WHITE PLAINS, N.Y., Jan. 30 (UPI) -- Premature birth, which can lead to lifelong health complications, is a growing public health problem in the United States that remains a grossly misunderstood and understudied issue, a survey by the March of Dimes released Thursday has found.
The survey, to be published in the February issue of American Journal of Preventive Medicine, found nearly one in eight U.S. babies is born too soon -- meaning before 40 weeks gestation. One quarter premature births will endure slow mental development and physical disabilities including cerebral palsy. The biggest concern, the survey authors suggest, is the public continues to perceive premature birth as the mother's personal problem and not a public health issue.
"The survey confirmed our hypothesis, if you will, that people were generally not aware of how serious the problem was of premature birth," said lead survey author Dr. Nancy Green, medical director of the March of Dimes, told United Press International.
A total of 1,967 men and women were questioned by the March of Dimes about what they knew of preterm delivery. Of the respondents, 65 percent of the women and 59 percent of the men said children were born prematurely because their mothers failed to take care of themselves during pregnancy.
"If you blame the mother, it allows you to not accept responsibility for the problem both on an individual level and on a social level," Green said.
Another problem, she added, is people think "the marvels of neonatal care" delete any worries about delivering a baby preterm. "There's still a problem and not every premature baby walks away unscathed."
March of Dimes data indicate preterm birth increased 27 percent from 1981 to 2000. In 2001, more than 476,000 U.S. babies -- or nearly 12 percent of live births for that year -- were born before 37 weeks gestation. One contributing factor is mothers postponing childbirth until later in their 30s and even in their 40s, Green said, adding many of these women resort to fertility therapies, which can result in multiple births, a key risk factor for premature delivery.
In the wake of increasing preterm births, the March of Dimes is launching a $75-million, five-year national awareness campaign to get premature birth on the public radar and reduce the number of preterm deliveries by 15 percent. The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Association of Women's Health, Obstetric and Neonatal Nurses will be partnering with the March of Dimes in this campaign.
Premature birth also is extremely costly. In 2000, hospital bills for 23,000 preterm-related infant stays topped $1.2 billion, with an average cost of $58,000 per baby. The typical newborn infant stay costs around $4,300, the March of Dimes reports.
African-American and Hispanic women have higher rates for preterm deliveries compared with whites, but those causes are not fully understood. However, whites have a very high percentage as well, with many white women postponing motherhood and resorting to fertility treatments, explained Dr. Charles Lockhood, chair of obstetrics and gynecology at Yale School of Medicine in New Haven, Conn.
"The vast majority of people who deliver babies prematurely are largely white, middle-class," Lockwood, a member and spokesman for the American College of Obstetricians and Gynecologists, told UPI. "It can happen to anybody from (former) President Kennedy's wife, Jacqueline Kennedy, to the poor rural person who doesn't receive any (prenatal) care. Everybody's at risk."
The closer a baby is born to 40 weeks, the better chance of a healthy life. Babies born at 37 weeks can experience complications at birth, such as difficulty breathing or low birth weight, but they have strong odds of leaving the hospital and living a healthy life, Lockwood said. Babies born between 27 weeks and 34 weeks have a greater risk of neurological and developmental disorders, such as mental retardation, and babies born at 24 weeks face only a 50 percent chance of survival.
Dr. Jay Iams, a professor of maternal-fetal medicine at Ohio State University in Columbus, said the risk factors for preterm birth are poorly understood. Clearly the mother's health and her age are factors, he said, as are smoking, hypertension, diabetes, and other underlying chronic conditions. But the bottom line is every pregnant woman is at risk for premature delivery.
"The majority, more than half of the women who experience preterm birth do not have any of those risk factors," Iams told UPI.
Not fully understanding the risk factors can make it difficult to prevent preterm birth, Iams explained. However, there are signs to look for, such as spotting, cramping or premenstrual feelings and back pain. Although these symptoms are common in pregnancy, if they persist for several hours, they could indicate premature birth.
Iams, who was the co-author of a National of Institutes of Health study on the subject, said preliminary findings will be presented at a maternal-fetal medicine meeting next week in San Francisco.
Among those findings is a study that found progesterone shots can thwart preterm delivery among women who had delivered previous infants too early. The progesterone was injected into mothers about halfway through the pregnancy at 16-20 weeks.
Iams said it is unclear whether women who deliver prematurely suffer from progesterone deficiency.
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(Reported by Katrina Woznicki, UPI Science News, in Washington)
