For More Babies, Birth Comes Too Soon

Picture a large can of soup. Betty Taylor of Durham, N.C., says that's how big her newborn son was when he arrived suddenly at 26 weeks, more than three months too soon.

"Even at a month old, Zeek could fit in the palm of his daddy's hand," she says.

Each year, half a million "preterm" U.S. babies arrive before their 37th week in the womb. Zeek's early debut, like most, could not be traced to a single cause.

"Without warning, my placenta abrupted [separated from the uterus]," Taylor says. "I was rushed to the hospital and delivered a 1-pound, 14-ounce boy." She visited Zeek in the hospital's intensive care unit for three months before she could bring him home.

Over the years, Zeek, now 8, has returned to the hospital for complications tied to his early birth. Fortunately, they were mild.

Significant increase

Like Taylor, more women are giving birth before their babies reach full term (about 40 weeks gestation). One in eight U.S. babies is preterm, says the Institute of Medicine. That's a rise of 30 percent in recent decades.

"The emotional and financial costs are devastating," says Diane Ashton, M.D, deputy medical director of the March of Dimes. It costs more than $26 billion a year to care for preterm babies. They spend weeks or months in hospitals for intensive, specialized care.

The problems don't end with discharge. Preemies can face respiratory distress, brain damage that includes cerebral palsy and learning disabilities, digestive problems, and hearing and vision loss. Complications can follow them through life.

"The earlier the birth, the smaller the weight and the less developed the organs. This can result in lasting physical, social, and learning disabilities," says Dr. Ashton.

Most U.S. preterm babies are born between 32 and 36 weeks of gestation. Mild to moderate learning deficits can show up in those cases, notes Louis J. Muglia, M.D., director of the Center for Preterm Birth Research at Washington University School of Medicine in St. Louis.

What prompts premature births? "It's a mix of physical, environmental, social, and even genetic influences," says Dr. Muglia. His studies show genes may account for black women having triple the rate of premature births of white women. Black women also have four times the risk for having extremely premature babies—infants born at less than 28 weeks gestation.

Suspected factors

Experts suspect the sharp rise in preterm births may be linked to the rise in assisted reproduction. This leads to riskier multiple births and more medically assisted deliveries (such as cesarean sections). The rise in obesity and diabetes may play a role, too. "Diabetes doubles the risk of having a baby prematurely," Dr. Muglia says.

The cause stays a mystery in about half of preterm births. There is no way to predict who will deliver early, although vaginal ultrasounds may help. But certain factors boost the risk for certain women:

• Abnormalities of the uterus, cervix, or placenta

• Being younger than 20 or older than 35

• Previous preterm births (even being born early yourself)

• Poor or no prenatal care

• Poor nutrition (such as being underweight)

• Sexually transmitted diseases

• Vaginal infections

• Smoking or alcohol abuse

• Excess stress

• Domestic violence before or in pregnancy

Many of these factors can—and should—be addressed before conception, Dr. Ashton says. "Early and regular care is key to spotting risks and problems sooner."

Strategies that may help

• Commit to a healthy lifestyle. Avoid smoking and alcohol, control your weight, lower your stress, and add a folic acid supplement. Doctors recommend 400 mcg of folic acid a day. Taking folic acid even a month before you conceive seems to limit preterm births, studies show. Folic acid also prevents certain birth defects. Eat lots of folic-acid rich foods, too, such as oranges, leafy greens, and fortified cereals.

• Treat pre-existing conditions. These include sexually transmitted diseases, vaginal infections, diabetes, high blood pressure, and even gum disease.

• Use the right tactics for multiple pregnancies. The chances of premature birth rise if you carry more than one baby, says Dr. Ashton. Doctors may suggest bed rest.

• Be wary of "scheduling" birth. It's not always easy to pin down due dates, Dr. Muglia says. Opting for a cesarean section delivery that's not medically required or inducing labor when you think the baby is due could lead you to deliver a baby who hasn't reached full gestation.

• Space out pregnancies. Getting pregnant within nine months of giving birth raises preterm risk. Delivering at 18-month to five-year intervals lowers the risk.

• Be alert for signs of early labor. These include contractions 10 minutes apart, vaginal spotting or bleeding, and a low, dull backache. Early labor may be halted with bed rest on your left side, interventions to slow contractions, or hormone injections to extend pregnancy. Talk with your health care provider.