Even Slightly Early Birth May Hurt Academic Performance


Elective C-Sections, Inductions Attractive Option for Some

Still, for women approaching the end of their pregnancy, the draw of elective induction is hard to ignore.

"Pregnancy can be a trying time for many women, and the physical and emotional demands can seem exhausting, particularly by the end of the third trimester," said Dr. Sudeepta Varma, clinical assistant professor of psychiatry at New York University's Langone School of Medicine. "Many full-term women ask their obstetricians to help bring on labor sometime sooner than the estimated due date -- some may ask for elective C-sections, induction of labor, or attempt naturopathic methods at home.

"This study is so crucial in reminding pregnant women and their doctors to hang in there and allow nature take its course."

Additionally, many may not be aware of what constitutes an ideal gestation period. In 2006, a team of researchers surveyed women to determine their perceptions of the earliest point in pregnancy at which it is safe to deliver a baby. More than half of the women who responded considered 34-36 weeks of gestation to be safe, and more than 40 percent chose 37-38 weeks of gestation. By contrast, the American Congress of Obstetricians and Gynecologists (ACOG) sets this lower limit at 39-40 weeks of gestation – a range chosen by only 7.6 percent of women surveyed.

ACOG is one of a number of national organizations that have launched efforts to discourage non-necessary induction of birth.

"There has been a huge push nationally to reduce early term births, mainly from March of Dimes, ACOG and the Society for Maternal Fetal Medicine," said Dr. George Macones, chair of the ACOG's Committee on Obstetric Practice at Washington University in St. Louis. "ACOG has been very consistent over the years that 'elective' deliveries -- either induction or caesarean -- should not occur until 39 weeks."

Dr. Michael Katz, medical director of the March of Dimes and the former chairman at department at Columbia from where the new study emerged, said while more research is needed to truly determine the impact of elective induction of birth, the study reveals a problem that his organization has strived to improve.

"The trend toward prematurity has been rising year by year, not just in U.S. but in rest of the world," Katz said. "Even if there were no studies, if one looks at the rise in elective procedures, it would seem illogical ... to trump the process that has its own time schedule.

"If you do something anti-evolutionary, you are begging for trouble."

Many doctors seem to have gotten the message.

"We have stopped doing planned c-sections before 39 completed weeks and the same for 'elective inductions,'" said Dr. John B. Coppes, medical director of the Mayo Clinic Health System in Austin, Minn. "This will just strengthen our case to promote this practice."

Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital in New York and an ABC News medical contributor, said he believes the new study will further encourage mothers-to-be and their physicians to avoid elective induction of birth.

"The major effect of this news is going to be to mothers wanting to be induced to be done with pregnancy," he said. "I will definitely bring up this point of brain development to discourage them from wanting induction."

Still, ACOG's Macones noted that he worries the study may also cause concern in women for whom early delivery is necessary.

"In my opinion, the pendulum may have swung too far and now we have to find the right balance," he said. "I think this reinforces the concept that elective -- I stress the word elective here -- deliveries should happen after 39 weeks. That is the take-home message."

To this point, study author Noble and other physicians said the research should not be interpreted to mean that an early birth is a guarantee of cognitive problems. Coppes, for one, said he is living proof that an early start does not automatically predispose a child to irreversible cognitive issues.

"I was born at 36 weeks and weighed five and a half pounds," he said. "I have gotten through college, medical school, graduate school and work for 40-plus years despite my start in life. It is good to wait as long as possible to deliver, but not to scare too badly those who have to deliver early."

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