Just in time for World Prematurity Day, the March of Dimes has released some shocking news: Complications from premature birth are now the leading cause of death in young children worldwide, according to new findings published in The Lancet—and it’s not just an “other countries” problem: Out of 162 high-resource countries, the United States ranks a dismal 141st when it comes to child deaths due to preterm birth.
Of the estimated 6.3 million deaths of children under the age of five in 2013, complications from preterm births accounted for nearly 1.1 million deaths, according to new findings published in The Lancet by a research team coordinated by Robert Black, M.D., of the Johns Hopkins Bloomberg School of Public Health, together with World Health Organization and London School of Hygiene & Tropical Medicine.
And in the U.S., specifically, 28.1 percent of deaths of children under 5 years old—that translates to 8,100—come from direct complications related to preterm birth.
While these stats may sound scary, the news isn’t all bad. ““The success we’ve seen in the ongoing fight against infectious diseases demonstrates that we can also be successful if we invest in prevention and care for preterm birth,” said the London School of Hygiene & Tropical Medicine’s Joy Lawn, M.D., Ph.D., a member of the research team and a long-term advisor to Save the Children.
Many of the causes for preterm birth are still a mystery to doctors, but to combat this the March of Dimes has invested $75 million as part of its Campaign to End Premature Birth. This money has gone toward creating three new collaborative research centers across the country devoted exclusively to understanding premature birth. Just today, March of Dimes announced plans to open a fourth, at the University of Pennsylvania.
“These centers are really providing a novel, trans-disciplinary approach to preterm birth because it’s such a complex issue,” Diane Ashton, M.D., deputy medical director of the March of Dimes and an ob-gyn in New York City, told Parents.com.
Environmental exposure, access to medical care, and genetic predilection all play some role in preterm birth, Dr. Asthon said, and researchers at these centers will focus in on these areas.
Education is key, as well. “Prematurity is such an important contributor to infant death, not only in the U.S., but globally,” Dr. Ashton said. “By raising awareness it allows us to pull together resources that are necessary.”
If you’ve had a preemie, this news is especially troubling, we know. But new research shows that most preemies can catch up to their full term peers in cognitive testing by the time they are teenagers. A study published in The Journal of Pediatrics in July found that the family and social environment that a child is raised in plays a much bigger role in cognitive development than gestational age.
A set of birth defects of the brain and spine, called neural tube defects, have been found by a new study to be more common among babies with Hispanic mothers. The March of Dimes report also found that Hispanic mothers are more likely to give birth prematurely–both findings are possibly linked to nutritional deficiencies more common to that community.
This report, updating a similar 2008 paper by the nonprofit foundation, also highlights the fact that a greater proportion of Hispanic women have babies each year than any other population in the United States, making it the fastest-growing ethnic group in the country.
“One of the things that caught our eye was, while Hispanics represent 17 percent of the population, 24 percent of premature babies are Hispanic,” said Dr. Edward McCabe, senior vice president and chief medical officer of the March of Dimes, an organization aimed at improving the health of mothers and babies.
Hispanic women may be more prone to giving birth prematurely — defined as before the 37th week of pregnancy — because of risk factors such as being three times as likely as white mothers to be younger than 17 years old. They are also less likely to have graduated from high school and more likely to lack health insurance. The rate of preterm births among Hispanics was about 12 percent higher than that of white mothers in 2012, the report said.
Neural tube defects, which include conditions such as spina bifida and anencephaly, are malformations of the brain and spinal cord that can cause death or disability.
Experts suggested that Hispanic mothers are significantly more likely to give birth to babies with these birth defects than white or black women because corn masa flour is a staple of the diet of a majority of Hispanics. Corn masa flour, used to make tortillas and other foods, is not fortified with folic acid, a B vitamin that can help prevent neural tube defects. Wheat flour manufacturers are required by the U.S. Food and Drug Administration to fortify that type of flour with folic acid, also called folate.
Also, Hispanic women are less likely to report taking a multivitamin containing folic acid prior to becoming pregnant, according to the report.
“This is why the March of Dimes is striving to have masa cornmeal fortified with folate,” said Dr. Diana Ramos, an associate clinical professor of obstetrics and gynecology at the University of Southern California Keck School of Medicine in Los Angeles.
“Corn masa flour is not part of the standard American diet, so, since 2012, we’ve been working on this, making progress slowly,” added Ramos, co-chair of the newly established March of Dimes Hispanic Advisory Council.
McCabe said the March of Dimes has launched a Spanish-language site, Nacersano.org, that offers information about the specific health needs of Hispanics. He said a variety of outreach efforts, including the website and new advisory council, are needed to help raise awareness in the Hispanic community about the need for folic acid consumption and prenatal health.
The Food and Drug Administration has approved the return of a drug that was widely used to treat morning sickness until it came off the market 30 years ago. Bendectin, now called Diclegis, will return to the market in early July after extensive study has shown it is safe and effective. Time.com has more:
Monday’s FDA decision means a new version of the pill once called Bendectin is set to return to U.S. pharmacies under a different name — Diclegis — as a safe and effective treatment for this pregnancy rite of passage.
In the intervening decades, the treatment is widely believed to have undergone more scrutiny for safety than any other drug used during pregnancy.
“There’s been a lot of buzz about this. Nothing better has come along” to treat morning sickness in those 30 years, said Dr. Edward McCabe, medical director for the March of Dimes, who welcomed the step.
“We know safety-wise, there’s zero question,” said Dr. Gary Hankins of the University of Texas Medical Branch in Galveston, who headed one of the company-financed studies of Diclegis that led to its approval.
U.S. sales of Diclegis are expected to begin in early June, according to Canada-based manufacturer Duchesnay Inc. The company has long sold a generic version of the pill in Canada under yet another name, Diclectin.
For all the names, the main ingredients are the same: Vitamin B6 plus the over-the-counter antihistamine doxylamine, found in the sleep aid Unisom. U.S. obstetricians have long told nauseated pregnant women how to mix up the right dose themselves.
In fact, in 2004 the American College of Obstetricians and Gynecologists issued guidelines calling the combination a first-line therapy.
The difference that prescription-only Diclegis would offer: Combining both ingredients with a delayed-release coating designed to help women take a daily dose before their nausea sets in.
The number of premature births in the United States has dropped to 11.7 percent of all births, the lowest number in a decade, and the 5th consecutive year the number has fallen. This news from the March of Dimes in its annual Premature Birth Rate Report Card. Though the U.S. as a whole earned a “C” grade from the report card, four states–Vermont, Oregon, New Hampshire, and Maine–earned “A” grades for their excellent prenatal health education programs and other measures, including smoking cessation programs, that help reduce preterm birth rates.
The March of Dimes has set a goal of reducing the total number of premature births to 9.6 by the year 2020, as the organization’s president, Dr. Jennifer L. Howse, discusses in this video about the report card:
A new report from the March of Dimes has upgraded the United States to a “C” grade for premature births, an improvement from its previous rating of “D.” The announcement was made to coincide with November as Prematurity Awareness Month.
Each year, the March of Dimes compares each state’s pre-term birth rate with the goal birth rate. The report says 40,000 fewer babies were born prematurely in the U.S. between 2006 and 2009.
“We set a goal of 9.6 % by 2020, and it’s a realistic goal we can get to and it would be a tremendous accomplishment,” says Douglas A. Staples, senior vice president of strategic marketing and communications for the March of Dimes. This year the state of Vermont was the only state to achieve that goal. The current nationwide rate is 12.2 percent.
A baby born before 37 weeks is considered premature and at serious health risk. Being born earlier than 37 weeks is the leading cause of newborn death in the United States, costing more than $26 billion each year, according to the report. While the U.S. ranks first in health care spending, it is 39th in infant mortality, according to a 2006 report.