LONDON, June 9, (RTRS): Babies born just 1 or 2 weeks before their 40-week gestation due date are more likely to develop learning difficulties such as autism or dyslexia, according to a British study published on Tuesday.
The findings show that even babies born at 39 weeks — the point at which many women choose to have a Caesarean section delivery — have an increased risk of a developing a learning disability compared with babies born a week later at 40 weeks.
Scientists in Scotland, analysing the birth history of more than 400,000 schoolchildren, found that while babies born at 40 weeks have a 4 percent risk of learning difficulties, those born at 37 to 39 weeks of gestation have a 5.1 percent risk.
“There was an increasing risk of special educational needs as the gestation date fell, so as deliveries got earlier, the risk went up,” said Jill Pell, an expert in public health and health policy Glasgow University, who led the study.
“Even being just a week early put the risk up.”
It is already known that a baby born prematurely — for example at 24 weeks of gestation — is more likely to have learning difficulties. But the risks for babies born in the 24 to 40 week range had not previously been studied.
According to the World Health Organisation, more and more women worldwide are delivering by caesarean section and a “significant proportion” of these surgical procedures are performed without any clear medical need.
Around a third of babies are born between 37 and 39 weeks of gestation, either by caesarean section or natural vaginal delivery.
Rates of autism have also been rising, with worldwide prevalence estimated at between 1 to 2 people in every thousand, although experts say this may be partly due to better diagnosis.
Pell noted this rise but said it would be “a leap too far” to link her findings directly to rates of autism, since autism was only one of a range of learning difficulties considered.
Pell, whose study was published in the Public Library of Science Medicine journal, stressed that caesarean sections were not the only factor behind early-term births, since some women go into labour naturally before 40 weeks of gestation.
But she said doctors and women should consider the risks of learning difficulties when thinking about a caesarean.
“It is now normal policy (in caesarean section) to deliver women a week early,” she said in a telephone interview. “But if you make a decision...for an elective pre-term delivery, then it has to be a balance, weighing up the risks and potential benefits.
“What this study shows is that special education needs are another factor that need to be considered.”
Children with special educational needs may have either a learning difficulty such as dyslexia or autism, or a physical difficulty such as deafness or poor vision.
Pell found that although the risk of educational difficulties was much higher in preterm than in early term babies, the absolute numbers of children with difficulties in the 37 to 39 week group were higher, because many more babies are born at this time than before 37 weeks.
In her study, early term births accounted for 5.5 percent of cases learning disabilities, while preterm deliveries accounted for only 3.6 percent of cases.
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Constipation: Stubborn cases of chronic constipation in childhood may become an adulthood problem for a significant percentage of kids, a new study suggests.
Dutch researchers found that among 401 children and teens treated for chronic constipation at their center, one-quarter were still having symptoms 11 years later, as young adults.
The odds of long-lasting constipation were greater when the problem arose later in childhood or when years passed between a child’s first bouts of constipation and his or her referral for specialized treatment.
The findings, reported in the journal Pediatrics, are based on a group of children and teens with symptoms serious enough that they were referred to a specialist clinic.
So they may not be representative of kids treated for less-serious constipation by their primary care doctors, note the researchers, led by Dr Marc A. Benninga of Emma Children’s Hospital in Amsterdam.
Experts generally recommend that children see their doctor if they have constipation problems that last more than two weeks. Typically, treatment involves diet changes — such as eating more fiber-rich grains, fruits and vegetables — and, with a doctor’s approval, stool softeners or laxatives.
The new findings suggest that children whose symptoms do not improve with initial treatment might benefit from earlier referral to a specialist, according to Benninga and his colleagues.
It’s estimated that functional constipation — constipation not caused by an underlying health condition or medication side effects — accounts for about 3 percent of all visits to the pediatrician. But there has been little research into how often those problems persist into adulthood.
The current study included 401 children and teenagers who were treated for chronic constipation at the researchers’ center in the 1990s.
All had at least two symptoms of chronic constipation — such as having fewer than three bowel movements a week and two or more bouts of fecal incontinence per week — and had not improved after using laxatives for at least two months.
After six to eight weeks of “intensive” treatment that included medication and behavioral therapy, the children were followed, through yearly surveys, to track their long-term progress.
After 11 years, the researchers found, three-quarters of the study participants were showing a “good” outcome — defined as having had at least three bowel movements per week in the past month, and fewer than two bouts of incontinence.
That left one-quarter who were still suffering symptoms. For comparison, that rate is much higher than studies have found among adults in the general population; in the US, for example, it is estimated that between 4 and 5 million Americans have frequent constipation — with older adults accounting for a large portion, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Benninga’s team also found that certain factors — including constipation problems starting later in childhood, and longer gaps between a child’s first symptoms and treatment referral — seemed to increase the likelihood of persistent constipation.
For example, they say, a boy whose symptoms began at age 3, and included only two bowel movements and multiple bouts of incontinence each week, would have a 7 percent chance of adulthood constipation if there were a one-year gap between the onset of his symptoms and his referral for specialist treatment.
Those odds increased to 31 percent with a 9-year delay before referral.
The findings, according to Benninga’s team, suggest that referring kids for specialist care earlier on might cut the risk of long-lasting problems.
“Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment,” they conclude.