The Facts on Premature Birth

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The United States received a "D" on the March of Dimes Premature Birth Report Card. What does that actually mean—and what should women know about premature births?

Why a Report Card?

Dr. Alan Fleischman, the March of Dimes Senior VP and medical director, says the report card is an opportunity to rally public and legislative support for programs that will help reduce the preterm birth rate. "The March of Dimes wants every woman of childbearing age to know that premature birth is a serious and common problem, and that although the causes of many premature births are unknown, there are some steps women can take to help them have a healthy baby," says Dr. Fleischman.

The report card gives each state and the nation a letter grade determined by comparing its preterm birth rate to Healthy People 2010 objectives. It also provides information about selected risk factors that contribute to preterm birth, including the rate of uninsured women of childbearing age, the smoking rate for women, and the rate of late preterm birth (defined as birth between 34 and 36 weeks gestation).

Long- and Short-term Consequences

According to Dr. Fleischman, there are many serious and long-term consequences of preterm birth. "These include learning disabilities, mental retardation or cognitive impairment, cerebral palsy, blindness, hearing loss, and other chronic conditions such as asthma," he says. "Even infants born just a few weeks too soon have a greater risk of respiratory distress syndrome (RDS), feeding difficulties, temperature instability (hypothermia), jaundice, and delayed brain development."

Dr. David Sorrentino, attending neonatologist for St. Christopher's Hospital for Children in Philadelphia, agrees. "There is a long list of potential problems associated with prematurity," he says. "Generally the risks decrease in severity and frequency as the pregnancy approaches term gestation."

Neurological problems include apnea of prematurity, likely due to immaturity of the centers of the brain responsible for normal breathing patterns. Because infections in the uterus are responsible for a significant portion of preterm births, there is also an increased risk in infections for the baby. Newborn immune systems are not at adult levels of functioning and they rely on Mom's antibody protection that comes across in the third trimester. Preterm infants' immune cells function at an even lower level as they may not have obtained a full complement of antibodies from the mother. "This puts them at risk for increased rates of infections and commonly they need to be in a hospital for care which exposes them to procedures that increase infection risk," says Dr. Sorrentino.

Can Preterm Birth Be Predicted?

Though the study of genomics has helped define genetic predispositions to prematurity, there is still no way to predict preterm birth. "There are no great predictors of preterm births but there are a few identified risk factors," says Dr. Sorrentino. "The number one risk factor appears to be a history of prior preterm birth. Another prominent risk factor is multiple gestations; lower socioeconomic status is a risk factor, as is African American heritage. Maternal ages greater than 30 or less than 17 increase risk of preterm birth as well."

Risk factors include the following:

• Women who have had a previous preterm birth.
• Women who are pregnant with twins, triplets or more.
• Women with certain uterine or cervical abnormalities.

Lifestyle factors include the following:

• Late or no prenatal care.
• Smoking.
• Drinking alcohol.
• Illegal drug use.

Preventing Preterm Births

Mothers can take some steps to ensure the healthiest outcomes for their babies. Most important, they should get prenatal care—even one prenatal visit has been shown to improve outcomes. This does not mean they should only be seen once, as good ongoing care is optimal for the best outcome. "The earlier the mother is seen in pregnancy the better the pregnancy will go," says Dr. Sorrentino.

9 Questions to Ask Your OB-GYN

The March of Dimes recommends some specific things that every woman can do to help her baby be born healthy and full-term. Some of these steps can be taken even before you're pregnant. Here are nine questions you can ask your healthcare provider in a pre-pregnancy health checkup:

• How can diabetes, high blood pressure, infections, or other conditions affect my pregnancy?
• How can certain medications (prescription, over-the-counter or home remedies) affect my pregnancy?
• How does taking a multivitamin with folic acid daily, especially before pregnancy, help me have a healthy baby?
• What is my ideal weight?
• How can I stay away from cigarettes, alcohol, and illegal drugs?
• How can I manage the stress in my life?
• How long should I wait between my pregnancies?
• What if premature birth runs in my family?
• What are the signs of preterm labor and what should I do?

Education Is Key

The purpose of the March of Dimes report card is to educate the public on the risks of preterm birth and give a plan to reduce the incidence of prematurity. Education in caring for a preterm baby is also needed.

Katie-Anne Gustafsson, mother of two from Eskilstuna, Sweden, was stunned at how little post-term education she received after the preterm birth of her son. "What surprised me was that we were given no real information about caring for our premature baby once we left the hospital," says Gustafsson. She also wishes they would have been given counseling afterwards. "I'm surprised that no counseling was offered once the baby was born," says Gustafsson. "Years later, I'm still terrified that something will happen to Jake, and often feel very scared at letting him do things that are normal for most kids. Despite a healthy second pregnancy and the fact that I'm a logical person who knows that I wasn't to blame for the premature birth, the events surrounding Jake's birth still haunt me."