Jul
14
2006

Too many preemies

A whopping one in eight babies in the US is now born prematurely. (Doctors consider a baby “premature” if he/she is born before 38 weeks gestation.) And the US Institute of Medicine, in a report released yesterday, says urgent steps are needed to turn the tide.

Hanging in there: Premature infants born today are far more likely to survive, and at earlier ages, than those born even a decade ago. But they're also more likely to experience a whole host of both acute and chronic health problems. (Photo by maria mono)
Hanging in there: Premature infants born today are far more likely to survive, and at earlier ages, than those born even a decade ago. But they're also more likely to experience a whole host of both acute and chronic health problems. (Photo by maria mono)

You may be wondering, “What’s the big deal?” I kind of shrugged it off, too. After all, both of my kids were born at 37 or 38 weeks, and experienced no problems. And we’ve all heard miracle stories of babies born as early as 22–25 weeks surviving.

Turns out that’s the magic word—surviving—along with thriving.

About 20% of babies born before 32 weeks gestation don’t survive their first year, and many premature infants experience life-long health problems, such as asthma or other lung disease, cerebral palsy, blindness, hearing loss, and retardation or learning disabilities. Even babies born only a week or two early have additional health risks and 30% higher medical costs compared to kids born at 40 weeks.

Trying to keep premature infants alive and thriving costs the US $26 billion a year. No one’s suggesting that we shouldn’t do everything possible for these little guys, of course, but is there any way to improve the situation?

What causes premature birth?

Ah, if only we knew.

Infertility treatments are one cause: moms who take fertility drugs or undergo in vitro fertilization (IVF)are more likely to become pregnant with twins, triplets, or even higher order multiples, and those babies are far more likely to be born early than singletons. (62% of twins and 97% of other multiples conceived this way were born prematurely.)

But they explain only a fraction of the nation’s premature births.

Certain infections can cause early labor. Other risk factors are poor diet, obesity, maternal stress, lack of pre-natal care, and smoking. Mothers under 16 or over 35 are more at risk, as are poor women, and black women. But differences in socio-economic status and behavior don’t completely explain the problem, either.

(Interestingly, the rate of premature infants born to black women (17.8%) has decreased slightly in the last decade while it’s increased for infants born to white women (11.5%). The authors of the study say this is because black women are less likely to undergo fertility treatments increasingly used by white women.)

Truthfully, doctors don’t know what causes most preterm births or how to prevent them. And they have only a few tools to predict which women will experience preterm labor.

So what should we do?

The US Institute of Medicine recommends three things:

  • Doctors who practice IVF should implant fewer embryos at a time. (The issue in the US is this: insurance usually doesn’t cover the procedure, which costs roughly $15,000 a try, so doctors try to improve the odds of a woman getting pregnant by implanting several embryos at a time. Which sometimes works too well. Many countries in Europe allow doctors to implant only a single embryo at a time, but they also pay for multiple IVF attempts. Those countries have discovered that, despite paying more up front to achieve a pregnancy, they’re saving money on the back end by treating fewer premature infants.)
  • More pregnant women should undergo first trimester ultrasound exams. (This is the only way to be certain of the fetus’ age. With more and more women being induced or undergoing C-sections, it’s possible that some babies are being born prematurely because their parents and doctors thought they were older than they really were.)
  • And the government should increase funding for research into the causes and prevention of premature birth.

Your Comments, Thoughts, Questions, Ideas

Liza's picture
Liza says:

A new drug ("Gestiva") meant to help women carry their babies to term does not appear to delay the earliest preterm births--those linked to the highest risk of death and serious health problems. The results of a single clinical trial, released on Monday, show that Gestiva did not seem to prevent births before 32 or 35 weeks' gestation. The drug does, however, appear to reduce births before the 37th week. The FDA is considering whether or not further study of the drug is needed.

posted on Tue, 08/29/2006 - 10:22am
Liza's picture
Liza says:

A genetic mutation may explain why African American women at at higher risk of having premature babies due to early rupture of the amniotic membrane.

The authors of a paper in the Procedings of the National Academy of Sciences said,

"Preterm birth is known to be two to three times more common in African American than European-American women, but socioeconomic status and access to health care do not fully explain the difference."

Premature rupture of the amniotic membrane occurs in 3% of all pregnancies and one-third of all premature births. And the genetic mutation associated with it was found in 12.4% of African American women in the study, versus 4.1% of European American women.

posted on Tue, 08/29/2006 - 10:28am
Liza's picture
Liza says:

The British Fertility Society (BFS) has recommended that severely overweight women should be denied access to free fertility treatment in the UK and that obese women must lose weight before undergoing IVF.

Richard Kennedy of the BFS said,

"Obese women are less likely to get pregnant and more likely to encounter health problems. It makes sense to address obesity before seeking fertility treatment."

The experts also recommended that women over 40 not be allowed to start National Health Service-funded fertility treatment, but that single women, same-sex couples, and couples with children from previous relationships can undergo the procedure.

The recommendations were aimed at "tackling a wide disparity in the social criteria used by different NHS trusts to decide whether treatment should be allowed. Dr. Mark Hamilton, chairman of the BFS, said,

"Continued inequality of access to treatment is unacceptable in a state-funded health service and the source of considerable distress to a great number of people with fertility problems."

posted on Wed, 08/30/2006 - 4:53pm
Liza's picture
Liza says:

A whopping 27% of the babies born at the University of Kentucky's Chandler Medical Center in Lexington are premature. (That's because 1 in 7 babies born in Kentucky are premature, and many women experiencing high-risk pregnancies are transferred to Chandler.)

Folks at Chandler have teamed up with five other hospitals, the March of Dimes, and the Johnson&Johnson Pediatric Institute to try and reduce premature births by focusing on the moms. They're paying a LOT more attention to women's health from the beginning of pregnancy until the end.

According to the Time article,

"Much of [the] focus is on the nuts and bolts of a healthy pregnancy: screening for bacterial infections, watching for signs of domestic violence, discouraging alcohol consumption, encouraging smoking cessation (1 in 4 pregnant women in Kentucky smokes), monitoring weight gain and nutritional intake and, when necessary, giving drugs to prevent preterm labor. Weekly injections of a progesterone-based drug after week 16, for example, can reduce the recurrence of premature births by one-third.

A major emphasis of the new project is on educating the public about the dangers of preterm labor--and reminding physicians that a vacation, for instance, isn't a good-enough reason to schedule an early delivery. The assumption: if mothers knew the real risks of prematurity, they would be less likely to request induced labor or a C-section and would stick out the pregnancy to term.

The project is also focused on the final three weeks of pregnancy, a time when most mothers-to-be assume they are out of the woods. But as Dr. Henrietta Bada, chief of neonatology at the University of Kentucky, explains, those last few weeks in the womb are critical for a newborn's development. The health risks for a baby born at week 35, she says, are more like those of a baby born at week 30 than one born at week 37. 'The perception is that a big baby--even if he's premature--is going to act like a term baby. He's not.'"

The goal at Chandler medical center is to reduce preterm births by 15%. Here's hoping they reach that goal!

posted on Wed, 11/15/2006 - 3:54pm
Ann C.'s picture
Ann C. says:

All of my 3 children (ages 29, 24 & 21 this year, 2007) were born at 38 weeks gestation.
I did breastfeed each for over a year, which has it's own benefits (emotional, physical..),
and all were quite healthy and still are. None are over-weight, and 2 went on to college.
As far as mentally, they all did well in school, when they applied themselves!!
Two of them did use the special ed deal in high school for behavioral reasons..
The youngest, the only son, did wind up using Adderall for 2 years, which helped
make him sit still for the learning experience we strive for here in the USA.. He weaned
himself off it and went on to college.
Then, there's my step-son, who was really a preemie, 2 months premature, he almost
died 3 times, was kept alive.. has bad eye-sight, lead a very sheltered life coz his
mom didn't want him to lift a finger, but years later made his dad the primary provider.
That son is extremely self-centered, thinks everything in the house is his for his
consumption, acts like a 7 year old and will probably never move out of the house
and on his own as I don't believe he has the skills... this is partly due to his upbringing
but ALOT to do with his prematurity..

posted on Sat, 06/23/2007 - 11:35am
Liza's picture
Liza says:

Two sets of sextuplets were born (in Minnesota and Arizona) within 24 hours of each other.

Brianna Morrison, who used fertility drugs, gave birth to her six babies on Sunday, June 10, in Minneapolis. Jenny Masche, who used artificial insemination, delivered her babies on Monday, June 11, in Phoenix.

The Minnesota babies (four boys and two girls) were born very early, at only 22 weeks. They weighed between 11 ounces and 1 pound, 3 ounces. (For comparison's sake, think of a can of soda: that's 12 ounces.) 22 weeks gestation is the outer limit for fetal viability, and it's just that--an outer limit. Sadly, four of the Morrison babies have died, and the remaining two are in critical condition.

The Arizona babies (three boys and three girls) were born at 30 weeks, and 4 days. All but one weighed less than three pounds. The "older" Masche babies are in better shape than the Morrison babies: they're breathing on their own.

Here's an article from the LA Times: "Multiple births, multiple risks"

posted on Tue, 06/26/2007 - 5:19pm

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