Early Planned Birth Tied to Greater Risk for Developmental Problems

Babies delivered by planned birth before the optimal gestational period of 39-40 weeks are more likely to have developmental problems, according to a new study of 153,000 Australian children. The findings are published in the journal Pediatrics.

In recent years there have been significant changes in clinical practice resulting in an increase in planned births before the ideal time at 39-40 weeks’ gestation, particularly through the use of elective caesarean section and induction of labor.

“While the association between being born earlier — lower gestational age — and poorer developmental outcomes is well established, our results revealed that poor development is further exacerbated in the case of planned birth, where a considered decision made to deliver an infant determines gestational age,” said senior author Associate Professor Natasha Nassar at the University of Sydney Menzies Centre for Health Policy.

“Significant changes in clinical practice have seen an increase in planned births before 39-40 completed weeks’ gestation from an increased use of primary and repeat cesarean section and a greater use of labor induction.”

“At a population level this has resulted in a decrease in modal gestational age with planned birth accounting for almost half of births before 39-40 weeks. It is of paramount importance to ensure there are no unintended harms from such a significant shift in clinical practice.”

Using the Australian Early Development Census instrument, children in the study were evaluated in five areas: physical health and wellbeing, language and cognition, social competence, emotional maturity, and general knowledge and communication.

Children scoring in the bottom 10 percent of these domains were considered “developmentally vulnerable,” and children who were “developmentally vulnerable” on two or more domains were classified as “developmentally high risk.”

Compared to children born vaginally following spontaneous labor, the combined adjusted relative risk of being developmentally high risk was 26 percent higher for a planned birth at 37 weeks and 13 percent higher at 38 weeks.

The findings remained after taking into account other important factors linked to poor child development such as socioeconomic disadvantage, lower maternal age, maternal smoking in pregnancy, and fetal growth restriction.

“The timing of planned birth is potentially modifiable, and the benefits of waiting should be communicated to clinicians, mothers, and families,” says study co-author, Dr. Jonathan Morris of the Kolling Institute and the University of Sydney.

The study also reports that the risk of being “developmentally vulnerable” increased with decreasing gestational age.

Compared to children with a gestational age of 40 weeks, the adjusted relative risk of being developmentally high risk was 25 percent higher at 32-33 weeks, 26 percent higher at 34-36 weeks, 17 percent higher at 37 weeks, and six percent higher at 38 weeks.

Compared to children born vaginally following spontaneous labor, the adjusted relative risk of being “developmentally high risk” was seven percent higher for labor induction or pre-labor cesarean section.

“There is an urgent need for strategies to inform more judicious clinical decision making about the timing of planned birth, said lead author Jason Bentley from the Menzies Centre for Health Policy.

“In cases where labor occurs naturally before 39 weeks or planned birth is unavoidable, it is important that there are appropriate interventions and support in early childhood for these potentially vulnerable children.”

Source: University of Sydney