Furthermore, during the 7-year period, the increase in the rate of US term stillbirth appeared to be continuous (estimated slope: 0.0186/1000/year, 95% confidence interval 0.002−0.035).Assuming 3.5 million term US births per year, and given 6 yearly “intervals” with this rate increase, it is possible that more than 335 additional term stillbirths occurred in the United States in 2013 as compared with 2007.
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This study raises the possibility that the 39-week rule may be causing unintended harm.
Additional studies of the actual impact of the adoption of the 39-week rule on major childbirth outcomes are urgently needed.
In addition, during the 7-year period, there was a progressive shift in the timing of delivery from the 40th week to the 39th week.
Absent this confounding factor, the magnitude of association between the adoption of the 39-week rule and the increase in rate of term stillbirth might have been greater.
The progressive adherence to the 39-week rule throughout the United States has caused a well-documented, progressive reduction in the proportion of term deliveries occurring during the early-term period.
Because of the known association between increasing gestational age during the term period and increasing cumulative risk of stillbirth, however, there have been published concerns that the 39-week rule—by increasing the gestational age of delivery for a substantial number of pregnancies—might increase the rate of term stillbirth within the United States.
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Between 20 in the United States, the adoption of the 39-week rule caused a progressive reduction in the proportion of term births occurring before the 39th week of gestation.
During the same interval the United States experienced a significant increase in its rate of term stillbirth.
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