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Understanding Prematurity

newborn ion incubator

iStockphoto

For a growing number of babies, birthdays come too soon. The rate of premature births in this country has increased 31 percent since 1981, and today about one in eight babies, or half a million each year, are born prematurely -- before 37 weeks of pregnancy.

Babies born too soon are more likely than full-term babies to experience newborn health problems, such as difficulty breathing, as well as lasting disabilities, such as mental retardation, cerebral palsy, or vision or hearing loss. Babies born before 32 weeks face the highest risk of serious complications, but even those born between 34 and 36 weeks (called late preterm births) are more likely than full-term babies to develop jaundice or have difficulty breathing, feeding, or regulating their body temperature.

What can you do to increase the likelihood that your baby gets a full nine months of healthy growth and development? Fortunately, quite a bit.

About 25 percent of premature births result from early induction of labor or cesarean delivery due to pregnancy complications, such as placental problems, or health issues in the mother, such as uncontrollable high blood pressure. In most of these cases, early delivery is the safest route. However, a recent March of Dimes study suggests that increasing rates of induced labor and cesarean deliveries are contributing to the rising number of late preterm births. Clearly, women should aim for continuing a pregnancy to term when this option is safe for both mother and baby.

Most premature births result from spontaneous preterm labor; in nearly 40 percent of these cases, doctors cannot determine the cause. Studies suggest, however, that the body's natural response to certain bacterial infections, such as uterine infections, may play a role. These infections may lead to inflammation and the release of hormone-like substances that may trigger labor. Unfortunately, women with uterine infections often have no symptoms, making it difficult to diagnose and treat them in time. Other infections to watch for include urinary-tract infections and periodontal (gum) disease, though how or why they relate to preterm labor is still not completely understood. Urinary-tract infections are easily diagnosed and treated with early and routine prenatal care, as is gum disease with regular visits to the dentist.

Certain chronic health conditions (such as high blood pressure, diabetes, or blood-clotting disorders), pregnancy complications (such as vaginal bleeding), and lifestyle factors (such as smoking, drinking alcohol, or taking street drugs) can also play a role in preterm births.

Three groups of women are most at risk of developing preterm labor: those who are pregnant with multiples, those who have given birth prematurely in the past, and those who have certain problems with their uterus (such as an abnormally shaped uterus with reduced room for fetal growth) or cervix (such as a weak, sometimes called "incompetent," cervix, which tends to open too early in pregnancy).

Other factors may also increase the risk of preterm labor, though they are less common than those already mentioned. Women who receive late or no prenatal care, who become pregnant with a single fetus from in vitro fertilization, or who wait a short time -- less than nine months -- between pregnancies may also be at increased risk of preterm labor. African-American women and women younger than 17 or older than 35 are also at increased risk, though the reasons why are not well understood.

Even if you do everything right, you may still deliver prematurely. But you can reduce your risk by taking good care of yourself before and during pregnancy. If you're planning to get pregnant, see your ob-gyn for a preconception checkup. She can identify health risks that may contribute to preterm labor and make sure chronic health conditions, such as high blood pressure and diabetes, are under control. You should also try to reach a healthy weight before becoming pregnant, as women who are either overweight or underweight are more likely to experience preterm labor. Quit smoking now to eliminate any risk to your baby.

If you're already pregnant, keep all of your prenatal appointments so your doctor can detect and treat any problems, such as a urinary-tract infection, that could contribute to preterm labor. Eat a well-balanced diet and gain the recommended amount of weight (25 to 35 pounds for women who begin pregnancy at a normal weight and 15 to 25 pounds for women who are overweight). Women who gain the recommended amount of weight are less likely to have a premature baby.

If you're experiencing possible signs of preterm labor, your doctor will probably recommend some tests. She will do an internal exam to see if your cervix has begun to dilate -- a sign that labor may be starting. She may also recommend a vaginal ultrasound to get a better look at your cervix and a vaginal swab to measure levels of fibronectin, which is a biological glue that helps the fetal sac attach to the uterine lining. Fibronectin is normally found in vaginal secretions during the first 22 weeks, and then not until one to three weeks before delivery. If the vaginal swab done between 22 and 34 weeks shows fibronectin, you may be at increased risk of preterm labor.

If your doctor determines that you're in preterm labor, she may suggest treatment with one of several drugs called tocolytics. These drugs can postpone delivery for two to seven days, which may not sound like much, but even a few extra days in the womb can make a lifesaving difference for your baby. Delaying the baby's birth also gives your doctor time to schedule your delivery in a hospital with a neonatal intensive-care unit.

If you're less than 34 weeks pregnant, your doctor may treat you with corticosteroids. These drugs help speed the maturation of your baby's lungs and reduce the risk of serious newborn complications. If you go into labor after 35 weeks, your doctor may not attempt to delay delivery. Babies born after this time generally do well, though they may need some extra care during the newborn period.

It's most likely that you will deliver a healthy baby at full term. But premature birth is a serious and widespread problem in this country, and all pregnant women should learn how to protect their baby. The best way to do this is to be proactive about your health and get help right away if you experience any signs of preterm labor.

Call your doctor or go to the hospital right away if you experience even one of these symptoms:
* Contractions that make your belly tighten up like a fist every 10 minutes or more frequently
* Change in the color of your vaginal discharge or bleeding from your vagina
* The feeling that your baby is pushing down
* Low, dull back pain
* Cramps, with or without diarrhea

Your doctor may tell you to:
* Come to the office or go to the hospital for a checkup
* Rest on your left side for one hour
* Drink two to three glasses of water or juice (not coffee or soda)
If your symptoms get worse or don't go away after one hour, call your doctor again or go to the hospital.

Copyright © 2007. Used with permission from the November 2007 issue of American Baby magazine.

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