How to Prevent Preterm Birth
I often worry when I write about pregnancy-related health news that I'm going to scare mothers-to-be. One pregnant colleague joked that she was afraid to bite into a doughnut after reading an article I wrote on how nourishment during pregnancy may impact a baby's health into adulthood. So, it's with a bit of hesitation that I report on a study published today in the Journal of the American Medical Association. It found that premature babies (defined as those born before 37 weeks of gestation, or more than three weeks before their due date) were at greater risk of dying throughout childhood. The highest risk was observed in those born at or before 27 weeks of gestation; those born more than eight weeks early also had a higher risk of becoming infertile adults, compared with babies born at full term.
These findings are pretty scary stuff, especially given that preterm birth is often difficult if not impossible to prevent. Medications given to halt premature labor, like magnesium sulfate or nitroglycerin patches, often fail to halt labor for more than a day or two. Plus, the problem is getting worse because of the increasing average age of expectant mothers and growing use of fertility treatments, leading to multiple births and medical complications that often end pregnancy early. Preterm births now account for nearly 13 percent of all U.S. births, compared to 9 percent 25 years ago.
Still, the new finding "should be interpreted with extreme caution," says Mary D'Alton, chair of obstetrics and gynecology at Columbia University Medical Center in New York. She tells me that medical care for premature labor has changed very significantly over the past 30 years since the researchers, from Norway, began tracking that country's preterm infants. "It's now standard to give steroid medications to women about to deliver at 24 to 28 weeks, which wasn't the case back then," she explains. Steroids help the baby's lungs mature and reduce the incidence of cerebral palsy, infant death, and chronic health problems.
Though there's no way to guarantee a full-term birth, pregnant women can take certain steps to maximize their odds:
Don't smoke. As the label on the cigarette pack often states, "Smoking by pregnant women may result in fetal injury, premature birth, and low birth weight." And it doesn't help to just cut back on smoking: Recent research suggests you have to go cold turkey. The same goes for cigars, hookah pipes, and the like.
Consider getting progesterone shots if you've had a previous preterm birth. Weekly progesterone injections, administered from week 16 through week 34, can help delay early labor, says Dalton. The trick is identifying women most at risk before they actually go into labor. Women who've already given birth to a premature baby are at greater risk. So, too, are those women who were premature babies themselves, according to the new study.
Curtail activity if your doctor recommends it. Doctors are moving away from recommending bed rest for pregnant women with any kind of problem, says Dalton, but they might recommend it or at least suggest reducing activity if a woman's cervix is short and has begun to dilate early. The jury is still out over whether this can indeed stop premature labor, but it probably can't hurt.
Eat a healthy diet and get a moderate amount of exercise. This can help reduce the likelihood of developing pregnancy-related complications like preeclampsia or gestational diabetes, both of which may necessitate premature delivery if the mother's or baby's health is at risk. Here's what the American College of Obstetricians and Gynecologists recommends for a healthy diet and for exercise.
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Reader Comments
There's a lot more that can be done, too
Get regular dental care, and handle periodontal disease early in pregnancy if not before - extreme prematurity has been linked to oral health problems. (especially in the early-mid 20-weeks range)
If you're dealing with a multiples pregnancy, just swapping to omega-3 enhanced eggs can increase gestation an average of 6 days. In the preemie world, that's huge. Fish oil or other sources of Omega-3 fatty acids are linked to better function for preemies as well, though the research is still preliminary.
Fortunately, I've seen more OBs recommeding 'limited activity' or 'conservative activity' rather than total bed rest. Mainly because as noted, there's mounting evidence that total bed rest CAN hurt, and without evidence that it does something specific, that's a negative balance for the sake of feeling like they're doing 'something'. Cochrane Medical Abstracts in 2004 said that bed rest showed no benefits and lacked sufficient research, at the same time as having negative implications for the woman. In 2001, the review of bed rest for multiple gestation pregnancies indicated that bed rest could increase the rates of premature births, rather than making gestation last longer. Some people point to the research showing that the babies may be slightly larger for gestational age if the mother was on bed rest, but other research indicates that multiples do better at full term regardless of size for gestational age - up to 42 weeks, just like singletons. Term is term.
Self-modified activity - listening to your body - was what was advised by my care providers for my multiples pregnancy. My body would definitely tell me to rest. Doing THAT can't hurt. Actual 'real' bed rest may.
premature babies
My sister was born early and weighed 2 lbs. 10 ozs. She had to stay in the hospital for 3 mos. She is now 41 yrs. old. She is very blessed to have no problems related to being born prematurely.
preventative measures
Premature births and maternal distress related to hypertension and preeclampsia can result in over 10,000 infant deaths and up to $5 billion in annual health care costs in the U.S. But a recent medical breakthrough can alleviate both the worry of infant death and the cost of this expensive health concern. David Chaffin, MD, and Denise G. Webb, CRNP developed MIST in 2002 at the Marshall University's Maternal Hypertension Center through Cabell Huntington Hospital in Huntington, WV, conducting clinical evaluations with results showing a 50% reduction in preeclampsia and zero maternal and infant mortalities in treating over 1400 at risk women. Visit http://www.misttechnologies.com/ for more information and start asking your doctor for your MIST test today.
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preventing pre-term birth
Why do doctors even suggest bed rest when study after study indicates there is no benefit? You say that bed rest "probably can't hurt", but studies indicate that prolonged bed rest is harmful to the mother and can reduce the growth of the fetus.
Mar 26, 2008 08:46:42 AM [permalink] [report comment]