RISK FOR BABIES BORN 1 WEEK EARLY
Serious health problems more likely, finds study on UK children
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.’