Overall, the number of babies born too early is on the decline
Preterm births are the leading cause of newborn death in the United States, with nearly half a million babies (just less than 12 percent) born too soon each year. Even babies who survive an early birth often face lifetime health complications such as blindness, breathing difficulties, cerebral palsy and hearing problems. And though the Centers for Disease Control and Prevention notes an overall decline in the number of preterm births nationwide, African Americans still have double the rates of prematurity. We spoke to Gerson Weiss, M.D., chair of the department of ob/gyn at UMDNJ, about what causes preterm birth and what we can do to reduce risks.
What is preterm birth?
Weiss: It’s a premature rupture of the membranes before 37 weeks of pregnancy.
What causes preterm births?
Weiss: There are many causes. If a woman is severely hypertensive and develops pre-eclampsia, the uterine environment becomes detrimental; we’re better off taking the baby. If the uterus is overstretched—this is more common with twins and triplets. Stress is a very major factor. Stressors of need, produced by racism, by difficulty having to work too hard, not having enough rest, money problems. Smoking—because that decreases the amount of oxygen to baby. Drugs can do it. Some [drugs] almost immediately trigger labor. Cocaine, for instance, causes uterine contractions. Illnesses—diabetics will have to be delivered early. Abnormalities of uterus. Too short a cervix. What we don’t know sometimes is how to prevent preterm births.
Why are African-American women at higher risk of preterm births?
Weiss: Likely many reasons; we probably don’t know all of them. Racial stress is pretty major. This is a burden for many minorities. That can produce preterm birth. Many are poor, which will translate to mean they have poor nutrition. They may have a bad diet—too many calories without a lot of protein. They may be obese, which puts them at major risk of developing gestational diabetes.
African Americans, as a group, have higher risk of hypertension. This is another reason why preterm birth can happen. We aren’t that aware of all of the causes, but clearly, this is an issue that is a problem for all socioeconomic groups. By way of example: Socioeconomic level is a risk factor for prematurity, however, a middle-class African-American woman has higher risk of preterm birth than an impoverished white woman.
It’s hard to get away from the fact that racism is an issue. The United States has one of the highest prematurity rates in the world, certainly one of highest in developed countries. We have women come to this country from places where there is poverty, but they have lower risk of preterm delivery than in the U.S. For example, a Mexican woman comes to the U.S. and improves her socioeconomic status, income and education, but her children will still have higher preterm risk than she does, which would point to something in our society. Racism rises to top of that issue.
What can a woman do to lower her risk of a preterm birth?
Weiss: Stay healthy. Come up with methods to avoid stress. Get more sleep. Stop smoking. Stop using illicit drugs. Take a multivitamin with a high level of folic acid, which also decreases risk of birth defects. Get to a healthy weight.
What health risks do preterm babies face?
Weiss: A preterm baby is small and all its organs may not be developed. So it has the risk of respiratory problems, as lungs may not be developed. They may need more time in the NICU [neonatal ICU], where a variety of sophisticated therapies are necessary to help the baby. They may have trouble catching up. There may not be enough neurological development. Later in life, preterm babies are at increased risk of hypertension and diabetes—at much greater risk [than normal birth babies] when they are adults.
The March of Dimes Healthy Babies Are Worth the Wait campaign (launched in 2011 in Newark, New Jersey) seems to be helping reduce the numbers of preterm births. Why? What is the program doing specifically?
Weiss: The program is sometimes providing vitamins; increasing awareness of problems; educating nurses, physicians and patients about self-care. It is encouraging patients to come in early to correct or prevent problems. It is taking care of patients with specific programs, such as centering programs, where patients are seen anti-partum in groups. If a patient doesn’t have a partner, she runs the risk of being isolated, but participating in groups helps with bonding. The last thing you want to see is a woman present for delivery alone. The program screens for partner violence. They look for infections that may produce preterm delivery. They increase nutritional competence. They treat periodontal disease, which is related to preterm delivery.
What else can be done to fight preterm births?
Weiss: Share [with women] the important messages: They need to have support, care and live as healthy a life as they can. They need appropriate diet, weight control, physical activity.
And we need to keep this message alive. This isn’t something you can tell on one day and assume women have it forever. To assure someone takes instructions of caregivers to heart and avoids dangerous activities. Every woman who’s pregnant and who’s keeping the pregnancy really wants the best baby she can get. If a woman is doing things that are harmful to her pregnancy, there’s a likelihood that she really doesn’t understand that what she is doing is harmful.