Today has been designated National Prematurity Awareness Day. I know I have devoted several posts to preterm birth (PTB), and actually have several more that will eventually be committed to this blog, but in recognizing today’s significance, it is worth summarizing some of the facts related to PTB.
• Premature births (less than 37 0/7 weeks’ gestation) now account for 1 out of every 8 deliveries in the United States and have now surpassed fetal abnormalities as the leading cause of neonatal mortality, accounting for 25% newborn deaths in the first month of life
• Rates have increased more than 30% since 1981, from 9.4% then to 12.8% now
• More than 500,000 babies are born prematurely in this country each year
• Estimates of the cost of prematurity exceeded $26.5 billion in 2005, or about $51,600 per baby (15 times the cost of a baby born at term)
• Premature babies are at greater risk for long-term complications that may continue to compromise them and put a burden on the health care system throughout their lives
• Despite a March of Dimes campaign starting in 2003 to increase the awareness of PTB and decrease rates to 7.6% by 2010, rates have continued to increase annually
• The very preterm birth rate (less than 32 weeks’) has remained relatively constant at 1.8% to 2.0% for the past 20 years
• The increase in PTB can be almost entirely accounted for by an increase in deliveries between 34 and 37 weeks’ (late preterm births) which now constitute more than three-fourths of all singleton preterm births
• A significant percentage of late preterm births are by cesarean delivery (more cost; greater maternal risks)
• There is a growing awareness that late preterm birth can be associated with higher morbidity (respiratory distress syndrome, hypoglycemia, hyperbilirubinemia, hypothermia - poor temperature control) that increase initial cost of care, increase risk of rehospitalization during the first month of life, put the baby at risk for long-term complications, and increase cost related to sequelae of prematurity
• A significant portion of late preterm births are iatrogenic (elective cesarean; induction of labor) and might be avoided by careful attention to confirmation of gestational age, to more stringent scrutiny of indications for early delivery, and to predelivery assessment of fetal lung maturity in situations when dates or indications are not clear
• Patients and providers need to be educated in this area and widespread efforts must be made to reduce the incidence of late preterm birth
Short of large, comprehensive, expensive (but a good return on investment for those willing to listen) programs for preterm birth prevention, which seem to get more lip service than support, there clearly are interventions that could reduce not only late preterm birth, but also a significant number of babies destined for very preterm birth, or at least lengthen the gestational age at delivery of the latter. Early confirmation of gestational age, identification of risk factors, and focused interventions (progesterone therapy; cervical cerclage; smoking cessation programs; emotional support) based on early and ongoing risk assessment can be done now. The only question at this point is what will patients, providers, and society be willing to do to make it happen….?