Thursday, June 10, 2010

Special needs risk: 4.7% at 39 weeks and 4.4% at 40 weeks

There is a great deal of publicity in the media at the moment regarding a Scottish study that has investigated the risk of a baby developing special educational needs if it is born too early. In particular, conclusions are being drawn along the lines of how this new data should be used to inform women planning an elective cesarean.

I agree - HOWEVER - let's inform women properly and honestly.
This is the comment I submitted to Medical News Today this morning:

Difference is actually negligible

The presentation of the results of this research is very misleading, particularly in relation to the risks associated with cesarean delivery at 39 weeks’ gestation.

This is the actual percentage of children with SEN by gestation of delivery

37 weeks - 6.1%
38 weeks - 5.4%
39 weeks - 4.7%
40 weeks - 4.4%
41 weeks - 4.1%

As you can see, the difference between 39 and 40 weeks is negligible; the higher risk is present in the 37th and 38th week, which we know from other research increases other risks for babies too, such as respiratory distress.

The collective risk of all babies at 37-39 weeks is being used to disparage the legitimacy of choosing to deliver your baby at or after 39 weeks (many doctors, my own included, advise delivery at 39 and a half weeks with maternal request - i.e. during the 40th week).

Three final points worthy of note:

The authors state that while it's reported that early term births (at 37-39 weeks) account for 5.5% of SEN cases and preterm deliveries account for 3.6% of cases, this is because of the higher numbers of babies born between 37 and 39 weeks.

In the population of children studied (407,503), just 16.2% were born by cesarean delivery; therefore I would argue that the risk of SEN is just as likely, if not more, with a planned vaginal delivery (where Mother Nature decides on the gestational age or delivery is induced)
as a planned cesarean at or after 39 weeks.

The relatively small percentage of cesareans includes both planned and emergency surgeries, thereby further reducing the data pool of the very delivery type that such stark warnings are being given in reports like this one.

1 comment:

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