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'Late Preterm' Babies Face Surprising Risks

There's some disturbing new information out today about babies that are born too early, a trend that has been increasing in the United States: A new study found that babies born prematurely are at much greater risk for serious neurological problems such as cerebral palsy, even if they are just a few weeks early.

Joann Petrini of the March of Dimes and her colleagues studied more than 140,000 babies born in northern California between 2000 and 2004 found that the earlier babies were born the greater their risk for problems. For example, babies born between 30 and 33 weeks of gestation were nearly eight times as likely as full term babies to have cerebral palsy.

But even those born just four to six weeks before a mother's due date -- so-called "late preterm" babies--were more than three times as likely as full-term babies to be diagnosed with cerebral palsy. They were also at increased risk for developmental delays and mental retardation, according to the study published online today along with an editorial by The Journal of Pediatrics.

More than half a million babies are born too early each year in the United States, and the rate of premature birth has been rising, causing increasing concern among doctors. That's because preterm babies are at increased risk for a host of health problems, including breathing and feeding problems, jaundice, delayed brain development and death. Late preterm babies account for more than 70 percent of all preterm births, and for most of the increase in preterm birth rates in the last two decades.

There are a variety of reasons why more babies are being born too early. Part of it is due to the fact that more women are waiting to have children--older women are more likely to give birth early. In addition, an increase in IVF and other infertility treatments has increased the number of twins, who also tend to be born early. Also, doctors are more likely to induce labor at any sign of problems, and more women are asking their doctors to induce labor or schedule Caesarean sections, sometimes just to make their deliveries more convenient or predictable.

The new findings, the researchers say, provide powerful new evidence for why women and their doctors should try to do whatever they can to carry their babies to full term.

Anyone care to share their thoughts about scheduling C-sections?

By Rob Stein  |  December 11, 2008; 7:00 AM ET
Categories:  Motherhood  
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Comments

What does the last question have to do with the article? You ask about scheduling c-sections after writing extensively about the risks of pre-term delivery, but is there any evidence that women are asking for and doctors are agreeing to pre-term caesareans?

My first delivery was an emergency c, so my second was a scheduled c. I had to fight to get the ob to agree to a surgery date that matched my due date. Common practice is to schedule one week before the official due date. Still, the ob insisted that anything after 37 weeks is considered full term.

Posted by: jayef | December 11, 2008 12:27 PM | Report abuse

No doctor schedules a c-section or induces labor in a normal pregnancy before 7-10 days before the due date. Please stop making people who have c-sections out to be selfish idiots.

Posted by: ktd123 | December 11, 2008 12:34 PM | Report abuse

Huh? Are you suggesting that doctors are scheduling C-sections 4-6 weeks early for convenience or scheduling purposes??? Do you have any evidence for that, Rob?

The editorial you cite from the Journal of Pediatrics mentions the possibility that some of these early births are induced, but I didn't see any suggestion that the inductions (or C-sections) are for convenience.

Posted by: rlalumiere | December 11, 2008 1:41 PM | Report abuse

I was pressured and pushed to have a c-section. From comments like "We could just schedule you now" at month 5 to "Why would you want to have your baby in that environment any longer" at 37 weeks to "I think we've given this labor thing long enough." I had no complications during my pregnancy and was "scared" into it at the end. (I had a high sugar count suddenly at 37 weeks but I was already dialating) I went to a highly recognized practice and delivered at one of the best hospitals around. I put my trust in them. If I have another child I will NOT have it in a hospital and will seek a midwife and birthing center. I felt doctors were looking for reasons to administer additional tests and push surgery. It's an unfair situation when you want to do your best for your and your child's health and the expert you've been dealing with feels like a used car salesman in the end.

Posted by: dcmarva_girl | December 11, 2008 4:57 PM | Report abuse

Eight times as likely and three times as likely sound scary--but what is the actual statistical risk?

Nine years ago I had a 26-weeker by emergency C-section. Except for being small (which he might have been anyway) he has no lingering effects from it. We know many, many others with similar stories. Is the risk 10%? or 1%? Sure, pre-term babies are likelier to have problems--but what's the real number?

Posted by: dynagirl | December 11, 2008 5:17 PM | Report abuse

This bit about increased risks of CP even in mildly preterm infants is old news.

Preventing prematurity would only work to prevent CP if the causal chain of events went: Something causes Preterm Delivery, which in turn causes C.P.

But, in fact, the causal chain may well turn out to be: Something causes CP, which in turn causes a hormonal cascade to trigger Preterm Delivery (i.e., the baby's biological way of screaming, so to speak, "Get me out of here before anything worse happens!")

In that case, we wouldn't be trying to prevent Preterm Delivery--we'd need to prevent the events that cause CP itself (or that cause the specific subtypes of CP prevalent among infants of that gestational age, i.e., 34-36 weeks.)

In order to understand what those C.P.-triggering events are, and how to prevent them better, as is so often said, "Further research is needed..."

Posted by: TQWoods | December 11, 2008 8:22 PM | Report abuse

I, too, felt uncomfortably pressured to deliver my baby early -- and felt like I was being condescended to when I told the two OBs in my (highly recommended) practice that I wanted a natural birth. The prevailing attitude seems to be: why make it any more difficult than it needs to be? Take drugs, have surgery -- and they induced my labor just barely after my calculated due date had passed. I had a hell of an experience and ended up having a C-section after 29 hours of fruitless labor, though fortunately so far my son shows no evidence of stress or damage (even though I believe they induced my labor much, much too soon.)

As for the point of the article -- late pre-term babies -- I agree with the author that the prevalence of use of IVF and advanced maternal age probably have a lot to do with the rising numbers of early babies. That said, I also think the doctors really try to pressure women into making the birth experience profitable and convenient -- for doctors and hospitals, not the mothers.

If anything, doctors should be encouraging women to trust their instincts and intuition when it comes to having babies, and intervene with extreme measures only at their patients' request or in cases of true emergencies.

Posted by: boogshead | December 11, 2008 8:26 PM | Report abuse

I'm going to have to read the scientific study carefully. Induced labor may have nothing to do with increased rates of CP--or it may. You'd have to do subgroup analyses, controlling for weight and gestational age, parity, and all the "usual suspects", and compare the rates of CP according to the reason for early delivery (multiple gestation vs. induced/cs because of an emergent medical condition vs. induced for convenience vs. spontaneously preterm). Maybe the authors already did that--I'll have to read it. But "scheduling c-sections" may be completely irrelevant to the issue of CP

Posted by: TQWoods | December 11, 2008 8:49 PM | Report abuse

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