Sometimes, when a pregnant woman has reached 37 weeks of gestation, she wants an elective induction of delivery because she is tired of lugging a heavy fetus around or has pains in her back or legs. In rare cases, the mother wants to deliver early to celebrate the baby’s birthday on a memorable date like 22.2.22.
Obstetricians may find an elective near-term delivery out of convenience (especially in the US, when they are paid privately and prefer to be free on weekends and holidays, unlike Israel, when midwives are always available and the cost is covered by the National Insurance Institute).
In American hospitals, there has been a “39-week rule” for more than a decade; this means that a pregnant woman who has no identifiable risk factor for stillbirth and who does not have an accepted “indication” for labor induction has no choice but to wait until at least 39 weeks and 0 days before she can be delivered. This was set to limit “elective” delivery via labor induction or cesarean delivery before then.
When there is a medical reason for an earlier delivery, such as gestational diabetes or preeclampsia (a complication characterized by the mother’s high blood pressure and signs of damage to the liver or kidneys), the decision to deliver before the full term of 39-41 weeks (273 days and on) is correct.
For a century, it was a medical opinion around the world that if a woman reached 37 weeks of gestation, she could give birth without any short or long-term complications in her baby.
But this is incorrect, according to a massive, just-published study conducted at the obstetrics/gynecology department at the Hadassah-University Medical Center on Mount Scopus, the Hadassah-University Medical Center in Ein Kerem and the Hebrew University-Hadassah Braun School of Public Health and Community Medicine, all in Jerusalem.
The study, entitled “Long-term respiratory outcomes in early-term born offspring: a systematic review and meta-analysis,” has just been published in the American Journal of Obstetrics & Gynecology MFM.
Prof. Asnat Walfisch, who earlier this month left Hadassah and was named head of the Helen Schneider Women’s Hospital at The Rabin Medical Center-Beilinson Campus in Petah Tikva, was the lead author, along with Prof. Hagai Levin of the Braun School and Drs. Adva Cahen-Peretz and Lilah Tsaitlin-Mor of the medical faculty.
“For a century, term pregnancy has been regarded as delivery from 37 weeks. Before that, the fetus was regarded as premature, but after the 37-week boundary, even if there were a few problems after delivery, doctors thought there was no long-term risk to the child,” she told The Jerusalem Post in an interview.
TERM PREGNANCY was redefined in 2012 by the American College of Obstetricians and Gynecologists: Deliveries occurring between 37 and 0 days and 38 weeks and six days of gestation were defined as “early term”; deliveries at 39 weeks and 0 days to 40 weeks and six days as “full term,” and those at 41 weeks and 0 days to 41 weeks and six days as “late-term,” which should be avoided.
“Newborns exhibit the lowest immediate respiratory morbidity rates when born at full term (39 to 40 completed weeks of gestation). We evaluated whether early-term deliveries (37 weeks and 0 days to 38 weeks and six days of gestation) bear a substantial impact on overall and specific long-term respiratory outcomes of offspring up to the age of 18 years compared with full-term or later deliveries,” the authors wrote in the paper.
The team studied 2,400 abstracts of medical articles to search for studies focusing on long-term effects of deliveries before 39 weeks and chose 14 relevant studies that included nearly eight million patients in the US and Europe and also data from deliveries at Soroka-University Medical Center in Beersheba, which delivers the second-highest number of infants in Israel (after Jerusalem’s Shaare Zedek Medical Center/Bikur Cholim Hospital).
The team conducted qualitative and quantitative analyses and used follow-up data on the babies until they reached the age of 18. Babies born in spontaneous and induced deliveries before 39 weeks had more complications in the long-term as compared to those delivered later. Looking at hospital records, they saw that early-term births before 39-41weeks significantly increased the risk in children and youths of respiratory conditions including bronchiolitis, bronchitis, long-term pediatric respiratory disease, obstructive sleep apnea, pneumonia and asthma. It was previously published that these early-term deliveries. also resulted in long-term neurological conditions such as attention-deficit-hyperactivity disorder (ADHD). These complications are not noticed by pediatricians when the newborns are sent home.
“Clearly, children born at full term are healthier than those delivered prematurely or even at any time before 39 weeks, so doctors and mothers should not prefer an early-term delivery unless medically necessary,” Walfisch declared. “It’s like a cake taken out of the oven a few minutes too early. It will taste OK, but it’s not really ready.”