Babies born too soon is the biggest issue in obstetrics, and the numbers are rising. Prevent that, and you decrease infant deaths and disabilities such as blindness, deafness and lifelong respiratory problems.
In Utah, 11.4 percent of babies are premature. It's the leading cause of newborn death, it's phenomenally expensive and babies that survive may face a lifetime of health issues and disabilities, according to Dr. Sean Esplin, associate professor in the Division of Maternal-Fetal Medicine at the University of Utah School of Medicine. Esplin practices at Intermountain Medical Center and University Hospital.
Maintaining a healthy pregnancy and avoiding premature delivery is the topic of the Deseret News/Intermountain Healthcare Hotline on Saturday. From 10 a.m. to noon, Esplin and registered nurse Katrina Jensen, SelectHealth Healthy Beginnings care manager, will take phoned-in questions. Calls are confidential.
There are two types of premature births, those that occur spontaneously and those that are induced. For baby's sake, birth should never be induced before 39 weeks unless there's a medical issue that must be addressed. Sometimes, says Jensen, baby and mom just shouldn't be together because of a complication like toxemia that makes immediate delivery urgent. Barring that, a full-term birth is important.
Studies show that the average cost of caring for a preterm birth in newborn intensive care was $60,000 a decade ago and has continued to rise, Esplin said. The lifetime cost approaches half a million dollars for a single premature baby. And, in fact, it costs twice as much for the hospitalization of the 3,000 babies born prematurely in the state each year than for all the other babies born during the year combined.
The experts now have new tools to head off early delivery. Maintaining progesterone levels may reduce the risk by as much as 30 percent to 50 percent, so shots are given to women with a history of preterm birth. Any delay in delivery has benefits, particularly buying baby more time to develop, Esplin said. Mortality drops from 30 percent at 24 weeks to 10 percent at 28 weeks.
The biggest risk factor for preterm birth is having a history of preterm birth. Women who spontaneously delivered at least one baby at less than 37 weeks should be evaluated and offered interventions, he said. A previous still birth, lower socioeconomic status, lower maternal education level, unwed mothers, smoking, short time between pregnancies — Jensen said 18 to 24 months is optimal — and not starting prenatal care early on are all risk factors. So are weight extremes — either overweight or underweight, as well as uncontrolled diabetes and high blood pressure.
But more than half of preterm births occur to women who were not considered "at risk," so all pregnant women should know signs of preterm labor, including having six contractions or more an hour, painful or not. Their frequency is a more important indicator than the their strength. An increase or change in discharge, water leaking or breaking, and spotting are indications. "The feeling that something is just not right is truly a sign," Jensen said.
Both Esplin and Jensen are fans of a prenatal visit for women who are thinking about becoming pregnant so that they can deal beforehand with factors that could create problems in a pregnancy.