Prevention of Preterm Birth Starts with a Healthy Mom

November 17 is World Prematurity Day. It gives us, as health professionals, an opportunity to direct our attention to a devastating health issue that impacts 15 million babies each year and rededicate ourselves to reducing that number. Several organizations, including ACOG, are supporting the cause through education, awareness, and advocacy events. However, there’s one event in particular that, coincidentally, started this week and stands to make the most significant impact in terms of lowering the preterm birth rate in this country and that’s open enrollment through the Health Insurance Marketplace.

Prevention of preterm birth starts with a healthy mom and that means access to prenatal care and preventive services. There are several risk factors for preterm birth, some of which include high blood pressure, low pre-pregnancy weight, alcohol and drug abuse, smoking, a prior preterm birth and a birth less than 12 months ago. Adequate health insurance coverage can make the difference between a pregnant woman carrying to term or delivering too early and the Affordable Care Act has helped make that coverage accessible to millions of women.

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Support Preeclampsia Awareness Month Today

In an effort to increase public awareness and research funding, ACOG is pleased to support the Preeclampsia Foundation’s petition to Congress to have the month of May officially designated as national “Preeclampsia Awareness Month.” Please take a moment to show your support by signing the petition today—the deadline is December 31, 2011.

The main focus of my ACOG presidential initiative is something that has consumed my professional career for more than 30 years: preeclampsia and hypertensive disorders during pregnancy. Over the past two decades, preeclampsia in particular has been a growing problem in the US, and it is a leading cause of maternal and infant death and illness. Yet despite decades of research, we still don’t know what causes it or how to prevent it. 

What we do know is that certain women are at increased risk of developing preeclampsia, including women who are obese, carrying two or more babies, pregnant for the first time, older than 35 years, African American, or who have diabetes, lupus, or kidney disease, among a few factors.

Preeclampsia is high blood pressure that occurs only during pregnancy and usually starts sometime after the 20th week of gestation. Some of the warning signs include headaches, vision problems, rapid weight gain, and upper abdominal pain. Hypertensive disorders during pregnancy, including preeclampsia, often require very preterm delivery to protect the health of both mothers and infants and are a major contributor to the high prematurity rate.

Even though preeclampsia causes so many preterm births and related deaths, it is among the most poorly understood, understudied, and underfunded conditions compared with other diseases. More research is critically needed so that we can develop evidence-based guidelines for prevention and treatment.

Drop in Cesareans, Teen Births, Premature Babies Welcome News

The CDC recently released preliminary 2010 data on births in the US and there’s good news. For starters, preterm births declined for the fourth straight year. Although the rate is still high, it’s clear that progress is being made in preventing premature births.

The other good news is that the cesarean delivery rate also decreased. I’d like to believe that ACOG’s concerted efforts to educate physicians and the public that there are increased risks associated with cesarean birth, as well as our efforts to encourage vaginal birth after cesarean (VBAC), has something to do with this. We’ve also educated doctors and patients about not inducing labor or scheduling a cesarean before 39 weeks of pregnancy without a pressing medical need to do so. A full term pregnancy is 40 weeks and babies need these last few weeks to gain weight and fully develop lung function.

Births to teens fell again for the third straight year, hitting a record low. Fewer teens are having sex and more of them are using contraception when they do.

This new data is encouraging, but we must keep the momentum up on driving these rates down further and in the process, improving maternal and infant health outcomes.

Let’s Focus Attention on Prematurity Awareness Month

Did you know that prematurity is a leading cause of infant morbidity and mortality in the US? In fact, about 12% of all babies in the US—roughly 500,000—are born preterm each year. According to the March of Dimes, there is some hopeful news: Preterm birth rates improved in nearly every state between 2006–2009.

A pregnancy is considered full term at 40 weeks. Any birth before 37 weeks gestation is considered premature. In the majority of premature births, preterm labor starts spontaneously. In other cases, the baby is delivered early because of health problems with the mother or the baby, or both, and it’s safer to get the baby out. Additionally, women should not be induced or delivered by cesarean before 39 weeks gestation unless there is a medical indication.  

Preterm babies have a high risk of serious problems with their vision, hearing, breathing, and nervous system development. Sadly, some don’t survive. Unfortunately, despite the advances in medicine, we don’t yet know what causes preterm labor nor can we prevent most preterm births. 

If you have uterine contractions, vaginal bleeding or discharge, leaking amniotic fluid, pelvic pressure, mild abdominal cramps, or any unusual symptoms before 37 weeks of pregnancy, call your obstetrician. Medication can help your baby’s lung development if preterm labor is caught in time.

We continue educating physicians and patients about this national problem and are committed to finding ways to reduce preterm births.

Increased Health Risks for DES-exposed Women

Back in the 1940s and until 1971, women took a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriages and other pregnancy complications. As a result, millions of babies were exposed to DES in utero with profound health consequences.

Now, a new study in the New England Journal of Medicine quantifies the magnitude of that impact. Government researchers analyzed data from three studies that began in the 1970s, looking at 12 health risks in 4,600 women who were exposed to DES in utero and compared them to 1,900 women who were not.

Investigators found that exposed women had higher rates of infertility (33% vs. 16%), miscarriage (50% vs. 39%) and premature delivery (53% vs. 18%) than unexposed women. In addition, they were more likely to develop preeclampsia (26% vs. 14%), miscarry in the second trimester (16% vs. 2%), and experience early menopause (5% vs. 2%). DES daughters also had a slightly higher risk for breast cancer after age 40 (4% vs. 2%).

Little can be done now to undo this public health disaster. Researchers plan to follow these women through menopause and study their daughters to see whether the impact will affect future generations.