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The Battle Against Premature Births
While medical advances in general make the news every day, the premature birth rate continues to climb and experts aren't sure why or how to stop it.

 



By Michelle Apuzzio

 



Instead of gazing at two adorable baby boys swaddled in blue and sleeping peacefully in their bassinets, Marla Wolk and her husband kept vigil in the intensive care ward as their premature sons, born at 26 weeks, shrank to 1 pound each. The Wolks wondered if they should even decorate their home nursery.

 



After a miscarriage and a molar pregnancy in which placental tissues form abnormally, Marla Wolk received the disheartening diagnosis of twin-to-twin transfusion syndrome, a blood circulation disorder sometimes fatal to both fetuses, during her pregnancy in 2003.

 



Oliver and Ian are thriving 3-year-olds now, but their parents carry with them the memory of those tense first months.

 



While medical advances in general make the news every day, the premature birth rate continues to climb and experts aren't sure why or how to stop it.

 



  • Nationally, the premature birth rate has risen by more than 30 percent in the last 20 years.

  • The rate of premature birth for African-American mothers is particularly high, accounting for about 18 percent of African-American births in 2002, (compared to 11 percent of white, 11.6 percent of Hispanic births).

  • Premature birth is blamed for 75 percent of neonatal deaths and 50 percent of neurological disorders nationwide. Babies born too soon are also at higher risk for developmental delays, vision and hearing difficulties, chronic respiratory issues and cerebral palsy.


The March of Dimes has partnered with several medical associations to achieve its goal of reducing premature births by 2010. Currently, research is focusing on:

 









Little Babies, Big Numbers



Premature birth is the leading killer of newborns under 1 month old:



  • 500,000 - Number of U.S. babies born premature each year


     

  • $79,000 - Average hospital charges for care of premature infants
     

  • 50 Premature births with unknown cause
     

  • 31 Increase in premature births in the United States over the last two decades
     

  • 12 Live births that are premature in the United States each year
    Source: March of Dimes





    • assessing the risk factors in women who had previous preterm deliveries;

    • how genes interact with lifestyle factors, such as smoking;

    • why some racial groups have higher rates of preterm birth; and

    • what role infections and stress may play in the incidence of premature birth. The March of Dimes is also funding clinical trials for drug therapies related to premature birth. Historically, the organization has been active in funding significant public health research, including Salk's polio vaccine, as well as human genome and DNA studies.


    All Things Not Being Equal

     



    Noting the trends connecting premature birth and race, Raymond Cox Jr., M.D., head of obstetrics and gynecology at St. Agnes Hospital in Baltimore, told a recent March of Dimes summit on prematurity that racial disparities within health care have multiple causes and the disparities are not limited to prenatal care. Poor health-care access, possible genetic factors and behavioral factors, such as pregnancy spacing, nutrition, infections and stress, could all influence differences in health care among the races, he said.

     



    Meanwhile, health-care providers and researchers trying to reduce premature births point to the following needs:

     



    • Better maternal health care between pregnancies - Ideally, such care would promote healthier future pregnancies by addressing risk factors through family planning, chronic disease management, weight management, smoking cessation, oral health care, nutrition counseling and mental health services. As an example, Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital, notes that even though the message to increase folic acid intake before and during pregnancy has been widely disseminated, "Some folks are still not getting it."




    Health care between pregnancies needs to be a team effort of primary care providers, as well as pediatricians who are treating the mother's other children, Riley says.

     



    • More data on premature births - The lack of sufficient data is an obstacle for both researchers and care providers. Riley recently served on an Institute of Medicine committee that issued a report on preterm birth, examining its causes, consequences and prevention. She said her group had difficulty getting enough data on prematurity. Without a uniform format for reporting premature birth across states, it's difficult to nail down trends and causes.

    • Better understanding of the link between premature births and periodontal disease - Periodontal disease is emerging as a risk factor or indicator of premature birth risk, something that both care providers and women need more information on, Riley says. "Obviously, there's more to this than 'Your teeth are bad and you're going to have a premature baby.'" Other factors that contribute to bad oral health may be more to blame for premature births.

    • More research into how infections affect premature birth - Researchers suspect that infections such as bacterial vaginosis and urinary tract infections play a role in preterm births, but it is not clear how, or how best to treat them. It is known, Riley says, that administering antibiotics to mothers does not alter the preterm birth rate.

    • Better understanding of the risks of in vitro fertilizations and assisted reproductive technology - Both of these raise the risk of premature birth, whether they create singleton babies or multiple fetuses, Riley notes.


    Looking Ahead

     


    There is reason to be optimistic: A recent, large-scale study looking at progesterone treatment in women who had previously delivered a premature newborn yielded some encouraging results. The study found that the women with prior preterm birth had a relatively lower risk of delivering another premature infant if they received progesterone injections. Riley has used this treatment with a few patients, but she says access to the drug can be problematic. The Food and Drug Administration (FDA) is close to approving Gestiva, an injectable form of progesterone now compounded by only one pharmaceutical company, she reports.

     



    Health professionals are also optimistic that continued research will lead to better treatments and, in some cases, aid in the prevention of premature birth.

     





    In the meantime, families and their health-care providers must cope with the ongoing issues of premature births, especially the health complications. "Prematurity does not end the day you leave the NICU," said Wolk.



    Michelle Apuzzio is a freelance writer and mom.

    Posted March 2007

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