Premature birth, defined as delivering between 20 to 37 weeks of pregnancy, is a significant global health concern that often goes unnoticed. In a normal, healthy pregnancy, a woman may be more concerned about the possibility of miscarriage or her baby being born with a genetic disease than whether she may deliver early. There are many competing factors that women and their physicians often take into account when monitoring a pregnancy and — without risk factors or symptoms — premature birth often does not get the attention it deserves.
The premature birth rate is estimated to affect approximately 1 in 10 babies in the U.S., and this is one of the highest rates in the developed world. Despite staggering statistics and the abundance of ongoing medical research in this area, unknowns still exist about the prevalence of premature birth, including how to identify risk and, most importantly, how to prevent so many babies from being born too soon.
[See: The Fertility Preservation Diet: How to Eat if You Want to Get Pregnant.]
Although the final stages of pregnancy can be uncomfortable for a tired, sore and anxious new mom, the last several weeks in utero are extremely important for a developing baby. Significant developmental progress is being made in a baby’s brain, lungs and liver, and babies are still gaining weight, which helps prepare their bodies for life outside the womb.
Surprisingly, about 50 percent of women who go on to deliver early do not show any symptoms. The best indication that a woman may deliver early is if she’s had a previous premature birth. However, about 40 percent of women who deliver prematurely are first-time moms, making the identification of risk extremely challenging for doctors who are closely monitoring their otherwise healthy patients.
I deliver approximately 30 to 40 babies per month, and, unfortunately, a significant number of these babies can come early. When a baby is born too soon, it is at an increased risk for a variety of serious health concerns. Premature babies are more susceptible to brain bleeds, heart defects and breathing problems. Additionally, a premature baby may suffer from long-term physical disabilities, like cerebral palsy, or behavioral issues such as ADHD or anxiety. Gastrointestinal complications, vision, hearing and dental issues can also occur in a baby who is born prematurely.
As a doctor, I try to do everything I can to help a mother deliver a full-term baby, yet there are still too many babies that need to spend time in the neonatal intensive care unit, or NICU, after birth. And although medical advancements and the integrity of care in the NICU are exceptional in the U.S. and in many other countries, sadly, many babies leave with lifelong complications. Or they do not leave at all.
In addition to the physical risks to the child, premature birth also results in significant economic impacts to the health care system. It is estimated that premature births cost the U.S. health care system approximately $31.5 billion annually (source: 2006 Institute of Medicine published data in 2015 dollars). This enormous sum is a result of labor/delivery and NICU costs, early childhood medical care and/or long-term care associated with more serious conditions. For additional context, a baby delivered at term costs approximately $5,000.00, while a premature baby costs the healthcare system approximately $50,000.00, a ten fold increase.
[See: How to Cope With Gestational Diabetes.]
An increasing number of academic institutions and corporate organizations are researching premature birth to try to unlock the secrets of this medical condition that affects so many. Given my high-risk patient population, I have been particularly interested in this research. Fortunately, I was recently able to try the only commercially available product that identifies an asymptomatic pregnant woman’s individualized risk for having a preterm birth very early into her pregnancy.
One of my patients, Elizabeth, a 30-year-old mother of one, delivered prematurely with her first child. When she was expecting her second, naturally I was on high alert and wanted to closely monitor her progress to ensure this baby did not come too soon. Around the same time she came to the office for her first prenatal visit, I had been introduced to a new biomarker test, called the PreTRM® test, which is a clinically validated blood test administered to a woman in her 19th or 20th week of pregnancy. The PreTRM test is able to identify — very early in a woman’s pregnancy — the specific risk an asymptomatic patient has of delivering early.
Elizabeth was a model patient. She was healthy, proactive about doctor’s appointments and diligent about covering up her skin when she went outside to protect herself from mosquito bites (she lives in Florida where there have been documented cases of the Zika virus). But, because she had delivered prematurely in the past, she was at the top of my mind for the PreTRM test. Not surprisingly, her test results showed she was at an elevated risk for delivering early. Although she was already on prophylactic progesterone (which helps prevent premature contractions/labor), I monitored her cervical length on a weekly basis. When her cervical length began to shorten, which is a risk factor for premature birth, she was able to receive steroids for fetal lung maturity. Steroids have been proven to speed up the maturation of fetal lungs to improve outcomes if delivered prematurely. Elizabeth delivered a healthy baby boy at 38 weeks.
Although I knew Elizabeth may be at risk for premature birth, the PreTRM test helped solidify and guide the interventions I conducted to help prolong her pregnancy. As Elizbath said: “Once I received a high-risk result, it helped me prepare and gave me greater peace of mind that we were taking all of the necessary steps we could to prolong my pregnancy.”
The PreTRM test isn’t for everyone — it’s specifically designed for women who don’t show symptoms and who are only carrying one baby (i.e. not twins or triplets).
If women are already showing symptoms of premature labor, including cramping in the lower abdomen, frequent contractions that exist in 10-minute-or-less intervals, increased pelvic pressure, backache, vaginal bleeding or fluid leakage from the vagina, they should call their doctor immediately.
Similarly, patients who exhibit common risk factors should be closely monitored by their physicians for premature birth symptoms. The most common risk factors include: problems with the uterus, placenta or cervix; those who’ve conceived via in vitro fertilization; those carrying multiples (twins, triplets); women with an infection or another chronic health condition; stress; poor nutrition/diet; physical injury; or someone who is using drugs or alcohol.
[See: The Best and Worst Exercises for Pregnant Women.]
Despite advances in medical research and the development of tests designed to predict risk, there is no”silver bullet” on the market that can actually prevent premature birth. However, being able to predict risk early gives both the patient and doctor helpful information. A patient who is confirmed to be at high risk can prepare for a potential early delivery and plan with family and loved ones accordingly. Similarly, her doctor take appropriate medical interventions to help prolong the pregnancy, including frequent cervical length measurements, infection screening, pelvic rest and/or progesterone therapy. A patient who receives a low-risk result can take comfort in knowing premature birth is likely one less thing to worry about.
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The Overlooked Pregnancy Epidemic: Premature Birth originally appeared on usnews.com
