (38.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
419 (39.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
729 (39\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
729 (39\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Previous PTB}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
25 (8.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
48 (9.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
84 (7.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
157 (8.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
157 (8.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Race} \emph{Caucasian} \emph{African} \emph{South East Asian}
\emph{Other}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
233 (77.1\%) 41 (13.6\%) 16 (5.3\%) 12 (4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
390 (77.4\%) 61 (12.1\%) 20 (4\%) 33 (6.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
832 (78.4\%) 122 (11.5\%) 37 (3.5\%) 70 (6.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1455 (77.9\%) 224 (12\%) 73 (3.9\%) 115 (6.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1455 (77.9\%) 224 (12\%) 73 (3.9\%) 115 (6.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Low education (\textless{} 8 years)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
101 (33.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
153 (30.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
294 (27.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
548 (29.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
548 (29.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{BMI}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22.5 (20.7-25.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22.5 (20.2-25.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23.4 (20.2-25.4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1867\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1867\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS\selectlanguage{ngerman}§\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Excessive Weight Gain (IOM)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
124 (60.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
221 (62.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
434 (56\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
779 (58.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
779 (58.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Smoking habit} \emph{Smoking} \emph{Stopped in pregnancy}
\emph{Stopped prior to pregnancy} \emph{No smoking}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
30 (10.\%) 17 (6\%) 8 (2.8\%) 229 (80.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
54 (10.9\%) 25 (5\%) 16 (3.2\%) 400 (80.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
89 (9\%) 45 (4.5\%) 45 (4.5\%) 809 (82\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
173 (9.8\%) 87 (4.9\%) 69 (3.9\%) 1438 (81.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
173 (9.8\%) 87 (4.9\%) 69 (3.9\%) 1438 (81.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Assisted reproductive technologies}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
21 (6.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23 (4.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
41 (3.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
85 (4.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
85 (4.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.08*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Diabetes} \emph{Pregestational diabetes} \emph{Class A2 GDM}
\emph{Class A1 GDM} \emph{No diabetes}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8 (2.6\%) 15 (5\%) 26 (8.6\%) 253 (83.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13 (2.6\%) 14 (2.8\%) 28 (5.6\%) 449 (89\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14 (1.3\%) 20 (1.9\%) 90 (8.5\%) 937 (88.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
35 (1.9\%) 49 (2.6\%) 144 (7.7\%) 1639 (87.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
35 (1.9\%) 49 (2.6\%) 144 (7.7\%) 1639 (87.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Hypertensive disorders} \emph{Chronic Hypertension}
\emph{Chronic Hypertension superimposed Preeclampsia} \emph{Gestational
Hypertension} \emph{Preeclampsia} \emph{Normotensive}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (3\%) 0 16 (5.3\%) 14 (4.6\%) 263 (87.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (1.8\%) 0 30 (5.9\%) 23 (4.6\%) 442 (87.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
15 (1.4\%) 0 74 (7\%) 29 (2.7\%) 943 (88.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
33 (1.8\%) 0 120 (6.4\%) 66 (3.5\%) 1648 (88.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
33 (1.8\%) 0 120 (6.4\%) 66 (3.5\%) 1648 (88.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
NS**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Vaginal bleeding (Abruption/Placenta previa)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
29 (9.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
55 (10.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
60 (5.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
144 (7.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
144 (7.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}\textbf{0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Liver disorders}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10 (3.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14 (2.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
40 (3.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
64 (3.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
64 (3.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{pPROM}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
133 (44\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
205 (40.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
505 (47.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
843 (45.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
843 (45.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{0.03*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Clinical chorioamnionitis}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1 (0.3\%9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7 (0.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10 (0.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10 (0.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Type of labor} \emph{No labour}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
106 (35.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
176 (35\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
270 (25.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
552 (29.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
552 (29.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Induced labour}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
41 (13.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
99 (19.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
226 (21.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
366 (19.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
366 (19.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Spontaneous labour}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
155 (51.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
228 (45.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
563 (53.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
946 (50.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
946 (50.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Mode of delivery} \emph{Vaginal delivery (spontaneous and
operative)}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
157 (52\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
257 (51.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
642 (60.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1056 (50.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1056 (50.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Cesarean in labor}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
39 (12.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
70 (13.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
147 (13.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
256 (13.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
256 (13.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Cesarean not in labor}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
106 (35.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
176 (35\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
270 (25.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
552 (29.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
552 (29.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Antenatal corticosteroids} \emph{No steroids}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
111(36.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
305 (60.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
817 (77\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1233 (66\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1233 (66\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{1 course}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
178 (58.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
195 (38.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
232 (21.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
605 (32.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
605 (32.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{2 courses}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13 (4.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4 (0.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12 (1.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
29 (1.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
29 (1.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{ASA prophylaxis}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10 (3.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11 (2.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23 (2.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
44 (2.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
44 (2.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{LMWH prophylaxis}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8 (1.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13 (1.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24 (1.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24 (1.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Progesterone Prophylaxis}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23 (7.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
26 (5.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
31 (2.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
80 (4.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
80 (4.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Non ressuring fetal monitoring (category III sec ACOG)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
18 (6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32 (6.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
51 (4.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
51 (4.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
101 (5.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NS*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Growth restriction (IUGR)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
41 (13.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
68 (13.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
88 (8.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
88 (8.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
197 (10.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Diagnosis of fetal anomaly} \emph{None}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
295 (97.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
496 (98.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1039 (97.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1039 (97.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1830 (98\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.7**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Cardiovascular}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (0.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (0.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9 (0.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{CNS}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Gastrointestinal}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Genito-urinary}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2 (0.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\emph{Others}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4 (0.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8 (0.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8 (0.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
15 (0.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Amniotic fluid} \emph{Oligo/anidramnios} \emph{Polidramnios}
\emph{Normal}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
18 (6\%) 7 (2.3\%) 277 (91.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
31 (6.1\%) 8 (1.6\%) 465 (92.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
52 (4.9\%) 16 (1.5\%) 993 (93.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
52 (4.9\%) 16 (1.5\%) 993 (93.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
101 (5.4\%) 31 (1.7\%) 1735 (92.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Low education: primary and secondary school; Excessive Weight Gain:
above IOM guidelines per BMI category; Previous PTB: prior birth
\textless{} 37 weeks; Class A1 GDM: diet, Class A2 GDM: Insulin therapy;
Non reassuring fetal monitoring category III tracing according to ACOG.

* Chi square test, ** Fisher Exact test, \selectlanguage{ngerman}§ ANOVA on ranks, + ANOVA

\textbf{Table 2: Circumstances at delivery}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
& \textbf{34 w (n: 302)} & \textbf{35 w (n: 504)} & \textbf{36 w (n:
1061)} & \textbf{Total (n: 1867)} & \textbf{P}\tabularnewline
\midrule
\endhead
\textbf{Mode of late preterm birth} & & & & & 0.06*\tabularnewline
\emph{Spontaneous preterm labor} & 116 (38.4\%) & 170 (33.7\%) & 400
(37.7\%) & 686 (36.7\%) &\tabularnewline
\emph{pPROM} & 57 (18.9\%) & 98 (19.5\%) & 243 (22.9\%) & 398 (21.3\%)
&\tabularnewline
\emph{Indicated} & 129 (42.7\%) & 236 (46.8\%) & 418 (39.4\%) & 783
(42\%) &\tabularnewline
\bottomrule
\end{longtable}

* Chi square test

\textbf{Table 3: Neonatal outcomes}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{34 w (n: 302)}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{35 w (n: 504)}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{36 w (n: 1061)}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Total (n 1867)}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{P}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Male}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
168 (55.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
283 (56.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
604 (56.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1055 (56.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.9*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Mean birth weight}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2291.7 \selectlanguage{ngerman}± 411.1\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2484.6 \selectlanguage{ngerman}± 422 g\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2721 \selectlanguage{ngerman}± 423 g\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1867\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01+}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Weight percentile} \emph{AGA}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
239 (79.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
402 (79.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
853 (80.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1494 (80\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.04*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{LGA}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
42 (13.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
45 (8.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97 (9.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
184 (9.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{SGA}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
21 (7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
57 (11.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
111 (10.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
189 (10.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Median NICU length of stay}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7 d (5-12 d)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5 d (3-8 d)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3 d (3-5 d)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1867\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{\textless{}0.01§}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{NICU stay longer than 5 days}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
238 (78.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
279 (55.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
307 (28.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
824 (44.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{\textless{}0.01§}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Metabolic acidosis at birth} \emph{No acidosis}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
290 (96\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
488 (96.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1039 (97.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1817 (97.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{0.01**}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Mild acidosis}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6 (0.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (0.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Moderate acidosis}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7 (0.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Severe acidosis}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
15 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (0.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
33 (1.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{5' Apgar score \textless{} 3}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.7**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Cardiopulmonary resuscitation}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
20 (6.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
27 (5.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
48 (4.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
95 (5.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.3*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Respiratory support} \emph{No support}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
208 (68.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
411 (81.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
971 (91.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1590 (85.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Invasive}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5 (1.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (1.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13 (1.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
27 (1.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Non invasive}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
89 (29.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
84 (16.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
77 (7.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
250 (13.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Seizures}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3 (0.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.02**}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Therapeutic hypothermia}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.9 **\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Jaundice}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
145 (48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
188 (37.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
241 (22.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
574 (30.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{}0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Sepsis}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22 (7.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
27 (5.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
23 (2.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
72 (3.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Hypoglycemia}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
92 (30.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
126 (25\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
196 (18.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
414 (22.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Difficulty feeding}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
57 (18.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
70 (13.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
65 (6.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
192 (10.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{} 0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Cerebral lesion} \emph{None}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\emph{302 (100\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
502 (99.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1056 (99.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1860 (99.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.9**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Stroke}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Basal nuclei anomalies}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{IVH \textgreater{}=2}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Congenital anomalies} none\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
267 (88.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
462 (91.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
990 (93.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1719 (92.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.1**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Cardio vascular}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10 (3.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5 (1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
21 (2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
36 (1.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{CNS}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Gastrointestinal}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (0.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Genito-urinary}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7 (1.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
11 (0.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\emph{Others}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22 (7.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
25 (5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
41 (3.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
88 (4.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Chromosomal anomalies}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1 (0.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (0.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.5**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Adverse Composite Neonatal Outcome}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
82 (27.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
89 (17.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
85 (8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
256 (13.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{}0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Hypoglycemia and difficulty feeding}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
129 (42.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
170 (33.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
239 (22.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
538 (28.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{}0.01*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Metabolic acidosis/ resuscitation}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
20 (6.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
27 (5.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
48 (4.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
95 (5.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.3*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Respiratory support}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
94 (31.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
93 (18.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
90 (8.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
277 (14.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{\textless{}0.01*}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Maternal other indication: 1 case of severe asthma, 1 case of severe
headache.

Fetal other indication: 1 case of Rh isoimmunization, 1 case of fetal
arrhythmia.

Mild acidosis: BE between -6 e -12 or pH 7.20-7.30

Moderate acidosis: BE between -12 e -16 or pH 7.00-7.19

Severe acidosis: BE less than -16 or pH \textless{}7.00

* Chi square test, ** Fisher Exact test, \selectlanguage{ngerman}§ ANOVA on ranks, + ANOVA

For details about specific definitions please see table S1 .

\textbf{Table 4: Multivariate analysis of the effect of gestational age
and circumstances at delivery on neonatal outcomes}\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
& \textbf{Composite adverse neonatal outcomes} & \textbf{Composite
adverse neonatal outcomes} & \textbf{Neonatal resuscitation} &
\textbf{Neonatal resuscitation} & \textbf{Metabolic complications} &
\textbf{Metabolic complications} & \textbf{Respiratory support} &
\textbf{Respiratory support}\tabularnewline
\midrule
\endhead
& \textbf{AOR (95\%CI)} & \textbf{P} & \textbf{AOR (95\%CI)} &
\textbf{P} & \textbf{AOR (95\%CI)} & \textbf{P} & \textbf{AOR (95\%CI)}
& \textbf{P}\tabularnewline
\textbf{Gestational age} & & & & & & & &\tabularnewline
\emph{34} & \textbf{4.2 (3-6)} & \textbf{\textless{} 0.01} & 1.4
(0.8-2.5) & 0.2 & \textbf{2.6 (2-3.4)} & \textbf{\textless{}0.01} &
\textbf{4.8 (3.5-6.7)} & \textbf{\textless{}0.01}\tabularnewline
\emph{35} & \textbf{2.3 (1.7-3.2)} & \textbf{\textless{} 0.01} & 1.1
(0.7-1.8) & 0.7 & \textbf{1.7 (1.3-2.1)} & \textbf{\textless{}0.01} &
\textbf{2.3 (1.7-3.2)} & \textbf{\textless{}0.01}\tabularnewline
\emph{36} & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§) & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ &\tabularnewline
\textbf{Circumstances at delivery} & & & & & & & &\tabularnewline
\emph{Spontaneous PTL} & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ &\tabularnewline
\emph{pPROM} & 0.9 (0.6 -- 1.3) & 0.5 & 0.5 (0.2-1.2) & 0.1 & 0.9
(0.7-1.2) & 0.6 & 0.8 (0.5-1.2) & 0.2\tabularnewline
\emph{Indicated} & \textbf{1.7 (1.3- 2.3)} & \textbf{\textless{} 0.01} &
\textbf{2.3 (1.4-3.6)} & \textbf{\textless{} 0.01} & \textbf{2.2
(1.7-2.7)} & \textbf{\textless{}0.01} & \textbf{1.6 (1.2-2.2)} &
\textbf{\textless{}0.01}\tabularnewline
\bottomrule
\end{longtable}

Multivariate logistic regression models investigating the role of
gestational age and circumstances at delivery on neonatal outcomes. The
following variables were tested as potential confounders: maternal age,
parity, previous preterm birth, race, education, BMI, excessive wait
gain, smoking, utilization of assisted reproductive technologies,
treatment with LDA, progesterone, or LMWH, antenatal corticosteroids

AOR: adjusted OR

The area under receiver operating characteristic (ROC) curve was
respectively 0.68 for composite adverse neonatal outcomes, 0.65 for
neonatal resuscitation, 0.66 for metabolic complications, and 0.69 for
respiratory support.

For details about specific definitions please see table S1 .

\textbf{Table 5: Multivariate analysis of the impact of maternal medical
conditions, fetal characteristics, pregnancy complications, and
gestational age at delivery on neonatal morbidities}\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
& \textbf{Composite adverse neonatal outcomes} & \textbf{Composite
adverse neonatal outcomes} & \textbf{Neonatal resuscitation} &
\textbf{Neonatal resuscitation} & \textbf{Metabolic complications} &
\textbf{Metabolic complications} & \textbf{Respiratory support} &
\textbf{Respiratory support}\tabularnewline
\midrule
\endhead
& \textbf{AOR (95\%CI)} & \textbf{P} & \textbf{AOR (95\%CI)} &
\textbf{P} & & \textbf{AOR (95\%CI)} & \textbf{P} & \textbf{AOR
(95\%CI)}\tabularnewline
\textbf{Gestational age} & & & & & & & &\tabularnewline
\emph{34} & \textbf{4.2 (3-6)} & \textbf{\textless{}0.01} & 1.3
(0.8-2.4) & 0.2 & \textbf{2.4 (1.8-3.2)} & \textbf{\textless{}0.01} &
\textbf{4.9 (3.5-6.9)} & \textbf{\textless{}0.01}\tabularnewline
\emph{35} & \textbf{2.2 (1.6-3.1)} & \textbf{\textless{}0.01} & 1.1
(0.7-1.8) & 0.7 & \textbf{1.6 (1.3-2.1)} & \textbf{\textless{}0.01} &
\textbf{2.2 (1.6-3)} & \textbf{\textless{}0.01}\tabularnewline
\emph{36} & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ &\tabularnewline
\textbf{Diabetes} & & & & & & & &\tabularnewline
\emph{No Diabetes} & \selectlanguage{ngerman}§ & & & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ &\tabularnewline
\emph{Pregestational Diabetes} & \textbf{2.6 (1.2-5.7)} & \textbf{0.02}
& & & \textbf{6.1 (2.8-13)} & \textbf{\textless{}0.01} & \textbf{3.3
(1.6-7.1)} & \textbf{\textless{}0.01}\tabularnewline
\emph{Class A1 GDM} & 0.6 (0.3-1.1) & 0.3 & & & 1.2 (0.8-1.8) & 0.3 &
0.7 (0.3-1.2) & 0.1\tabularnewline
\emph{Class A2 GDM} & 0.7 (0.3-1.6) & 0.07 & & & \textbf{2.7 (1.5-4.8)}
& \textbf{\textless{}0.01} & 0.6 (0.3-1.4) & 0.2\tabularnewline
\textbf{Hypertensive disorders} & & & & & & & &\tabularnewline
\emph{Normotensive} & \selectlanguage{ngerman}§ & & & & \selectlanguage{ngerman}§ & & \selectlanguage{ngerman}§ &\tabularnewline
\emph{Cronic HTN} & 0.5 (0.2-1.7) & 0.3 & & & 1.1 (0.5-2.3) & 0.7 & 0.6
(0.2-1.7) & 0.3\tabularnewline
\emph{Gestational HTN} & 0.7 (0.3-1.3) & 0.2 & & & 1.2 (0.8-1.8) & 0.4 &
0.6 (0.3-1.2) & 0.2\tabularnewline
\emph{Preeclampsia} & \textbf{0.3 (0.1-0.9)} & \textbf{0.03} & & &
\textbf{2.2 (1.3-3.8)} & \textbf{\textless{}0.01} & \textbf{0.4
(0.2-0.9)} & \textbf{0.04}\tabularnewline
\textbf{pPROM} & \textbf{1.7 (1.3 -- 2.3)} & \textbf{\textless{} 0.01} &
& & & & &\tabularnewline
\textbf{BMI} & \textbf{1.03 (1.003-1.06)} & \textbf{0.03} & & & & &
\textbf{1.03 (1.005 -- 1.06)} & \textbf{0.02}\tabularnewline
\textbf{Abruption/bleeding} & \textbf{1.6 (1.05-2.5)} & \textbf{0.03} &
\textbf{2.7 (1.5 -- 4.7)} & \textbf{\textless{} 0.01} & & & \textbf{1.6
(1.05 -2.5)} & \textbf{0.03}\tabularnewline
\textbf{Amniotic fluid} & & & & & & & &\tabularnewline
\emph{Normal} & \$ & & \$ & & & & &\tabularnewline
\emph{Oligohydramnios/anhydramnios} & 0.9 (0.5-1.7) & 0.9 & 1.4 (0.6 --
3) & 0.8 & & & &\tabularnewline
\emph{Polyhydramnios} & \textbf{2.4 (1.02 -- 5.8)} & \textbf{0.045} &
\textbf{4.9 (1.9-12.6)} & \textbf{\textless{}0.01} & & &
&\tabularnewline
\textbf{Non reassuring fetal status} & & & \textbf{4.1 (2.3 -- 7.3)} &
\textbf{\textless{}0.01} & \textbf{2.1 (1.4-3.2)} & \textbf{\textless{}
0.01} & \textbf{1.7 (1.03 -- 2.9)} & \textbf{0.04}\tabularnewline
\textbf{Spontaneous PTL} & & & & & \textbf{0.7 (0-6-0.9)} &
\textbf{\textless{} 0.01} & &\tabularnewline
\textbf{IUGR} & & & & & \textbf{1.8 (1.3 -- 2.5)} & \textbf{\textless{}
0.01} & &\tabularnewline
\bottomrule
\end{longtable}

Multivariate logistic regression models investigating the role of
maternal conditions (diabetes mellitus, hypertensive disorders, liver
disorders), fetal characteristics (non-reassuring fetal status, IUGR,
prenatally diagnosed fetal anomalies or aneuploidies, and amniotic fluid
disorders), pregnancy complications (pPROM, spontaneous PTL,
chorioamnionitis, vaginal bleeding from placental abruption or abnormal
placentation) on neonatal outcomes. To control for confounding, the
following variables were tested in each model: maternal age, parity,
previous preterm birth, race, education, BMI, excessive wait gain,
smoking, utilization of assisted reproductive technologies, treatment
with LDA, progesterone, or LMWH, antenatal corticosteroids

The area under receiver operating characteristic (ROC) curve was
respectively 0.71 for composite adverse neonatal outcomes, 0.62 for
neonatal resuscitation, 0.64 for metabolic complications, and 0.72 for
respiratory support.

AOR: adjusted OR

For details about specific definitions please see table S1 .

\selectlanguage{english}
\FloatBarrier
\end{document}

