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BMJ 2009; 338 doi: (Published 13 January 2009) Cite this as: BMJ 2009;338:b76

Elective caesarean sections are safest at 39 weeks, not before

Women who have an elective caesarean section before 39 weeks put their babies at risk of preventable neonatal complications, according to a cohort study from the US. Risks were highest for babies born electively at 37 weeks (adjusted odds ratio 2.1, 95% CI 1.7 to 2.5), but were still increased for those born at 38 weeks (1.5, 1.3 to 1.7).

These authors studied 13 258 women having repeat elective caesarean sections at 19 academic hospitals. More than a third (35.8%) had their surgery before the recommended 39 weeks. The combined incidence of complications was 15.3% (128/834) at 37 weeks, 11% (430/3909) at 38 weeks, and 8% (524/6512) at 39 weeks, a significant trend. Risks began to go up again for deliveries after 41 weeks, leaving a narrow two week window for the best chance of a good outcome.

The authors included 10 complications in their combined outcome, including respiratory distress, sepsis, hypoglycaemia, admission to neonatal intensive care, and death. Only one baby died. Most of the increased risk associated with early delivery was driven by respiratory problems, sepsis, and hypoglycaemia.

Women who opted for early delivery were older and more likely to be married and have private insurance than the others.

Millions of Chinese smokers risk premature death

Chinese researchers recently estimated that smoking was directly responsible for the premature deaths of well over half a million Chinese adults in 2005. Most died of cancer (268 200), cardiovascular disease (146 200), or respiratory disease (66 800), particularly lung cancer, stroke, and chronic obstructive pulmonary disease. In their cohort study, smoking accounted for an estimated 12.9% of all deaths in middle aged and older men and 3.1% of all deaths in middle aged and older women in 2005.

The study comprised 169 871 Chinese adults who were over 40 when recruited. They were followed up for eight years. Overall, smoking increased …

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