World Prematurity Day: Preterm birth rate worsens in US for fourth consecutive year in 2018; 1 in 10 infants born prematurely
About 1 in every 10 infants are born prematurely - before completing 37 weeks of pregnancy - in the US, according to the Centers for Disease Control and Prevention (CDC). Premature births are the leading cause of death in children below 5 years of age across the globe.
With World Prematurity Day around the corner, it draws attention to the rising rates of preterm birth rate in the US, a trend which had earlier dropped between 2007 and 2014. There are no tests in place to accurately predict preterm conditions yet, say experts. And scientists are trying to figure out why preterm babies face a slew of health issues much into adulthood.
World Prematurity Day is observed on November 17 every year to acknowledge the journeys of preterm infants and their families and to raise awareness of the challenges faced by children born preterm.
The final few months and weeks, experts say, are crucial for a developing baby, as the fetus goes through important growth inside the mother's womb. It is during this period that the baby develops brain, lungs, and liver completely. And when babies are born early, they show higher rates of death and disability.
According to the March of Dimes, a non-profit organization, the preterm birth rate in the US has worsened for the fourth year in a row, from 9.63% in 2015 to 10.02% in 2018.
"If you look at the increases since 2014, cumulatively we're talking about 27,000 babies", Becky Russell, the senior director of applied research and evaluation at March of Dimes told npr. She adds that the difference in these numbers may seem small but it means about 3,000 more babies who were born prematurely - and it's a worrying trend line.
The rise may be due to social and economic factors, Russel explains. She says that she is not entirely sure about what is driving the rise in the premature birth rate but speculates that an "unequal access to maternal care, and high poverty rates", increases a mother's risk of delivering prematurely.
Further, the CDC finds that racial and ethnic differences have some role to play in preterm birth rates. Their 2018's estimate shows that the rate of preterm birth among African-American women was about 50% higher than the rate of preterm birth among white women.
But Rachel Hardeman, a public health researcher at the University of Minnesota thinks there could be other reasons behind the trend. It is racism and structural discrimination, rather than race, that influences black women's risk for premature delivery, Hardeman told npr. She adds that research has shown that chronic stress from racism is associated with a higher risk of premature birth among African-American mothers, which also puts them at a higher risk of infant death.
Besides stress, smoking, drinking alcohol and using illegal drugs put women at greater risk for preterm births. Women who have had an earlier experience with preterm birth are more likely to give birth to preterm babies in the future. Other risk factors include being pregnant with twins, triplets, or more and showing certain abnormalities of the reproductive organs.
Despite this, about half of preterm labors involve no known risk factors at all. Brice Gaudilliere, a physician-scientist at Stanford University believes the mother's immune system contributes to preterm labor. “The immune system is exquisitely sensitive to all sorts of environmental changes, including the mother’s nutrition and stress. The immune system could be the biological common denominator for the many known and suspected factors that contribute to preterm labor", he told ScienceNews.
Though the immune system has been linked to preterm birth for decades, they have not resulted in predictive tests or treatments, he notes. This could be due to a paucity of information on all the causes of preterm labor, perinatologist Roberto Romero at Wayne State, who directs the perinatology research branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, or NICHD, told ScienceNews.
On the brighter side, survival rates of premature babies in the US are improving, thanks to advances in neonatal care. Middle- and low- income countries, on the other hand, are struggling. A lack of adequate newborn care means the lives of many preterm babies are at risk.
What about disabilities?
Babies born prematurely remain at a higher risk of a range of developmental problems later in life, like cerebral palsy, vision and hearing problems, as well as developmental delays, according to the CDC. Of the 15 million infants who are born before 37 weeks every year, nearly 9 million are left with lifelong harm to the brain, sometimes resulting in conditions such as epilepsy or cerebral palsy.
"Preterm birth does still lead to catastrophic brain injuries in a small but important number of babies every year, injury that leaves these infants as they grow with drastic reductions in their abilities to interact with their families and their environment", Bobbi Fleiss, Research Fellow at RMIT University, told MEA WorldWide (MEAWW).
"Once a baby is born preterm, we have no brain regenerative or protective treatments to offer them", Fleiss told MEAWW. She studies brain cells that control brain development and immunity: microglia. Fleiss and the team are trying to understand how these cells misbehave and cause injury that hampers brain-building functions in preterm babies. By targeting these brain-building functions, Fleiss and team believe they can get brain development 'back on track’ in preterms, so they have the opportunity to live life to the fullest.
"Our work on these cells provides new ways to think about how to identify infants at risk of injury, see how the brain is being injured and how to develop options for protection and repair", Fleiss told MEAWW.
These infants also face breathing problems, infections and other complications that can cause issues much into adulthood. Previous studies have shown that premature children can experience developmental delays and have a higher risk of learning disorders such as attention-deficit/hyperactivity disorder.
But another study showed that many premature babies grow up to be healthy adults without any major illness. “There were no studies that we know of that looked at good health in premature births into adulthood. These findings matter for the growing number of people born prematurely because they show that most can lead a healthy, resilient life with good overall function in adulthood", lead author Dr. Casey Crump, vice chair for research in the Department of Family Medicine and Community Health at Icahn School of Medicine, was quoted as saying.
This, however, does not apply to all premature babies. Crump adds that babies who are born extremely premature - 22 to 27 weeks - can still face health complications.