Wednesday, November 17, 2010

Baby is NOT at Term at 37 Weeks

I've already blogged about the inaccuracy of due dates, but I wanted to take the time to emphasize the fact that though many women and their doctors believe that 37 weeks is "at term" it is NOT.

A recent study conducted by a group of physicians associated with the March of Dimes organization points out that considering babies term at 37 weeks may not be such a good idea after all. There seems to be new evidence that suggests that the outcome for a baby born after less than 37 completed weeks of pregnancy is significantly different for one born after 38 completed weeks.
The study proposes that the phrase “late preterm” be used when describing neonates born between 37 0/7 weeks and 38 6/7 weeks because of the new research which states that babies born during this period suffer from increased mortality and neonatal morbidity when compared to children born later in the pregnancy. (via the unnecesarean)

Why is this a concern?
Many women find the end of pregnancy uncomfortable and exhausting. They and their family members have been waiting for months and they are anxious to finally meet their new baby. Women frequently request that their doctors deliver their baby once they've reached term, which many believe to be 37 weeks. Doctors are frequently happy to oblige to an induction or a cesarean section before the due date is reached. However, a baby that does not reach full gestation and initiate spontaneous labor may face severe complications.

Complications of non-medically indicated deliveries between 37 and 39 weeks:

    • increased NICU admissions
    • increased transient tachypnea of the newborn
    • increased respiratory distress syndrome
    • increased ventilator support
    • increased suspected of proven sepsis
    • increased newborn feeding problems and other transition issues
    • Morbidity rates double for each gestational week earlier than 38 weeks

Via dou-la-la:
New research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called "late preterm."

A study in the American Journal of Obstetrics and Gynecology in October calculated that for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages.

A study of nearly 15,000 children in the Journal of Pediatrics in July found that those born between 32 and 36 weeks had lower reading and math scores in first grade than babies who went to full term. New research also suggests that late preterm infants are at higher risk for mild cognitive and behavioral problems and may have lower I.Q.s than those who go full term.

What's more, experts warn that a fetus's estimated age may be off by as much as two weeks either way, meaning that a baby thought to be 36 weeks along might be only 34.

Timing of Fetal Brain Development: cortex volume increases by 50% between 34 and 40 weeks gestation, brain volume increases at a rate of 15mL/week between 29 and 40 weeks gestation
Furthermore, the process of generating a due date relies on sometimes faulty memories of mothers about their cycle, and assumes all women’s cycles are the same length. Research shows that women’s cycles can vary widely, and these variances can profoundly impact when a baby will be mature enough to be born. (via lamaze)

Don't believe it when your doctor tells you he can tell by ultrasound that the baby is nice and big and so ready to come out -- ultrasound for measuring the baby's weight can be 1-1.5 lbs off!

And please please please do not ask your doctor to perform an induction or cesarean section once you've reached "term at 37 weeks." Baby is ready to come when he/she comes!

5 comments:

  1. I totally agree! When people keep asking me if I'm getting impatient (I'm 36 1/2 weeks) I tell them I'm just ready to meet the baby. Despite how uncomfortable I may be becoming, and how long that may last, I know my baby will let me know when she's ready to come. If that means I got 4 weeks over my "due date" that's fine. When I tell people that, they look at me like I'm crazy, but when you think that my due date could be off by 2 weeks, then that's not that long I'm going "overdue."

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  2. Really interesting--thanks for sharing. I work in health research and, before I left for maternity leave, was in the planning stages for a project in which we debated including babies born at 35-36 weeks. Our obstetrician said that there was a case to include these babies because obstetricians (and paediatricians?) treated them similarly to full-term infants (37+ weeks). Even though the research shows the increased morbidities like you have shown here even for 37-38 weekers.
    Another interesting point is that we referred to these babies as "near-term", whereas the research you quote says "late pre-term". I think that, if you want to try to avoid early inductions / sections, late pre-term is definitely a better, as it indicates there are more similarities between these babies and pre-term infants, rather than full-term ones.

    PS--I clicked over here today from the blogroll at First the Egg. I'll have to go through and check out some of your previous posts!

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  3. Thanks for commenting!

    I agree, I think late "pre-term" would get more moms thinking hard about what the status of their baby's gestation is at 37 weeks.

    Thanks for stopping by! :)

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  4. Thank you so much for this post and helping raise awareness of the crisis of preterm birth. Now, I wish everyone would read it.

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  5. Just an FYI ai I have had a previous 36 weeker who has long lasting immune system problems because of it. His oncologist told us that baby's get a huge dump of IGA between 37 and 38 weeks. They don't know when just that it's not in 37 wk babies but it us 38 wk babies. It's the only branch of your immune system that can't pass thru breast milk so if they don't get it in utero they just don't get it. Which puts them at risk to develop an immune system problem later. His suggestion was no inductions betide 39 weeks and then only if necessary.

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