Preterm births: This county is home to most of California's preemies

The tiny foot of a baby born preterm. Fresno County has the highest rate of preterm births in California, according to the March of Dimes 2017 Premature Birth Report Card.
The tiny foot of a baby born preterm. Fresno County has the highest rate of preterm births in California, according to the March of Dimes 2017 Premature Birth Report Card. THE FRESNO BEE

For the second year in a row, Fresno County has the highest preterm birth rate in California, putting infants who are born too soon at increased risk of death before their first birthday or of a lifetime of disabilities.

And despite a community effort to prevent and reduce prematurity in Fresno County, the rate increased this year, according to the latest March of Dimes Premature Birth Report Card that was released Wednesday.

The county rate increased to 10.1 from 9.5 in the 2016 report card. California’s rate crept up only slightly from 8.5 last year to 8.6.

The March of Dimes, which rates and grades states and counties for preterm births, said rates worsened in 43 states in 2017, plus the District of Columbia and Puerto Rico. And the increases were across all racial and ethnic groups.

The organization gave Fresno and Kern counties a grade of “C” for a rate that was between 9.3 and 10.3. States and counties with a rate equal to or less than 8.1 got an “A.” Orange County (7.6), Ventura (7.7) San Francisco (8.0) and Santa Clara (8.1) got an “A.” No county got a flunking grade.

Fresno County’s poor ranking came as little surprise to people who have been working to reduce the preterm birth rate and infant mortality. Prematurity (birth prior to 37 weeks gestation) is the leading cause of infant death.

But it’s not all medical solutions and practices. It’s also learning how we can value our families and how we can improve access.

Sandra R. Flores, Fresno County Preterm Birth Initiative

“The data reinforces the urgency and need for this focus in our community,” said Sandra R. Flores, program director for the Fresno County Preterm Birth Initiative, which is part of a large, 10-year effort led by the University of California at San Francisco.

The county’s initiative was created in May 2015 with funding from the Lynne and Marc Benioff and Melinda and Bill Gates foundations. The initiative’s priorities are health and education before pregnancy, care and support during pregnancy and coordination of care.

“But it’s not all medical solutions and practices,” Flores said. “It’s also learning how we can value our families and how we can improve access.”

The March of Dimes recognizes there is no single cause or solution to premature birth, said Shantay Davies, maternal and child health director for Fresno and counties from San Joaquin to Kern.

Fresno County’s preterm birth rate could be fueled by several factors, including poverty and health disparities, she said. “One of the things we do know is ZIP code can determine the risk of a mom’s preterm birth just as much as her genetic code.” Help to reduce preterm births are not made available to all women, she said. “Some women are less likely to get the care they need, and that’s particularly true for Hispanic and black women.”

Davies said the March of Dimes has several studies about preterm birth that are relevant to Fresno County, including research on commercial pesticides and the largest genome-wide study that has identified specific genes that correlate to spontaneous preterm births. The March of Dimes also is asking for grant proposals from local entities to implement interventions to reduce preterm birth. Fresno County is listed as a high priority, she said.

Flores said the county’s preterm birth initiative continues to collect information from parents to develop strategies for reducing preterm births. It’s a complex issue, she said. “And it’s going to require some deep thinking and some deep listening to the community.”

He was 11 ¼ inches long – not quite a ruler.

Ashlee Alvarez, Visalia mother of premature infant

Six years ago when Nicole Hutchings gave birth to her son at six weeks early (he weighed 4 pounds, 9 ounces and had to stay in the hospital for 10 days), she had no idea preterm birth was so common in Fresno County. Last year, she joined the county’s preterm birth initiative as a member of its parent advisory committee, community forum and steering committee.

Hutchings, 40, of Fresno, wants to raise awareness about preterm birth and get resources to women both before and after delivery. “I was having to ride the bus after having a cesarean. It was really hard for me. I wanted to give up, but I would see this little baby and I kept going.”

Ashlee Alvarez, 28, of Visalia, is excited that the March of Dimes continues to search for reasons why premature births occur, and why they occur too often in Fresno County.

Alvarez had no warning that she would give birth to her son, Ami, at 25 weeks and three days in January 2015. The delivery was an emergency. “My blood pressure was high and it was causing some abdominal pain and also preventing him from growing and maturing in the womb, and it could have given me seizures.” Ami weighed 1 pound at birth. “He was 11 ¼ inches long – not quite a ruler,” she said.

Ami is doing fine, she said. But his premature birth has made her nervous about having a second child. “I don’t want to go through that again. I already know how fortunate I was to have my son turn out as well as he did.”

Barbara Anderson: 559-441-6310, @beehealthwriter