Long-term follow-up of children born after amniocentesis

Children whose mothers had second trimester amniocentesis: follow up at school age

OBJECTIVE

To explore potential long term consequences of second trimester amniocentesis.

DESIGN

Children exposed to second trimester amniocentesis have been followed prospectively from birth to school age and compared with children whose mothers declined the test.

SETTING

The Hospital for Sick Children, Toronto.

SAMPLE

Eighty-six children exposed to amniocentesis and 44 children whose mothers declined the test.

INTERVENTIONS

Second trimester amniocentesis for the late maternal age indication.

MAIN OUTCOME MEASURES

Standardised tests of intelligence, academic achievement, speech articulation, visual-perceptual-motor ability and fine motor coordination were administered. Parents reported on child behaviour using standardised measures of behaviour problems, social competence, hyperactivity and temperament. Physical growth was also measured, and parents reported on child health.

RESULTS

Group differences were not observed.

CONCLUSIONS

Second trimester amniocentesis does not appear to compromise child development, behaviour, growth or health.

Evaluation of auditory system in preschool children whose mothers had mid-second trimester amniocentesis

A prospective study was conducted in the Otorhinolaryngology department, National University Hospital, Singapore to evaluate the effects of mid-trimester amniocentesis on the auditory system in preschool children of about four years of age. Fifty-nine children whose mothers had mid-second trimester amniocentesis and 63 children (control group) whose mothers did not have amniocentesis in that pregnancy were recruited. The children were subjected to audiological tests to assess hearing impedance abnormalities. The incidence of prematurity, neonatal admissions, ear and respiratory infections, auditory function, speech and language development in children were evaluated because these factors have a bearing on the development of auditory impedance abnormalities. There was no significant increase in the neonatal admission rates, impairment of speech and language development and auditory function in children whose mothers had mid-second trimester amniocentesis compared with the control group whose mothers did not have amniocentesis. An incidental finding in this study was an increased incidence of respiratory illnesses in the children in the amniocentesis group (57.6%) compared with the control group (30.1%). This needs further evaluation with a properly designed study.

Population-based study of long-term outcomes after amniocentesis

Amniocentesis is now commonly used in many countries; it is important to know whether there are any long-term adverse effects on children born after this procedure, in particular disabilities that may emerge during childhood or adolescence. We studied consecutive liveborn offspring of women who had had amniocentesis and compared them with matched controls whose mothers had not had amniocentesis. The controls were matched for age of mother, residence by geographic health unit, sex, and when the birth occurred. 1296 cases and 3704 controls were studied. With the exception of one disorder, the offspring of women who had had amniocentesis were no more likely than controls to have a registrable disability (such as hearing disabilities, learning difficulties, visual problems, and limb anomalies) during childhood and adolescence. The follow-up period was 7-18 years. Children of women who had amniocentesis had a significantly higher rate of haemolytic disease due to ABO isoimmunisation than matched controls. The results of this study should therefore be reassuring to women having amniocentesis, and be useful to women making decisions about having this procedure.

Child outcome following mid-trimester amniocentesis: development, behaviour, and physical status at age 4 years

Four-year-old children whose mothers had mid-trimester amniocentesis (n = 88) were compared with children whose mothers chose not to have the procedure (n = 46). Intelligence, visual-motor-perceptual skills, language, behaviour, social competence, temperament, physical growth, hearing, and middle-ear function were measured using standardized procedures. Health histories were obtained by maternal report. The results suggest that the wide range of developmental and behavioural variables studied is not influenced by removal of amniotic fluid in the mid-trimester. However, mothers who had amniocentesis were more likely to report a history of ear infections in their child (P = 0.04). In support of this finding were the results of audiological assessment which demonstrated a trend toward a higher rate of bilateral middle-ear impedance abnormalities in children whose mothers had amniocentesis (P = 0.06). Further study of the upper respiratory system is recommended to explore potential long-term sequelae of mid-trimester amniocentesis.