Preterm birth for the first time exceeded all other causes as the No. 1 cause of death for children under the age of 5 years worldwide. Preterm birth is delivery of an infant prior to 37 weeks of pregnancy.
Three of the four cities with the highest rates of preterm delivery in California are found in the Valley. Fresno and Stockton are worst hit with rates at 10.2 percent of births in the 2015 March of Dimes Preterm Birth Report Card.
Babies who survive an early birth run the risk of lifelong health problems including learning disabilities, hearing loss, blindness, cerebral palsy, bowel and digestive problems, asthma and chronic lung disease. What is even more alarming in terms of the societal costs and long-term implications for the health of Americans is that being born early and of low birth weight increase the risk for heart disease, hypertension, heart attacks, obesity and diabetes.
Here are 10 things we can to lower the risk.
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▪ Take folic acid supplements prior to pregnancy.
▪ If a woman has a history of a prior preterm pregnancy, progesterone injections can be given during future pregnancies. This cuts the rate of preterm births in half.
▪ If possible, pregnancy should be planned. Women at risk of getting pregnant should avoid smoking, excessive use of alcohol and exposure to social drugs.
▪ Space pregnancies a minimum of 18 months apart.
▪ Whenever possible, women should see a doctor for a preconception checkup before getting pregnant. At that visit, they should expect testing for urinary- and genital-tract infections. If there is an infection, treatment can be initiated prior to or early in pregnancy.
▪ In many women, the cervix usually starts to shorten several days to weeks before the actual painful contractions or premature rupture of membranes. Women should attend prenatal care appointments even when they are feeling well.
▪ At the Maternal Fetal Center at Valley Children’s Hospital, we evaluate the cervixes of all women during ultrasound examinations in mid-pregnancy (16-26 weeks). If the cervix is noted to be shortened, women can take vaginal progesterone supplements to delay preterm birth and to prepare the newborn with steroids to mature the fetal lungs.
▪ Some women have a predisposition to delivering their babies prematurely. Physicians face the frustration of not seeing patients early enough to initiate treatment. Access to care remains a major deterrent for many patients in our community.
Women with uterine abnormalities, large uterine fibroids that protrude into the cavity of the womb, or women who make antibodies in their blood against the placenta are at risk for recurrent preterm delivery. Women with medical conditions such as lupus, hypertension, diabetes mellitus and kidney diseases can also be managed.
▪ A lot has been said about “healthy eating and lifestyle.” This is easier said than achieved. With some of the highest teen pregnancy rates in the United States being in the Valley, this contributes in no small measure to our high preterm delivery rates. However, the young mothers are also most vulnerable to exposure to cigarettes, social drugs, alcohol, and dietary indiscretion with foods high in saturated fats and simple sugars. I simply ask young women to “skip soda, pass on cigarettes and drink low-fat milk.”
▪ For information, go to www.marchofdimes.org.
The annual cost associated with preterm births in the United States is estimated at about $26 billion. The cost in human suffering, family disruption, individual cost and the implications for future health highlighted by the prenatal origins of adult disease (hypertension, diabetes, heart attacks and death from cardiac causes by age 50 years) make our investment in time and effort today a societal imperative.
We must come together to reverse the impact of this public health scourge in the Valley.
Beni Adeniji, M.D., practices at Valley Children’s Hospital.