Episode Transcript
Dr. Jones: The modern intensive care nursery is a medical miracle. Over the past 30 years, our ability to help very premature babies survive has increased dramatically, but we haven't made any headway in preventing preterm births. Why? And what can we do about it? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.
Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.
Dr. Jones: The U.S. leads the developed world in rates of premature births. In Europe, the rates are about 8% to 10%. In the U.S., 12% to 13% of births are premature. So let's say 1 in 10 of babies are born prematurely. That's a big number.
Premature birth is defined as birth before 37 weeks. Of course, a baby born at 37 weeks minus 1 day is a pretty big baby that does usually quite well. Babies born at 34 to 36 weeks are called late preterm. Although they do pretty well, they can still have some difficulties. There have been big efforts in the U.S. to decrease the rates of late preterm births. The most successful of those efforts are to make sure that the moms and their doctors are careful about electively delivering babies early, meaning, don't deliver them early either by caesarean section or by inducing labor just because it's convenient.
Babies born at 32 to 34 weeks are called moderately preterm. Babies born 28 to 32 weeks are said to have severe prematurity. And babies born before 28 weeks are said to have extreme prematurity. Neonatal nursery costs for a baby born before 28 weeks can be about a quarter of a million dollars compared to less than $1,000 for a baby born at term.
I must say, in my professional life, I've contributed to the rate of preterm births in Utah. As a specialist in infertility who does in-vitro fertilization, I have contributed to the creation of my share of twins and triplets, and a couple sets of quadruplets. Part of the increased rate of prematurity in the U.S. is the way we do in-vitro fertilization. In many countries in Europe, IVF is paid for by national health insurance. But the rules are that only one embryo is transferred in young women who are likely to get pregnant. In the U.S., we have guidelines, but there are no legal rules about how many embryos to be transferred.
We all remember the octo-mom who gave birth to eight babies from IVF. We tried very hard to encourage our couples to transfer only one embryo because of the risk of twins. But many couples really want to become pregnant and they think that twins would be just fine. We do try to educate and convince, but often, couples want two. And with the young couples, putting two embryos back that are good quality puts the risk of twins at about 50%. And about 50% of twins are delivered prematurely. Okay, I got that off my chest and offered full disclosure.
Now, let's think about some other causes of prematurity. The number one risk of prematurity is having had a previous premature birth. Women know that risk before they get pregnant again so we should make sure that the next baby doesn't come too soon. About two to three years from the last pregnancy gives the best chance for the best baby. For women who have had a preterm birth that wasn't because of multiples, we can offer a natural hormone called progesterone during the next pregnancy that can decrease the risk of the next baby being premature.
There are a number of conditions in the mother that can increase the risk of prematurity. Cigarette smoking, excessive use of alcohol and other drugs of abuse, can increase the risk of prematurity. Obesity, social instability and intimate partner violence are also a few conditions that increase the chance of having a premature baby. With this in mind, we should give women all the opportunities to have babies when they have good health habits, a healthy weight and social stability. This means offering counseling and contraception for women whose babies would be healthier if their moms were a little healthier.
There are health conditions that can cause problems with pregnancy and with health, the mom, that can increase the chance that a mom might need to be delivered early. Diabetes and hypertension are two. Women with medical problems can seek pre-conceptual counseling so they can get their illnesses under control and be on medications that don't harm a baby.
There are structural conditions that can lead to premature birth. Structural problems with the uterus, such as uterine fibroids that push on the uterine cavity where the baby grows. Or women who were born with an abnormally shaped uterus. Women who have had operations on their cervix to treat an abnormal pap smear may be at an increased risk for having a preterm birth. Women with cervical or vaginal infections, such as chlamydia or bacterial vaginosis, may be at increased risk for a preterm birth. Many of these conditions can be treated or improved prior to getting pregnant.
Lastly, sometimes we just don't know why babies come early. We do our best as obstetricians to slow preterm labor and to give moms medications that can help their preterm baby's lungs be stronger. If we know that a woman has had a previous preterm birth for no good reason, we can try progesterone. But still, we depend every day on that miracle I call the neonatal intensive care unit to do their magic and grow our little, tiny babies when our moms can't. Thanks for joining us on The Scope.
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