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http://www.sciencedaily.com/releases/2007/12/071212202023.htm

Elective Caesareans Carry Increased Risk Of Breathing Problems

ScienceDaily (Dec. 12, 2007) — Babies delivered by elective caesarean section around term carry up to a fourfold increased risk of breathing problems compared with babies delivered vaginally or by emergency caesarean section, concludes a study from Denmark published on the British Medical Journal website.

The rate of delivery by elective caesarean section is increasing. Previous studies have shown that elective caesareans are linked to an increased risk of newborn respiratory problems. The exact reasons for this are unknown, but one explanation is that hormonal and physiological changes associated with labour are necessary for lungs to mature and that these changes may not be present in infants delivered by elective caesarean section. Gestational age at the time of elective caesarean section may also be important.

So researchers at Aarhus University Hospital in Denmark investigated the association between elective caesarean sections and newborn respiratory problems. They also analysed the importance of timing of elective caesarean sections. Over 34,000 live born singleton babies without birth defects and with gestational ages of 37 to 41 weeks were included in the main analysis. Deliveries were categorised into two groups: elective caesarean section and intended vaginal delivery (i.e. all vaginal deliveries and emergency caesarean sections).

Factors that could affect the results, such as maternal smoking and alcohol intake during pregnancy, maternal body mass index, maternal age and education, were also taken into account. 2,687 infants were delivered by elective caesarean section. Compared with infants intended for vaginal delivery, infants delivered by elective caesarean section were found to have an increased risk of general respiratory problems.

This risk increased the earlier the caesarean was performed. A nearly fourfold increased risk was found at 37 weeks gestation, a threefold increase in risk at 38 weeks gestation, and a doubling of risk in infants delivered at 39 weeks gestation. Adjusting for maternal factors had little effect.

For example, at 37 weeks, 2.8% of infants delivered by intended vaginal delivery had general respiratory problems compared to 10% of infants delivered by elective caesarean section. At 38 weeks, the proportion was 1.7% compared to 5.1% and at 39 weeks, 1.1% compared to 2.1%. The risks of serious respiratory problems showed the same pattern but with higher risk estimates than those for general respiratory problems. Analyses after restriction to low risk pregnancies revealed slightly smaller risk estimates at 37 weeks gestation but essentially unchanged estimates at 38 and 39 weeks gestation for serious respiratory problems, whereas the estimates remained unchanged at all gestational ages for general respiratory problems.

Babies delivered by elective caesarean section at 37 to 39 weeks of gestation carry a two to fourfold increased risk of respiratory morbidity compared with babies delivered by intended vaginal delivery, say the authors. They suggest that a significant reduction in neonatal respiratory morbidity may be obtained if elective caesarean section is postponed until 39 completed weeks of gestation.

http://www.reuters.com/article/2007/12/12/us-caesareans-breathing-idUSL1149998920071212

Caesarean babies risk more breathing problems

By Ben Hirschler

LONDON | Tue Dec 11, 2007 7:11pm EST

LONDON (Reuters) - Babies delivered by non-emergency caesarean are up to four times more likely to have breathing problems than those delivered vaginally, Danish researchers said on Wednesday. The finding adds to evidence on the risks of elective caesareans, or C-sections, which are increasingly popular around the world.

Anne Hansen of the Aarhus University Hospital, Denmark, said the risks were greatest when a caesarean was performed early and she urged women not to choose the procedure before the 39th week of pregnancy. "This is important information for women who choose elective sections ... we suggest you should not do elective caesareans until 39 weeks, whereas a lot of elective sections are done at 37 and 38 weeks today," she said. Just why caesarean babies are at higher risk is unclear but Hansen said it was likely due to hormonal and physiological changes associated with labor.

The process of labor triggers the release of stress hormones in the mother, which are passed on to the fetus and are thought to be key in maturing the baby's water-filled lungs. Cases of breathing problems associated with caesarean births are often not serious but they typically require incubator and oxygen treatment. Hansen and colleagues based their research, which was published in the British Medical Journal, on a study of more than 34,000 births in Denmark. They found a nearly fourfold increased risk of breathing difficulties in caesarean babies delivered at 37 weeks, a threefold increase at 38 weeks and a doubled risk at 39 weeks.

As a result, 10 percent of caesarean babies had respiratory problems when delivered at 37 weeks, compared to 2.8 percent of infants intended for vaginal delivery. By 39 weeks, the proportion was 2.1 percent compared to 1.1 percent. Hansen stressed that C-sections still had many benefits, particularly in the case of breech babies and where the mother or baby was in danger. But the medical profession should do more to try and curb rising demand for non-emergency caesareans. "Most women choose it because their first delivery was a scary experience and we should really try to make sure the first delivery is a good experience," she said.