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Prematurity Explained

pregnant belly

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You've probably read about miracle babies who weigh barely a pound at birth and not only survive but thrive. These children are the exception, however. While medical experts have made great strides in care for the smallest babies, very premature newborns are at high risk for breathing problems, mental retardation, cerebral palsy, and vision or hearing loss.

The number of preemie births is rising: Between 1995 and 2005, it grew by 15 percent. Most of these births are between 34 and 36 weeks; this is only four to six weeks early, but these babies, compared with full-term babies, are more likely to develop jaundice or to have difficulty breathing, feeding, or regulating body temperature. They're also more prone to develop learning and behavior problems in childhood, which isn't surprising given the fact that a baby's brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks.

Most premature births result from spontaneous preterm labor -- and about half the time, the doctor can't determine the cause. However, studies suggest that your body's natural response to certain bacterial infections, such as those of the uterus, may play a role. These can lead to inflammation and the release of hormone-like substances that can trigger labor. Unfortunately, women with uterine infections often have no symptoms, making it difficult to diagnose and treat them in time; plus there's not much you can do to prevent them in the first place. But other infections that may contribute, such as urinary tract infections (common symptom: frequent urination accompanied by burning and pain) and STDs (potential symptoms: vaginal discharge and burning during urination), are easily diagnosed. If you think you have one of these, see a doctor immediately.

Many preemie deliveries are done via cesarean -- in fact, most of the growth in the number of single-baby premature births is attributed to c-sections, according to a recent March of Dimes study. This may mean that some early deliveries aren't medically necessary. Before you decide whether to move forward with a c-section, discuss the potential benefits and risks with your doctor.

prenatal checkup

Veer

Even if you do everything right, you may still deliver prematurely. Of course, that's not what you want to hear! But you can reduce your risk by taking good care of yourself before and during pregnancy.

If you're planning a pregnancy, see your doctor for a preconception checkup. She can identify health risks, such as STDs, that may contribute to preterm labor. Also make sure that health conditions, such as high blood pressure and diabetes, are under control. If you've delivered prematurely before, your doctor can inject you during pregnancy with progesterone, a hormone that might reduce your risk of having another early birth.

You should also work toward reaching a healthy weight before becoming pregnant -- overweight or underweight women are more likely to go into early labor. Quit smoking now, and start a regular exercise routine.

When you get pregnant, your prenatal appointments serve as regular checkups -- your doctor can detect and treat any problem, such as a urinary tract infection, that could contribute to preterm labor. Eat a well-balanced diet and gain the recommended weight: 25 to 35 pounds for women who start pregnancy at a normal weight and 15 to 25 pounds for overweight women. Weight gain within this range significantly cuts risk of premature delivery. And be sure to take a prenatal vitamin daily. It contains folic acid, and studies show that taking this B vitamin before and during pregnancy provides many benefits: cutting your risk of premature delivery in half; reducing the risk for certain brain and spinal cord defects; supporting the rapid growth of the placenta and fetus; and aiding in the production of new DNA as cells multiply.

If you experience any signs of preterm labor, call your ob-gyn right away or go to the hospital. To see if you're really in labor, your doctor will do tests, including an internal exam that shows if your cervix has started to dilate. She may also perform a vaginal ultrasound to get a better look at your cervix and a vaginal swab to measure levels of fibronectin, a biological glue that helps attach the fetal sac 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 none is detected, you're unlikely to deliver in the next two weeks. Fortunately, most women with possible signs of preterm labor go on to deliver at term.

If tests show you're in preterm labor, your doctor may treat you with tocolytics, medicines that can postpone delivery. The delay is only a couple of days but gives you time to take a dose of corticosteroids, which speed development of your baby's lungs and reduce the risk of serious newborn complications. These medications are recommended only if you're less than 34 weeks pregnant.

Originally published in the November 2008 issue of American Baby magazine.

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