Doctor says octuplets at risk for disabilities

From The NY Times Room for Debate blog:

A woman in Southern California has given birth to eight babies, the world’s second live-born set of octuplets. With advances in fertility treatment, multiple births are becoming more common, but how many are too many? What are the costs of delivering and caring for premature babies? And what about the emotional costs?

Jeffrey Ecker, an associate professor at Harvard Medical School, who is an attending perinatologist at Massachusetts General Hospital, says:

It’s hard not to be excited about the birth of a baby. That’s especially true if you’re a patient who has had trouble becoming pregnant or a doctor taking care of such women. And yet, as a high-risk obstetrician, I find the news today that a woman in California has given birth to octuplets as much worrisome as happy.

To start there are potential problems for the newborns’ short and long-term health. Multiple gestations — twins, triplets and beyond — are almost always born premature. The average gestation of a single, uncomplicated pregnancy is 40 weeks. Twins average 36 weeks, triplets 33. Subtract two or three weeks for each additional fetus and it becomes obvious that most pregnancies of more than five (quintuplets and beyond) never make it to the point at which they can make survive outside the womb, which in spite of all our technologies seems fixed near 24 weeks of gestation.

News reports indicate that this week’s octuplet pregnancy reached 30 weeks, and that is extraordinary, but even if many or all eight survive there are real and important concerns about their vision, lung, brain and other organ development. Increasingly we’re learning that prematurity is linked to cerebral palsy and learning disabilities. Premature multiples aren’t just small, they are sick.

Multiple pregnancies also raise concerns for the mothers’ health. Risks of high blood pressure and high blood sugar rise with increasing number of fetuses. And as the uterus grows so do the chances that the over-stretched womb will bleed during delivery. Treating the preterm labor that is inevitable requires medication, hospitalization and bed rest, which each bring the possibility of other complications. None of this is easy.

Finally, the news of the octuplets raises concerns regarding assisted reproduction. Many of us in this business view a higher-order multiple pregnancy like that which made news yesterday as a failure: a failure to regulate drugs and stimulation and thereby limit the number of gestations.

Worries about both the mothers’ and the babies’ health is such that when triplets, quads and beyond arise, doctors discuss the option of fetal reduction: stopping the heart beats of some number of fetuses to improve the chances for those that remain. To be sure, reduction will seem wrong to some patients and no one could ever require that someone follow such a path. All this, especially for those for whom reduction is not an option, argues for a careful and considered discussion up front, before medications are given and the process begun. Better to cancel a cycle of stimulation or in vitro fertilization and start again than risk over-stimulation and the octuplets that can result.

So today we will hope for the continued good health of this California mother and her babies. But we will also hope that such cases only rarely — maybe never — happen again.