# Obstetric Interventions, Neonatal Health, and Child Development

> **NIH NIH R01** · COLUMBIA UNIV NEW YORK MORNINGSIDE · 2020 · $363,076

## Abstract

Project Summary/Abstract
 This project ties together and explores three noteworthy trends that have taken place in
the U.S. over the past two decades: (1) The gestational age distribution of full-term births
(almost 90% of births in the U.S.) has been changing: Those at 40 and 41 weeks decreased by
11% and 38% respectively, while those at 37, 38, and 39 weeks increased by 31%, 27%, and
41% respectively. (2) Rates of caesarian section (C-section) delivery rose 44% and inductions
of labor increased by 150%; C-sections now account for over 1/3 of all births and almost 1/4 of
births are induced. The rapid increases over the past decade in particular coincided with no
improvements in fetal, infant, or maternal mortality and are substantially higher than what would
be expected based on trends in risk factors, suggesting that in many cases these interventions
(which can shorten gestation) are not medically necessary. There has been speculation that
changes in the gestational age distribution have resulted from increases in “elective” (non-
medically necessary) C-sections and inductions, but this allegation has not to date been tested.
(3) Cognitive and behavioral disorders such as ADHD, learning disabilities, and autism have
increased substantially over recent decades, and recent research indicates that shorter
gestation, even by one week within the “full term” range, leads to increased risk for adverse
neonatal morbidities that are associated with childhood cognitive and behavioral disorders. We
will use unique linked vital statistics data from the states of NJ and CA to advance our
understanding of how these 3 noteworthy trends are related by: (1) Documenting trends and
patterns in gestational age (GA) and method of delivery in low risk term pregnancies and
conducting analyses of spatial diffusion of “elective interventions.” (2) Estimating effects of GA,
method of delivery, and their interaction on autism and other developmental outcomes in low
risk term pregnancies and assessing the contributions of changes in GA and delivery methods
to trends in child disability. (3) Exploring salient neonatal outcomes as pathways. This project
will provide important, timely, and policy-relevant information with high relevance for healthcare
delivery and population health.

## Key facts

- **NIH application ID:** 9977216
- **Project number:** 5R01HD090119-04
- **Recipient organization:** COLUMBIA UNIV NEW YORK MORNINGSIDE
- **Principal Investigator:** NANCY E REICHMAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $363,076
- **Award type:** 5
- **Project period:** 2017-09-11 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9977216

## Citation

> US National Institutes of Health, RePORTER application 9977216, Obstetric Interventions, Neonatal Health, and Child Development (5R01HD090119-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9977216. Licensed CC0.

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