Earlier "Term" Births May Have Long Term Consequences...

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Monday, May 22, 2006

There's an interesting article in the Washington Post that talks about the rise in early "pre-term" births (34-36 weekers) and the long term health problems that may be associated with that rise.

"As Babies are Born Earlier, They Risk Problems Later"

Some snippets from the article:

The percentage of babies born slightly early has been increasing steadily for more than a decade and is now at an all-time high. So many babies are being born a few weeks early -- more than 350,000 annually -- that the average U.S. pregnancy has shortened from 40 weeks to 39.

Many obstetricians argue that the trend is positive overall because they are preventing thousands of stillbirths and avoiding potentially serious risks for mothers. But other experts worry because these babies are prone to a long list of serious, potentially life-threatening complications, which often require intensive, costly treatment.

Although most of these babies fare well and face far less risk than very premature infants, researchers have begun to realize that they are nevertheless more prone to short-term complications, such as problems breathing and feeding, and jaundice. Studies are also starting to suggest that these children may tend to not develop as well as full-term babies, leading to behavioral, learning and other difficulties.

The article states that the average American pregnancy now lasts just 39 weeks, because these early pre-term births are becoming so common (and overdue babies are becoming so uncommon). It also speculates that the rise in fertility treatments may be leading to more pregnancies that will end earlier either naturally or by being induced to avoid complications.

It also talks about the ability to detect some problems for baby earlier. That, combined with the knowledge that MOST of these early babies will survive, makes it more tempting for a doctor to risk induction. (Lactivist readers know that the "emergency c-section" is the ultimate defense in malpractice court...even if the neede for the c-section was brought on by iatrogenic factors.

More from the article:

But some specialists question whether the increase in Caesareans and inductions is the reason for the drop in stillbirths. And they worry that too much of the increase may be due to women hastening delivery for nonmedical reasons -- they want to make sure their mother will be in town, their husband has a business trip pending, or they are just fed up with being pregnant.

"It's a common request," said Mark Lollar, an obstetrician in San Ramon, Calif., who routinely honors such requests for the wives of professional athletes so their husbands can be present. "I have no problem arranging that for them."

Lollar and other obstetricians insist that they make sure that the fetus is at least 38 weeks old. "We never compromise the mother or the baby's safety," Lollar said.

Other experts, however, say it can be difficult to calculate the precise gestational age of a fetus.

The interesting thing to note is that just this morning, I read a post on the Childbirth Choice debate board over at BabyCenter from a woman who said that her rural hospital has now started discouraging convienence inductions. She said that the hospital has no NICU and any baby that needs a transfer has to be airlifted to the nearest major city. For that reason, the hospital has started telling moms that they need to wait until they are term to deliver, unless there are medical reasons to do otherwise.

That's an encouraging trend and it shows that at least in some cases, hospitals are realizing that they may need to rethink their policies on induction.

Finally...

The lungs, brains and other organs of babies born even a week or two early are often underdeveloped, making the infants much more likely to have problems breathing, maintaining their body temperature and feeding. They are also vulnerable to infections and jaundice, which can be life-threatening or cause brain damage.

In addition to the added cost and anxiety the complications cause, late-preterm babies are about five times as likely to die in the first week of life and about three times as likely to die in the first year than full-term babies, studies show.

Now, I'd be curious to know if those rises in stats are associated with ALL babies born at that age group, or if they've been seperated out to allow for differences in induced babies and naturally early babies. I believe it's the former, which would skew the results somewhat.

It will be interesting to see if there are further studies done on this issue.

Labels: Childbirth Issues, Stats and Studies

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