Premature birth is the number one obstetric problem in the nation. In Iowa, the number of preterm deliveries increased 22 percent from 1994 to 2004. Jonathan Klein, MD, director of the state’s most advanced Neonatal Intensive Care Unit, located at University of Iowa Children’s Hospital within University of Iowa Hospitals and Clinics talks about preterm delivery and prematurity risks:
What technically describes a preterm delivery?
A normal delivery needs to last 40 weeks from the time of the woman’s last menstrual period. A premature delivery is any baby that’s delivered before 37 weeks post-menstrual age. Even higher risk prematurity is when babies are delivered before 34 weeks, before 32, before 28, and the highest risk, obviously, would be delivering around 24 weeks of gestation, which is only six months inside the mother.
Why do some women deliver early?
There are numerous factors that lead to preterm labor or early delivery. Some of the more common ones are:
- Multiple gestations—twins, triplets or higher multiple orders
- Poor prenatal care
- Pregnancy-induced hypertension—being pregnant causes high blood pressure within the mom, putting the mother’s life at risk and those babies need to be delivered early
- When the membranes surrounding the babies rupture and the fluid start leaking early which can lead to infection in the mother or the baby and leads to early delivery
- Cigarette smoking
- Teenage pregnancies
- Moms over the age of 40
Who is most likely to deliver their baby early?
The major factor right now tends to be related to socioeconomic status where there’s poor prenatal care. And so it’s important to try to get good health care for women that are thinking about becoming pregnant and during their pregnancy. Excellent prenatal care is one of the most cost-effective things that we can do.
Are some women at increased risks to deliver early?
Certainly teenage pregnancies and older women, and, like we said before, having multiple pregnancies (not multiple pregnancies, but having multiples where you’re pregnant with twins or triplets). There’s also a slight increased risk of early delivery with in vitro fertilization, but that’s relatively minor.
Can treatment prevent or delay preterm delivery?
One of the things obstetricians have been working very hard on is how to delay preterm delivery. Unfortunately, most of the well-studied medications used don’t seem to delay the pregnancy more than 48 to 72 hours. This is valuable because it allows us to give these mothers what is called antenatal steroids, which helps to rapidly mature the babies. But there’s not really a good way that’s been well demonstrated to prevent a birth when the mom has entered preterm labor at 24 weeks and get her all the way to 37 weeks. No one has found a good way to stop that preterm delivery.
Typically, what medical complications do preterm babies have?
There are numerous complications related to prematurity. Obviously the major one we’re concerned about is infant survival and the greatest effect on survival is lung disease that these babies have.
When they’re born prematurely, their lungs are very immature—they don’t function well—and the babies need to be on a respirator for additional oxygen, which puts them at risk of having permanent damage to their lungs or just not surviving.
Other things that premature babies are at risk for include:
- Bleeding within their brain. This is neurologically the most serious consequence. If they have a large bleed within their brain, they can have very serious neurological problems long-term and be at high risk of cerebral palsy. They’re at risk of blindness from being exposed to oxygen.
- Intestines that are very immature. Because they can’t feed themselves, they have to be tube-fed and can get infections with the intestines that can be life-threatening.
- Risk of infections. Many of the antibodies that protect us from infections come over during the third trimester. These babies have missed one-third of their pregnancy, so that they’re very immune compromised and missing good protection against infection. So that’s a very high risk.
- Brain development. The brain prefers to develop when it’s inside the mother rather than outside the mother, so the risk of learning disabilities increases.
What is the cost of taking care of a preterm baby in an intensive care unit?
In the short-term, it is very expensive. We’re talking many thousands of dollars per day. So for an individual baby who is born very premature, we could talk about hundreds and hundreds of thousands of dollars. But if we look at the number of quality-adjusted life years that is gained from this expense up front, these babies in the long-term (if you save a baby’s life and they go on to live a normal 75-80 year life) the amount of money per year is actually very little. It’s actually more cost effective to do neonatal intensive care than it is just to treat hypertension in an adult, for example. And in reality, the only thing that’s more cost-effective in the long-term than the neonatal intensive care, would be good prenatal care.
When is a preterm baby most likely to go home with their parents?
The usual thing we tell parents is to look at the original due date as the goal. We know when the baby is due. If the baby is born four months early, we might say the baby hopefully will go home in 120 days or four months later. We use the due date as a marker because we know that the baby’s lungs and brain and heart and kidneys and intestines should have matured by then. Some babies can mature even faster and sometimes they will go home within two to three weeks before their due date. But the due date is the common number that we look at.
Do babies born prematurely have a higher risk of other illnesses in their lifetime?
There is a slight increased risk of sometimes pulmonary problems such as asthma. The more serious problem is that we know pre-term infants at baseline are at risk of some learning disabilities. Unfortunately, premature infants have an increase risk of learning disabilities and attention deficit disorder. These are things that we look for most closely in follow-up.
Is the UI Children’s Hospital involved in any premature studies or research?
There’s a large set of genetic studies led by Jeff Murray, MD, in which they’re looking at genetic causes for preterm delivery, as well as genetic causes for variations leading to diseases within the premature baby itself. We hope that if we can find genes or a combination of genes that leads to preterm labor, then it might be possible to design therapies more effectively for these women or for the babies who have complications of prematurity. If we find genes that are related to these complications, we could detect problems sooner and treat them more efficiently. |
