C-sections linked to breathing problems in preterm infants

Research conducted at Yale School of Medicine shows that a cesarean (C-section) delivery, which was thought to be harmless, is associated with breathing problems in preterm babies who are small for gestational age.

The study was presented at the 32nd Annual Society for Maternal-Fetal Medicine (SMFM) Meeting in Dallas, Texas, by Heather Lipkind, M.D., assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine, and co-author Erika Werner, M.D., who is now at Johns Hopkins School of Medicine.

Preterm birth, which is delivery before 37 weeks of pregnancy, is a serious health problem that costs the United States more than $26 billion annually, according to a 2006 Institute of Medicine report.

The researchers reviewed eight years of birth certificate and hospital discharge information for 2,885 preterm babies considered small for gestational age. C-sections are often performed for babies diagnosed with intrauterine growth restriction who are not growing adequately in the womb

Lipkind and her team found that babies delivered by a C-section before 34 weeks of pregnancy who were small for gestational age had higher odds of developing respiratory distress syndrome than babies born vaginally at a similar gestational age.

The increased odds persisted after controlling for maternal age, ethnicity, education, primary insurance payer, pre-pregnancy weight, gestational age at delivery, diabetes and hypertension.

"Further research is needed to determine the optimal mode of delivery for this population," said Lipkind, senior author on the study.

At SMFM, The March of Dimes presented Lipkind and lead author Werner, with an award for innovative research focused on preventing premature birth.

Other authors on the abstract include David Savitz, Teresa Janevic, Stephen F. Thung, and Edmund F. Funai.