Se­ri­ous health prob­lems more likely, finds study on UK chil­dren

Daily Mail - - Front Page - By Fiona MacRae Sci­ence Re­porter

BA­BIES born only a week early are at higher risk of a host of se­ri­ous health prob­lems from autism to deaf­ness, re­search has shown.

A study of hun­dreds of thou­sands of Bri­tish school­child­ren found that those born at 39 weeks are more likely to need ex­tra help in the class­room than those de­liv­ered af­ter a full 40 weeks in the womb.

The find­ings are par­tic­u­larly wor­ry­ing be­cause one in five ba­bies in Eng­land and Wales is born at 39 weeks.

With most planned cae­sare­ans car­ried out at 39 weeks, the find­ing raises con­cerns that women who have the op­er­a­tion for non-med­i­cal rea­sons could un­wit­tingly be en­dan­ger­ing the health and prospects of their chil­dren.

Ob­ste­tri­cians said it em­pha­sises the need for sur­gi­cal de­liv­er­ies to be put off for as long as is safe for mother and child.

The find­ing also re­in­forces calls for more re­search into the causes of pre­ma­ture births – and ways of pre­vent­ing them.

Jill Pell, a pro­fes­sor of pub­lic health, made the link af­ter study­ing the school and hos­pi­tal records of 400,000 chil­dren.

Al­most 18,000 had been classed as hav­ing spe­cial ed­u­ca­tional needs. The term cov­ers learn­ing dis­abil­i­ties such as at­ten­tion deficit hy­per­ac­tiv­ity dis­or­der, autism and dyslexia, and phys­i­cal prob­lems such as deaf­ness and poor vi­sion.

The risk was high­est in those who spent the short­est time in the womb. For in­stance, ba­bies born at be­tween 24 and 27 weeks were al­most seven times more likely to need help at school than those de­liv­ered at 40 weeks. But even be­ing born just a few

weeks early made a dif­fer­ence, the jour­nal PLoS Medicine re­ports. Those born at 37 weeks were 36 per cent more likely to have learn­ing dif­fi­cul­ties, while for those born at 38 weeks the fig­ure stood at 19 per cent.

Ba­bies born at 39 weeks – both nat­u­rally and by cae­sarean – were 9 per cent more likely to have spe­cial needs.

In Eng­land & Wales, 22 per cent of ba­bies are born at 39 weeks. And 41 per cent of ba­bies are born at be­tween 37 and 39 weeks – a fig­ure that is on the rise, largely be­cause of an in­crease in non-emer­gency or elec­tive cae­sare­ans.

One in four ba­bies is de­liv­ered by C-sec­tion – al­most dou­ble the World Health Or­gan­i­sa­tion’s rec­om­mended rate. That fig­ure rises to more than one in two at some pri­vate hos­pi­tals.

Most will be per­formed for med­i­cal rea­sons but up to 7 per cent are car­ried out at the mother’s request.

Pro­fes­sor Pell, of Glas­gow Uni­ver­sity, stressed that women hav­ing planned cae­sare­ans shouldn’t panic about the in­creased odds of spe­cial needs, be­cause the chances of any one baby be­ing af­fected are very low.

Some 4.7 per cent of the ba­bies born at 39 weeks had spe­cial needs, com­pared with 4.4 of those who went to term.

But she added: ‘It is im­por­tant from a pub­lic health point of view as so many in­fants are born pre-term.

‘A third of de­liv­er­ies take place at 37 to 39 weeks. Across the coun­try, that is an aw­ful lot of ex­tra cases of spe­cial ed­u­ca­tional needs due to slightly early de­liv­er­ies.’ She ad­vises moth­ers-to-be due to have a cae­sarean to thor­oughly dis­cuss the pros and cons with their doc­tor.

Al­though the op­er­a­tion can be a life­saver, it car­ries well-doc­u­mented risks for mother and child. Ba­bies born by C-sec­tion are more than twice as likely to die in their first month as those born nat­u­rally.

In ad­di­tion, the mother is more likely to need in­ten­sive care, is at higher risk of blood clots and in­fec­tions, and may find it harder to bond with their new­born.

An ed­i­to­rial ac­com­pa­ny­ing the re­search re­port con­cludes: ‘These find­ings have im­por­tant im­pli­ca­tions for the tim­ing of elec­tive de­liv­ery. They sug­gest that de­liv­er­ies should ide­ally wait un­til 40 weeks of ges­ta­tion, be­cause even a baby born at 39 weeks – the nor­mal tim­ing for elec­tive de­liv­er­ies these days – has an in­creased risk of spe­cial ed­u­ca­tional needs com­pared with a baby born a week later.’

But Pro­fes­sor An­drew Shen­nan, an ob­ste­tri­cian at St Thomas’s Hos­pi­tal in London, said the risks of leav­ing elec­tive C-sec­tions to 40 weeks should be stud­ied.

The pro­fes­sor, who is also a spokesman for the baby char­ity Tommy’s, said: ‘The re­la­tion­ship be­tween early birth and later prob­lems in life, such as spe­cial ed­u­ca­tional needs, is well es­tab­lished.

‘The ear­lier the birth, the greater the risk, but as later pre-term births are far more com­mon, they still pro­vide a sig­nif­i­cant pro­por­tion of all in­di­vid­u­als with prob­lems.

‘How­ever the cause of early birth may con­trib­ute to the risk, for ex­am­ple, a baby who’s al­ready sick may need to be de­liv­ered early to give it a chance of sur­vival.

‘We do not know if chang­ing the date of de­liv­ery in elec­tive cases would re­duce risk, as there are other risks to the mother and baby in do­ing this. More re­search is re­quired.’

The Royal Col­lege of Ob­ste­tri­cians and Gy­nae­col­o­gists said that wait­ing un­til 40 weeks to per­form an elec­tive C-sec­tion also car­ried risks, and there­fore was un­likely to be bet­ter for the baby over­all. But the study’s find­ings do mean doc­tors should wait un­til 39 weeks, if pos­si­ble. RCOG spokesman Pro­fes­sor James Walker, a con­sul­tant ob­ste­tri­cian at St James’s Uni­ver­sity Hos­pi­tal in Leeds, said: ‘There are still some places where peo­ple are not do­ing it at 39 weeks. Al­though that is what we rec­om­mend, it doesn’t mean that ev­ery­body is do­ing it.

‘This em­pha­sises the need for wait­ing as long as safely pos­si­ble.’

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