Premature Birth Rate Increasing
Born Too Soon
CHRISTINE GORMAN / Time 11oct04
What can doctors and parents do about the alarming rise in the number
of premature births?
The birth of a newborn is usually a joyful event in the life of a family. The
memory of nine often uncomfortable months not to mention the intense effort
of labor and delivery begins to fade and the focus shifts to a wrinkled
little miracle with 10 impossibly cute fingers and toes. Everyone is trying to
decide whether the baby looks more like Mom or Dad. There are smiles all around,
and in a day or two the happy family will leave the hospital to begin a grand
new adventure at home.
Mindfully.org
note: While we are pleased that Time is bringing attention
to a rather sensitive problem, we hope that it adds more depth in the
reporting of causes in future articles.
Time has taken the safe route in reporting that smoking can cause
many problems with pregnancy, birth, and future development of the
newborn. Uterine infection and high blood pressure are also easy targets.
Stress, diet and inflammation can also be causes. There is probably not
much disagreement with any of these being selected as possible causes.
However, many other areas sorely need coverage nuclear power,
radioactive weapons used in Iraq, pesticides, plastics, genetically
engineered foods, microwaves for food as well as cell phones, cordless
phones, X-rays, thinning ozone, and the ever increasing pace of our lives,
with women working fulltime jobs well into the late stages of
pregnancy, and some working right up until labor.
While this next statement might not be popular, the truth of the matter is
that unless humans stop polluting the earth, we will not be able to
reproduce at all in very short time. No matter how much intervention is
done by the health care system, at that point it will be ineffective.
Lastly, another part of this subject that has not even been mentioned is
that the ever-increasing rates of morbidity in terms of miscarriages and
stillborn births. If Time includes all of these things in a future
article, it will indeed be printing a meaningful article.
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Thankfully, this enchanting scenario remains the case most of the time. But
the odds of a healthy start in life quickly begin to fall whenever a baby is
born more than a few weeks shy of the typical 40-week-long pregnancy. Premature
birth by which doctors mean at least three weeks early is the leading
cause of developmental disability in children, including cerebral palsy and
mental retardation, according to Dr. Eve Lackritz of the National Center for
Chronic Disease Prevention and Health Promotion. It is also a significant cause
of blindness, chronic lung problems and birth defects.
Yet, for a combination of reasons not all of them clear1 out of 8
babies in the U.S. is born at least three weeks before it is due. Even more
alarming, that ratio represents a 27% increase since 1980. Advances in neonatal
care have saved many children who might otherwise have died. And lots of babies
who leave the intensive-care unit grow up to be healthy, vibrant adults. But no
incubator no matter how high tech will ever replace the womb. The goal,
as doctors and nurses who treat ultrafragile preemies will tell you, should be
to keep infants from ever needing extraordinary measures in the first place.
Much of the jump in premature births in the U.S. can be tied to the growing
number of multiple births twins, triplets or more that result from
infertility treatments. If you have one baby, your chance of delivering
prematurely is just over 10%, according to Dr. Charles Lockwood at Yale
University, and your chance of delivering what is called a very preterm baby
(one born before 32 weeks) is less than 2%. But if you have twins, the most
recent federal data show, your chance of preterm delivery jumps to 58%, with a
12% chance of very early delivery. With triplets, you have almost no chance of
reaching full term and a 60% chance of delivering before 32 weeks.
Specialists in the U.S. often transfer several embryos into the womb during
in vitro fertilization (IVF) in hopes of boosting the chance that one of them
will "take" and therefore boost their clinic's success rate. Studies
suggest, however, that the odds of a successful pregnancy may be the same
whether you implant one, two or three embryos. Many European countries have
decided to restrict their IVF clinics to one or two embryos per pregnancy. Dr.
Lockwood and other physicians think such a limit might make sense in the U.S. as
well.
Assisted reproduction isn't the only problem. Doctors have long known that
smoking, uterine infection, high blood pressure and a prior history of preterm
delivery also place an expectant mother at greater risk of delivering early.
They're looking into the possibility that other factors, such as stress, diet
(both before and after conception) and inflammation may also play a role. But
they have something of a medical mystery on their hands. "Nearly half of
preterm births are from unclear causes," says Dr. Nancy Green, medical
director of the March of Dimes, which is in the early stages of a five-year, $75
million campaign to address the issue. You can do everything right and still
give birth to a premature baby.
Doctors admit that some of their best ideas for preventing early delivery
haven't worked very well. A drug called Ritodrine, which was approved by the
Food and Drug Administration in 1980, successfully stops preterm labor in many
women, but subsequent studies have shown that it has no overall effect on a
baby's health or survival. Treating all uterine infections, no matter how mild,
also appears to make no difference on the timing of delivery suggesting that
infection is only one stage in a larger, much more complex process. "We've
been taking the one-cause-at-a-time approach for 20 years," says Dr. Jay
Iams at Ohio State University in Columbus. "But it doesn't work that
way." Indeed, many researchers believe they won't really have a good grasp
of how to prevent prematurity until they answer an even more fundamental
question: How does a woman's body decide it's time to give birth in the first
place?
One intervention has shown some promise in early trials of women with a
history of premature delivery and no other known risk factors. Injecting these
women once a week with the hormone progesterone reduces their chance of
delivering early by a third. Researchers still don't quite understand why it
works. The placenta produces a lot of the hormone, so it wouldn't seem that
adding a little more would make a big difference. The treatment has not been
studied in women who are carrying more than one child.
Caution may be in order. No one wants a repeat of the problems that happened
with diethylstilbestrol (DES), a synthetic estrogen-like drug that was used in
the 1950s and '60s to prevent premature delivery and turned out to cause, among
other things, reproductive-tract abnormalities and a rare cancer. Unlike DES,
however, progesterone has a long safety record. And it is not being used in the
earliest days of pregnancy, when birth defects are more likely to occur. What
progesterone doesn't have is a major manufacturer, because the drug is not
protected by a patent. Instead it is usually produced in small batches at
compounding pharmacies.
Anyone who has ever cared for an extremely premature infant knows the stakes
are high. Doctors can sustain a tiny baby with severe bleeding in the brain,
with lungs so fragile that even the gentlest respirator can permanently damage
them. But should they? "That's when neonatology becomes a difficult and
ethically fraught field," says Dr. Myra Wyckoff of the University of Texas
Southwestern Health Science Center in Dallas. No matter how you answer the
question, surely the best solution is to find a way to reduce the number of
extremely premature births from happening in the first place.
Reported by Anna Macias Aguayo/Dallas; David Bjerklie/New York; Paul
Cuadros/Chapel Hill N.C.; Leslie Whitaker/Chicago
source:
http://www.time.com/time/magazine/printout/0,8816,1101041018-713195,00.html
16oct04