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Preventing Premature Births

  • Chris Woolston, M.S.
  • Posted March 11, 2013

Every year in America, more than 500,000 babies are born too early. They enter the world weeks or even months ahead of schedule, and they're more likely to suffer illness and disability.

Premature babies are usually underweight -- some weigh three pounds or less -- and underdeveloped. Their lungs may not be developed enough to work on their own, and their immune systems may not be ready to fend off germs. These obstacles can be too much for a small body to overcome: According to a report in Seminars in Perinatology, premature birth is now the number one cause of death and illness in newborn babies. In fact, the number of premature births in America has grown 36 percent since the early 1980s, according to the March of Dimes.

Because premature babies face extra obstacles, they often need care in the neonatal intensive care unit (NICU). In one study, the average first year medical costs for a "preemie" were about 10 times those for a full-term baby.

While medical care for premature babies has improved dramatically in recent years, preventing early births in the first place has proven to be a daunting challenge. As reported by the March of Dimes, premature births are more common today than 20 years ago. The organization is trying to reverse that trend through a five-year, $75 million campaign to educate women about the steps they can take to prevent premature delivery.

Are certain groups of women at higher risk?

Being poor, African American, under 20, or over 40 may put you at higher risk of having a premature baby. In fact, the chances that a black woman will deliver early are almost two times higher than for an Asian or a Caucasian woman, regardless of socioeconomic class, according to one report from The Lancet. If you've already delivered a baby prematurely, it can also increase your chances of having another "preemie." Preeclampsia, or high blood pressure developed during pregnancy, also puts you at higher risk.

Are there other risk factors?

Being overweight or underweight increases your risk of delivering early. Certain medical conditions (including diabetes, high blood pressure, and infections during pregnancy) also raise your chances of having a baby born too small and too soon.

You may already know that carrying twins makes you more likely to deliver early; in fact, the risk rises with each additional fetus. Smoking cigarettes during pregnancy increases your chances of having a premature infant; so does being malnourished or using street drugs. Some research has also linked bacterial vaginosis and other genital tract infections to premature birth.

Are there ways to ensure you don't have an early delivery?

There's no way to guarantee a healthy, hefty, full-term baby, says Charles Lockwood, M.D., chair of obstetrics and gynecology at the Yale University School of Medicine. "Rates of premature delivery are high even among women who do everything just right," he says. Still, he believes every woman should do what she can to give her baby the best possible start.

Here's what moms can do to lower the risk of a premature birth:

Get prenatal care. Lockwood puts regular prenatal care at "the top of the list" of ways to prevent premature births. Call your doctor as soon as you think you may be pregnant. At the first visit, your doctor will give you a thorough checkup, being especially alert for conditions that can threaten a pregnancy, including diabetes, high blood pressure, urinary and genital tract infections, sexually transmitted diseases, and anemia. If you have any of these conditions, proper treatment will help restore your health and protect your baby.

Get enough folic acid and iron. Two nutrients -- iron and folic acid -- are especially crucial for preventing premature births. The typical American diet doesn't provide much folic acid, so Lockwood recommends that all women who are pregnant (or planning to become pregnant) take a daily prenatal vitamin with folic acid. In addition to encouraging full-term birth, the Centers for Disease Control and Prevention (CDC) suggests that taking a supplement containing 400 micrograms of folic acid each day will help prevent spina bifida and other neural tube birth defects; after you're pregnant, that amount should be at least 600 micrograms daily. (If you have already had a baby with a neural tube defect, both the CDC and the March of Dimes recommend increasing your folic acid intake to 4 milligrams daily.)

If you have iron deficiency anemia, meaning your blood doesn't have enough iron, your doctor may prescribe iron supplements. Remember, no pill is a substitute for a healthy, well-balanced diet.

Don't smoke. Simply put, cigarette smoke poisons your baby's world. As reported in Seminars in Perinatology, smoking 1 to 9 cigarettes each day may be enough to cause a baby to be born ahead of schedule. Pregnant women who smoke are also more likely to suffer miscarriages.

Stay away from street drugs, especially cocaine. A research review in Seminars in Perinatology discussed a study that reported using cocaine can nearly quadruple the risk of premature birth. The March of Dimes urges all expectant mothers to stay away from any drug not approved by a doctor. The fewer chemicals in your body, the better!

Avoid alcohol. Heavy drinking can lead to premature births and fetal alcohol syndrome, which can cause severe, permanent mental retardation. Chronic drinking and binge drinking (consuming five or more drinks in one day) are particularly hazardous while you're pregnant or trying to conceive -- the latter because you may end up drinking heavily without knowing you're pregnant.

Even social drinking -- a drink a day or less -- may cause your offspring to suffer learning disabilities, according to a study by alcohol researchers at the University of Washington's School of Medicine in Seattle. The federal government urges women not to drink at all while trying to conceive, or when they're pregnant or nursing. "Any amount of alcohol during pregnancy is potentially dangerous to an unborn baby," warns the CDC.

Talk with your doctor about the medications, herbs, and over-the-counter remedies you're taking. Many people believe that herbs and other products sold in health food stores are safe for use during pregnancy, but that's not always true. Fenugreek seeds, for example, have induced labor in animal experiments and so aren't recommended for pregnant women. Talk with your doctor before taking any supplements or herbs -- even in the form of tea.

Watch your weight. Here's something to consider before you get pregnant: Women who are either significantly underweight or overweight sometimes have trouble carrying a child to full term. Underweight women are especially likely to go into early labor, Lockwood says. Overweight women are vulnerable to conditions such as diabetes and high blood pressure -- conditions that may force a doctor to induce labor early for the sake of the baby's health.

Keep moving. Unless your doctor advises it, bed rest is not the best way to delay an early delivery. A survey of nearly 1,700 women found that women who exercised regularly during their first and second trimesters cut their risk of premature birth by 20 to 48 percent. Your doctor can help you find an exercise program that's right for you.

Know the risk of multiple births. In this age of high-tech fertility treatments, multiple births -- twins, triplets, quadruplets, and even quintuplets -- are more common than ever before. As the number of babies in the womb increases, so does the risk of premature birth. In fact, experts believe the rise in the number of multiple births has helped fuel today's high rates of premature deliveries. If a woman on fertility treatments becomes pregnant with multiple fetuses, her doctor may recommend "selective reduction," which means aborting one or more. The dangers of premature birth should definitely factor in to this highly personal decision.

Cut down on your stress. Women who are stressed out and anxious are particularly likely to give birth too early, Lockwood says. Of course, avoiding stress is easier said than done, especially with a baby on the way. Take every chance you can to relax -- now might be a good time to check out a prenatal yoga class! If you find yourself feeling overwhelmed by your emotions, seek out a therapist, counselor, or other mental-health professional.

Pay attention to your body. Pain or burning while you urinate may be a sign of an infection or a sexually transmitted disease. Call your doctor promptly. You should also get help as soon as possible if you notice any of the signs of an early labor: Increased or unusual vaginal discharge (possibly containing water, blood, or mucus), pressure in the pelvis or lower abdomen, stomach cramps, frequent or regular contractions of the uterus (often painless), or a constant, dull ache in the lower back. If you are going into labor, your doctor can give you medications that just might buy you and your baby a little more time.

Can a doctor prescribe any medications to prevent an early delivery before labor starts?

Yes. If you have a history of delivering early, your doctor may prescribe certain drugs to help delay the onset of labor. Talk to your doctor about whether you're a good candidate.

Remember, there are no guarantees. Your baby may arrive too early despite your best efforts. But whatever happens, you'll want to know you did everything you could.

References

March of Dimes. Folic Acid factsheet. February 2010 http://www.marchofdimes.com/pnhec/173_769.asp

Centers for Disease Control and Prevention. Folic Acid. March 2010 http://www.cdc.gov/ncbddd/folicacid/index.html

March of Dimes: Preterm births rise 36 percent since early 80s. January 7, 2009

Interview with Charles Lockwood, MD, chairman of the obstetrics and gynecology department at the Yale University School of Medicine

Martin JA, Hamilton BE, et al. Births: Final data for 2004. National Vital Statistics Reports; Vol 55 no 1. Hyattsville, MD: National Center for Health Statistics 2006.

Evenson KR et al. Vigorous leisure activity and pregnancy outcome. Epidemiology. November, 2002. 13(6): 653-659.

Kelly SJ, Day N, Streissguth AP. Effects of prenatal alcohol exposure on social behavior in humans and other species. Neurotoxicology Teratology 2000; March-April; 22(2):143-9.

Robinson JN. The epidemiology of preterm labor. Seminars in Perinatology. August, 2001. 25(4): 204-214.

March of Dimes. Prematurity: What can I do to reduce my risk of having a premature baby? 2003.

March of Dimes, The Big Picture: Hospital Costs. 2005

March of Dimes. Who will deliver early? http://www.marchofdimes.com/21832_5758.asp

March of Dimes: What is the Prematurity Campaign? 2003

March of Dimes: During Your Pregnancy: Smoking, 2003

Slattery, M. Preterm Delivery. Lancet 2002; 360 (9344): 1489-1497.

March of Dimes. New report links birth defects, preterm births to being overweight before pregnancy. February 25, 2002.

Dartmouth-Hitchcock Medical Center. Alcohol and Pregnancy.

Olson HC, Streissguth AP, et al. Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. Journal of the American Academy of Child Adolescent Psychiatry, 1997: September; 36 (9): 1187-94.

Tough, SC. Delayed Chidbearing and Its Impact on Population Rate Changes in Lower Birth Weight, Multiple Birth, and Preterm Delivery. Pediatrics 2002; 109-399-403.

My Sick Newborn: Infection. Factsheet, University of Wisconsin and the Center for Perinatal Care at Meriter Hospital. Madison, Wisconsin.

Robert L. Goldenberg, MD. High-Risk Pregnancy Series, an Expert's view. Obstetrics & Gynecology, November 2002; 100 (5), part 1:1020-1037

Kesmodel U., Olsen SF, and Secher NJ. Does alcohol increase the risk of preterm delivery? Epidemiology 2000. September 11 (5): 512-8

Koumanns, EH, et al. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clinic Infect Disease.2002 October 15; 35 (supple 2); S152-72.

Fetal Alcohol Syndrome FAQs. Centers for Disease Control and Prevention. www.cdc.gov/ncbddd/fas/fasask.htm

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