Delivery at any time before the 39th week of gestation increases the risk of postnatal problems and mortality. A team of authors headed by Christian F. Poets has analyzed mortality and morbidity data from epidemiological studies of infants born between two and six weeks preterm, comparing them with infants born at full term. They present their findings in issue 43 of Deutsches Arzteblatt International (Dtsch Arztebl Int 2012; 109(43): 721-6).
As a rule, elective Cesarean sections are performed somewhat before full term, in order to prevent spontaneous delivery. However, the earlier delivery occurs, the greater the risks to the child. The risk of neurological complications or death rises from 0.15% for births at 39-41 weeks' gestation to 0.66% for births at 35 weeks' gestation. A higher percentage of children born before term require special educational support in elementary school. This may be one reason preterm birth is associated with an increased risk of subsequent entitlement to welfare benefits.
Overall, approximately 20% of all children born in Germany are 2 to 3 weeks preterm, and 5% are 4 to 6 weeks preterm. The authors therefore advocate establishing clear prohibitions and informing parents, in order to reduce dramatically the rate of elective deliveries before the 39th week of gestation. Attempts to do this in US hospitals have so far been successful.
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