Premature births and low-birth-weight babies are on the rise. According to the March of Dimes, the rate of infants born preterm in Texas increased 22 percent between 1993 and 2003.
“In spite of all of the advances in biomedical science and technology, we continue to see significant numbers of premature births in every municipality across the country,” says Dr. Fernando Guerra, a pediatrician and director of the San Antonio Metropolitan Health District. “Last year we had 3,100 infants born at less than 37 weeks of age. That means 12 percent of all births in Bexar County were preterm.”
A report released in July by the National Academy of Sciences’ Institute of Medicine echoes what Texas is seeing. The United States saw a 30-percent increase in premature births last year over 1981 rates. That’s one of every eight babies who is at greater risk of health problems such as cerebral palsy, developmental delays, chronic respiratory problems and hearing or vision impairment. Considering that the U.S. objective is a 7.6-percent preterm birth rate by 2010, it’s clear this issue is crying out for attention.
Causes of premature birth
What can be done about the alarming rise? The answers lie in the causes of preterm birth, which are complex and varied. Dr. Guerra says there are a number of biological factors, including anatomical and hormonal problems that can trigger premature labor. It appears race has something to do with it, too. In Texas, between 2001 and 2003, preterm birth rates were highest among blacks, followed by Hispanics, Native Americans, whites and Asians, according to the March of Dimes.
Two known causes of premature birth are multiple pregnancies, such as twins, and pregnancy-induced high blood pressure, known as pre-eclampsia, which often results in labor induction because of health risks to the mother. “It’s easy to say the rise in preterm births is caused by assisted reproductive technology, such as in vitro fertilization, because it often results in multiple fetuses,” says Dr. Rajam Ramamurthy, neonatologist and medical director of Premature Infant Development PREMIEre Program at the UT Health Science Center. “However, when we separate those numbers, we see that single pregnancy preterm births have also gone up. The cause is unknown, but we suspect increased environmental stressors are a contributing factor.”
More women than ever before are working — an estimated 60 percent work outside the home. According to Business Week, the labor-market participation rate for women 25 to 44 years of age — the average child-bearing years — rose from less than 20 percent to more than 75 percent between 1900 and 1999. “Women are on their feet more, resting less and juggling work and home life demands during their pregnancies,” points out Dr. Ramamurthy. The increased pace of life is bound to have an effect. There could be underlying genetic factors that are expressed when certain environmental conditions are present.
The usual enemies of good health — smoking, alcohol, drug abuse, risky sexual behavior and exposure to toxins like heavy metals — can all result in preterm births and low-birth-weight babies. In addition, uncontrolled infections have become associated with preterm births. Dr. Guerra says research shows an association between gum disease, such as gingivitis and its more serious form, periodontitis, as a risk for low-birth-weight and preterm deliveries. Urinary-tract infections have also been shown to increase the odds of preterm delivery.
Another worrisome trend is the jump in the number of women who aren’t getting prenatal medical care. The percentage of pregnant Bexar County women who received late or no prenatal medical care nearly doubled between 2004 and 2005, a fact highlighted in the Metropolitan Health District’s annual Health Profiles report released in July.
“A woman who finds herself pregnant and doesn’t want to be faces a big dilemma,” says Dr. Guerra. “Sometimes such women are in denial during those first few crucial weeks and months when changes in habits and behaviors could have a big effect on the pregnancy. Unfortunately, we see that just judging from numbers, there are many women ages 18-19 who are facing their second or third child who often fall into this category.”
The low prenatal care numbers could be a result of the Texas Department of State Health Services’ new electronic system that was implemented in late 2004. The late prenatal care cases are entered differently in the birth record system. However, some suspect concerns over immigration problems are scaring pregnant women away from seeking early prenatal care. If true, it’s distressing because a child born in the United States is automatically a citizen. It’s much better to have a healthy, full-term baby than a premature infant who will need long and costly care.
“The late prenatal care we’re seeing is very concerning to me,” says Dr. Dianna Burns, a pediatrician and president of the Bexar County Medical Society. “If we’re not getting the mothers in prenatal care, then we potentially could have an increase in our premature births.”
Some legislative changes on the horizon might prove helpful. Beginning next year, the Children’s Health Insurance Program (CHIP) will begin covering some prenatal care. And the U.S. Senate just approved a bill calling for a public/private effort to prevent preterm births. The “PREEMIE” bill sets the stage for expanding federal support for much needed research into the causes of premature birth.
There’s no miracle cure for preterm births, but there are a number of things women and society at large can do to help more infants enter this world on time: prenatal care, good nutrition, exercise, adequate rest and decreased stress.
Lower your risk
Know the risks associated with fertility treatments.
Before you get pregnant, get a complete physical to identify and control health problems, such as high blood pressure, diabetes or infections.
Get a thorough dental exam and cleaning before getting pregnant. Be rigorous about daily brushing and flossing, as well as getting regular cleanings throughout your pregnancy.
Maintain a healthy weight — being underweight before or overweight during pregnancy can increase your risk of preterm labor or birth.
Plan your pregnancies. A short time between pregnancies (less than 18 months) can increase your risk of a premature birth because your body hasn’t fully recovered from the previous pregnancy.
Don’t smoke, drink alcohol, engage in risky sexual behavior or use illegal drugs before or during pregnancy.
Eat a nutritious, balanced diet.
Take a daily multivitamin that includes 400 micrograms of folic acid before and during pregnancy to prevent neural tube defects.
Get a reasonable amount of exercise.
Avoid working hours with long periods of standing.
Decrease your stress. For instance, find more social support, leave an abusive relationship, and take time to rest and relax.
Although many risk factors for preterm birth such as genetics and pre-eclampsia are out of a pregnant woman’s control, there are a number of lifestyle choices you can make to increase your chances of a full-term pregnancy:
Employers can help
“Prematurity is the third most expensive condition treated in U.S. hospitals,” says Dr. Ramamurthy, who also serves as board president of the local March of Dimes chapter. “For a premature baby, the average hospital stay costs $58,000; for a seriously ill baby, it costs between $100,000 and $200,000.”
The average hospital cost for a full-term delivery is approximately $4,000. Companies are searching for ways to keep health coverage manageable. Most are finding prevention and keeping utilization low to be the most cost-effective ways to keep skyrocketing health care costs in check.
“Employers need to be aware of what makes for a difficult working environment for a pregnant woman. This might be standing for long periods, exposure to chemicals or high stress,” says Dr. Guerra. “As a community, we need to work together to make sure each pregnant woman experiences the best possible physical, emotional and environmental conditions. The cumulative burden and high costs of prematurity extend far beyond the family that must care for a preterm infant.”
Not sure where to begin? Start with education. The Texas Chapter of the March of Dimes provides free communication tools to help companies and their employees learn more about prematurity and pregnancy. You can download newsletters, articles, bulletin board flyers, paycheck stuffers, e-mail scripts and more; look under “Hot Topics/Prematurity” at marchofdimes.com/texas.
Prematurity and/or low birthweight is the leading cause of death in the first month of life, according to the March of Dimes, which has launched a National Prematurity Campaign to address the growing problem. Each May the organization sponsors WalkAmerica and on October 15th Signature Chefs, fund-raising events, in addition to volunteer opportunities. Want to make a difference to an unborn child? Call (210) 696-1030 or visit marchofdimes.com/texas.
Get your flu vaccine!
Pregnant women should get a flu vaccine in October because flu symptoms can cause premature labor.
Author: Kelly A. Goff