Baby and Toddler -April 2009

Thinking of delivering early? Know the risks

By Elizabeth Heubeck

Your due date is three weeks away. But the weight of the baby is getting exhausting, and your favorite physician in your OB/GYN’s practice leaves for an extended vacation in two weeks. This is your second child, and the first was delivered via cesarean section (c-section). You feel fairly confident that your physician will schedule an elective c-section for next week if you push for one. Should you?
Before you respond, you may want to consider some new research that highlights the risks to babies born just a few weeks shy of their due date.
Compelling data published in the Jan. 8, 2009, issue of the New England Journal of Medicine (NEJM) found that delivering infants at 37 or 38 weeks of gestation via elective repeat c-section dramatically increases newborns’ risk of certain medical complications. The study, which included more than 24,000 infants, concluded that this type of delivery at 37 weeks—just two weeks early—doubled newborns’ risk of breathing problems, bloodstream infections, and other complications at birth. Elective repeat c-sections done at 38 weeks, just one week early, increased the aforementioned risks by 50 percent.
Not surprisingly, the earlier infants are born, the more likely they are to face medical complications. One recent report, cited in the Feb. 23, 2008, issue of the Chicago Tribune, stated that up to 34 percent of all infants born between 34 and 36 weeks suffer at birth from breathing problems, jaundice, feeding difficulties, low blood sugar, unstable body temperatures, and other medical problems.
These risks pose a greater concern today than ever—the number of preterm births (defined as before 37 weeks gestation) in the U.S. have risen significantly since 1981. In fact, they are at an all-time high, and now constitute 31 percent, or one out of every eight, births.

Worth the Wait
When you consider the flurry of last-minute activity that takes place in utero, it’s easy to understand why preterm births increase the potential for medical complications.
In the late stages of gestation, the fetus is busy doing the following: building up fat to maintain body temperature outside the womb, maturing the liver so it can eliminate the toxin bilirubin from the body, and developing the lungs to exchange oxygen when the umbilical cord will no longer provide it.
Given the significant growth that takes place in utero during the final weeks of pregnancy, coupled with newfound knowledge of the risks that often coincide with early delivery, the increasing prevalence of early elective deliveries begs the question: Why?
Clearly, certain medical reasons such as preeclampsia and fetal distress warrant preterm elective deliveries. But anecdotal evidence suggests that, for more and more mothers-to-be, convenience has become the primary driver behind early elective deliveries. And, in many cases, it seems that doctors are following their patients’ orders.

Catherine Spong, M.D., is chief of the Pregnancy and Perinatal Branch of the National Institute of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda. She’s also co-author of the NEJM study that proved that even one week in utero can make a difference to an infant’s health at delivery. She hopes that women who are eager to deliver early will reconsider when they learn the risks.
“It’s important to be able to counsel both women and physicians that delivery at 37 weeks essentially doubles the risk of these medical complications. Even when you’re at 38 weeks and 6 days, your risk remains 20 percent higher than at 39 weeks,” says Spong.
The bottom line?
According to Spong, “You want to wait until it is really safe to deliver.” BC

Risks of Early Elective C-Section Delivery
Elective c-section delivery of infants at either 37 or 38 weeks (compared to 39 weeks gestation) increases the following risks to newborns:
Respiratory problems
Mechanical ventilation
Newborn sepsis (or signs and symptoms of infection during the first four weeks of life)
Hypoglycemia (or having a lower than normal level of blood glucose)
Admission to the neonatal intensive care unit (NICU)
Hospitalization for five or more days

Source: “Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes,” NEJM, Jan. 8, 2009.

© Baltimore’s Child Inc. April 2009


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