Preterm Birth: Analyzing The Risk

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There has been a rise in preterm birth over the past two decades with number of women opting for induction. Latest research  show that birth even one or two weeks early can increase the risk of complications and developmental delays. Preterm babies’ organs are not fully developed, so respiratory and digestive tract complications can arise early in life.

Preterm Birth

Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:

  • extremely preterm (<28 weeks)
  • very preterm (28 to <32 weeks)
  • moderate to late preterm (32 to <37 weeks).

Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated.

Preterm birth rates in the United States have risen by 30 percent between 1992 and 2006. Much of that increase  in preterm births has occurred between 34 weeks and 36 weeks. Meanwhile, the rate of medically induced labors has nearly doubled during this period.

The American College of Obstetricians and Gynecologists has identified specific conditions in which labor should be induced before 39 weeks, including preeclampsia, eclampsia and premature rupture of membranes.

Risks of Preterm Birth

The earlier a baby is born, the more severe his or her health problems are likely to be. Although babies born very preterm are a small percentage of all births, these very preterm infants account for a large proportion of infant deaths.

Preterm births between 34 weeks and 36 weeks raise the risk of,

  • Jaundice: Jaundice is the yellowing of skin and eyes that happens when red blood cells break down and bilirubin, a byproduct of red blood cell breakdown, floods the body. Most babies are able to metabolize bilirubin easily, and pass it in their stools before too much builds up in the blood. In some babies, though, red blood cells break down faster than normal or the body can’t metabolize bilirubin well. In those babies, bilirubin builds up to dangerous levels in the blood. When there is too much bilirubin in the blood, it can cause a type of serious brain damage called kernicterus. Historically, kernicterus has been seen primarily in premature or sick newborns or those with serious blood type incompatibility. It’s extremely rare in full term healthy infants, but when kernicterus does occur, it can lead to long term health problems.
  • Hypoglycemia:  Premature babies, especially those with low birth weight, who often have limited glycogen stores (sugar stored in the liver) or an immature liver function tend to suffer from hypoglycemia. The brain depends on blood glucose as its main source of fuel. Too little glucose can impair the brain’s ability to function. Severe or prolonged hypoglycemia may result in seizures and serious brain injury.
  • Respiratory distress: The earlier a baby is born, the less developed the lungs are and the higher the chance of neonatal Respiratory Distress Syndrome (RDS). Most cases are seen in babies born before 28 weeks. It is very uncommon in infants born full-term (at 40 weeks).
  • Death among newborns:  An estimated 1 million babies die annually from preterm birth complications. Preterm birth is the leading cause of newborn deaths (babies in the first four weeks of life) and the second leading cause of death after pneumonia in children under five years.
  • Increased risk of intravenous feeding:  Premature babies have immature digestive systems and are unable to suck, swallow and breathe normally. Intravenous feeding is sometimes used when treatment for other health complications is being implemented. This approach utilizes an IV that may be placed in the scalp, arm or leg.

Preterm Birth

  • A longer hospital stay than normal.
  • According to numerous studies, these babies have been shown to have lower academic test scores later in life
  • More behavioral problems compared with children born at full term.
  • Higher risk of  heart disease later in life: Babies who are born prematurely experience differences in how their heart forms and works as an adult, compared with babies who are born at full-term. According to a study published in the journal Circulation, this leads to a higher risk of cardiovascular disease later in life.

How to Avoid the Risk

There are certain things that women can do to lower the risk of having a premature baby, and help their baby be healthy. These include—

  • Quit smoking and avoid alcohol or drugs.
  • See your health care provider for a medical checkup before pregnancy. Get prenatal care as soon as you think you may be pregnant, and throughout your pregnancy.
  • Talk to your health care provider about—
    • How to best control diseases such as high blood pressure or diabetes.
    • A healthy diet and prenatal vitamins. It is important to take 400 micrograms of folic acid daily before and during early pregnancy.
    • Concerns about pregnancy and any warning signs or symptoms of preterm labor that will need medical attention.
    • The use of 17 alpha hydroxyprogesterone caproate (17P) if you had a previous preterm birth.
    • Breastfeeding. Breast milk is the best food for babies, whether they are born early or at term.

If a pregnant woman is healthy and the pregnancy is progressing well, it is best to let the baby come naturally, in its own time. That is, by the end of 39 or 42 weeks of pregnancy.   An early delivery should only be considered when there is a medical reason to do so.

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