Premature birth rates soaring, with babies' long-term outlook poor

[Thom Little]

Never before has this nation, despite having one of the world's most advanced medical systems, cared for so many babies born prematurely. More than 12 percent of all births occur at or before 37 weeks' gestation, or at least three weeks before full gestational age, almost all of them requiring extra, often intensive, medical care.

According to government statistics released this fall, the number of American babies born prematurely last year topped a historic half-million mark. Hospital costs alone for preemies totaled $18.1 billion in 2003, according to the March of Dimes. Added to that are the costs of parents' lost work time and health-care services for children after the initial hospitalization.

With the long-term effects of prematurity becoming ever clearer, doctors, policy experts and researchers are struggling anew to prevent the problem. But first they must better understand its causes.

"The results of prevention efforts for prematurity in the past haven't been spectacular," says Dr. Gabriel Escobar, an expert on premature birth and a research scientist at the Kaiser Permanente Division of Research in Oakland, Calif. "But we are seeing more and better-conducted research to try to figure out what we can do. There is a sense of urgency."



http://www.post-gazette.com/pg/05348/621684.stm

[elehhhhna]

1. Do they mean there are more preemie births or surviving preemies?

[brmdp3123]

8. Excellent point. There are more premature births,

but fewer late term miscarriages.

[HysteryDiagnosis]

2. Gotta be a reason for this... it doesn't just

happen.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15592264&query_hl=3

CONCLUSION: These results support the hypothesis that low folate levels during the second trimester of pregnancy are associated with an increased risk of preterm birth.

[MountainLaurel]

4. One issue

Is the increase in IVF pregnancies, which are often multiples, which in turn increase the chances of preterm births.

[HysteryDiagnosis]

7. Oh... I can see that as a player... I am sure it is hard to carry

multiples fullterm all the time.... but I absolutely believe a woman's nutritional status plays a part....

Here is my point exemplified:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15941892&query_hl=7
CONCLUSIONS: Increased urinary excretion of isoprostane and decreased antioxidant production is an imbalance that is consistent with oxidative stress, and it precedes clinical recognition of preeclampsia. The maternal diet is an underlying factor that provides an environment for free radical generation.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15971482&query_hl=7
CONCLUSION: Our results support previous reports that suggest that diets high in fiber and potassium are associated with a reduced risk of hypertension. Maternal intake of recommended amounts of foods rich in fiber, potassium and other nutrients may reduce the risk of preeclampsia.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15638817&query_hl=7
ONCLUSIONS: We conclude that in women with preeclampsia, prolonged dietary supplementation with l-arginine significantly decreased blood pressure through increased endothelial synthesis and/or bioavailability of NO. It is tempting to speculate that the supplementary treatment with l-arginine may represent a new, safe and efficient strategy to improve the function of the endothelium in preeclampsia.

Definition:
Background: The syndrome associated with pregnancy-induced hypertension (PIH), or preeclampsia, is the most common cause of maternal and perinatal morbidity and mortality. This syndrome occurs in 5-7% of pregnancies, and it only occurs spontaneously in humans and higher apes. PIH primarily is a disease of young primigravidas; however, multiple gestations, advanced maternal age, and genetic predisposition increase the risk. Preeclampsia is a multisystem disorder of the mother that affects the fetus because of uteroplacental insufficiency. The occurrence of seizures with PIH differentiates eclampsia from preeclampsia. The etiology is uncertain, with the onset far removed from clinical symptomatology.

[xultar]

3. That is cuz people are scheduling c-sections. I have a friend who

had her baby 3 wks early on purpose cuz she didn't wanna have it in July and the Dr only did c-sections on wednesday.

[WildClarySage]

18. Scheduled c-sections are a huge part of the problem.

My son was born at 36 weeks because he was 'big', my actual due date was an educated guess, and so they scheduled the section before he was ready. He spent a week in the NICU. This is not an uncommon scenario at all. Over 30% of deliveries are c-sections and due date mistakes are very common in women who aren't 'regular'.

[Warpy]

5. You give pregnant women poor nutrition, overwork them,

and deny them prenatal care, and this is what you're going to get. It's penny wise and pound foolish, typical GOP. Insurance companies won't cover prenatal care unless the woman is covered under a family policy prior to becoming pregnant, and how often does that happen?

You want to figure out what to do, Dr. Escobar? Stop voting Repuglican and work to get universal healthcare coverage in this country. Work to raise the minimum wage to a living level. Work to strengthen WIC and open the program to more low income mothers.

That's what you do.

[China_cat]

6. Exactly.

You can come up with all the other excuses you like but the biggest problem is lack of prenatal care. And I don't mean just a doctor or certified midwife. Nutrition, rest, understanding of what's going on. But the woman isn't important...only the fetus is. Too bad those who want to keep cutting aid don't seem to understand that the way to best strengthen that fetus is through the WOMAN it's attached to.

[liberalcanuck]

32. So well said! nt

[noamnety]

9. And on top of that

reduce access to affordable birth control, so those who know they can't or won't properly care for themselves during a pregnancy end up pregnant anyway.

[brmdp3123]

10. ????????????????

Every insurance plan I've ever been on covers pre-natal care, and I've been on alot.

[MountainLaurel]

12. 45 million Americans have no health insurance n/t

[Lars39]

13. You've been insured, a lot of women aren't even insured.

[madaboutharry]

14. When I was single and

had medical insurance from my job, not one plan would have covered me for pre-natal care unless I purchased it individually.

[CottonBear]

25. I've only had insurance that covers pregnancy for 5 years out of 25 years

of my working/career life. Heck, insurance did not even include well-woman cae like yearly check ups. I had to pay cash to my OB-GYN for check ups.

[nonconformist]

34. No, they don't. There are different plans.

And the plans that cover pre-natal care are substantially more expensive than a standard medical plan, and one must be covered under this plan prior to pregnancy or they cannot get coverage. These days, many employers that actually offer insurance do not offer the plans that cover pre-natal care.

Of course, this is if you have insurance at all. I've been uninsured for 3 years now, which is why I know about the pre-natal plans - I've been researching it.

[eyeontheprize]

37. You obviously weren't pregnant when you enrolled

in those plans. Also, more and more companies are only covering the employee and not dependents or family, if they offer insurance at all. Try and find an obstetricians willing to take patients without insurance or only coverage by Medicaid, it is impossible.

There is a persistent myth that it has to do with malpractice insurance, but it really has to do with greed. OB insurance it very expensive because insurers made bad investment choices, not because of high malpractice awards. Furthermore, obstetricians are very, very wealthy after paying their premiums.

[SoCalDem]

21. AMEN.. When i was pregnant, I awoke when I felt like it..Took a nap

when I felt like it. I did have two premature babies due to two abruptions , but there is somehting to be said for Moms-to-be being able to listen to their bodies instead of their bosses..

and modern science has evolved to "save" many babies who would never have lived in past times. The parents are only interested in saving their baby, and most ignore the possibilities of a lifetime of impairment.. I have been that mother, grasping at the word "viable" as I was hemorrhaging at 7 months.

Science can save the 25 wk fetus, but it cannot take away the impairment that might result from the treatment..


IVF doctors should have to pay all medical costs for every baby over 2 , that results from IVF.. Twins do well, but triplets, quads & litters turn the dream of parenthood into a lifelong nightmare for many families..

[WildClarySage]

26. Parents carrying multiple fetuses can choose selective reduction

though I would imagine that decision is very hard to make. Not sure I could do it. If the rabid right wingers would stop trying to compound the emotional issues inherent in termination decisions, I bet many parents would use their common sense rather than giving in to the emotional blackmail.


Mr WCS works with a guy whose wife carried four IVF babies and they're all physically impaired, two so severely that they're institutionalized. He told my hubby that he wishes his wife had been open to a selective reduction because they would then have had two healthy babies at home instead of two unhealthy ones at home and two non-functioning children in Charleston (an hour and a half, give or take, from home.) The emotional toll from that pregnancy has been enormous. But his wife wouldn't consider it because her church said it was God's Will.

[SoCalDem]

36. That's precisely why the DOCTORS should never implant more than 3

The would-be parents should not have to be in a position of making a "Sophie's Choice".. To have to choose which ones to "remove", knowing that the ones left may not make it to term either, is a choice that parents should never have to make.. Imagine how they would feel if they "removed" 2, and the woman later misscarried the others...they would always wonder if the ones they removed would have been the ones who would have survived..

IVF is so expensive that it creates such a desperation for people, and they take huge risks because they may not have the money (or time left on the clock) to try over and over..

[MountainLaurel]

42. Some can at least

My insurance plan (I work at a "religious" university) doesn't cover it, and I'd bet that the hospital here wouldn't perform them even if the parents requested it.

[Xithras]

11. According to my wifes OBGyn, improved neonatal care is a big factor.

I know it sounds backwards, but it makes sense when you think about it. My wife had this conversation with her OBGyn before our last baby was born (she'd noticed that the NICU was a lot bigger than when our first was born over a decade before), and he made an interesting point. A lot of these preemies would have simply been miscarriages and stillbirths a few decades ago. Modern medical technology has allowed doctors to detect miscarriage inducing problems and counter them until the baby is further along in its development and can survive in ICU. Problems that would have resulted in spontaneous late term abortions 25 years ago can be detected and the baby can be removed and placed into an incubator before abortion occurs. Improved care for the mothers has allowed women for whom pregnancy was biologically problematic to suppress problematic reactions to carry the baby longer.

My mother had four children and six miscarriages in her lifetime, and that sort of thing was once common. Nowadays, miscarriages after the first trimester are rare, and miscarriage rates within the first trimester are down significantly. Stillbirths are a tiny fraction of what they were 50 years ago. Many of the children "saved" by modern technology still don't make it to full term however, and end up as preemies. These kids are a HUGE portion of the increase in preemie births.

[Ilsa]

16. ITA. Alot of the "problem" is actually an "improvement" of another

statistic.

Yet, I still hear that as many as 25% of pregnancies are lost in the first two months, mainly due to severe genetic defects during meiosis or something. Some OB's think the number is higher, with another significant group having miscarriages without ever discovering they are pregnant. I think that happened to me once. I had not confirmed a possible pregnancy, had a unusual enough period and still didn't confirm as there was no reason tospend the money at that point.

[bleedingheart]

28. I concur

i posted my thoughts on this as well below and I believe that you are correct. What were once miscarriages are being labeled premature birth.

[SoCalDem]

41. and back in the day, there were a lot of "stillbirths"

these were sometimes preemies who just came too early, but they were also sometimes "late-term spontaneous abortions".

Nature makes very few mistakes, and if there is a congenital reason for a baby to not live, the Mother's body will usually reject it. Modern medicine can counteract this, but the result is sicker babies needing more care for longer time.

Modern prenatal care is rather new in the over-all scheme of things. A pediatrician told me something years ago and it's always stayed with me..

our first child was born with a severe birth defect, and we agonized for years (sometimes still do..he's 32 and happily married, well-employed and yet we still lament what he had to endure)..anyway the doctor said this:

"Until most babies were born in hospitals, the midwife or country doctor was "in charge" at the birth and if a baby had an obviously severe defect, and there was little medical care available, the child would just be "stillborn".. The family would receive the condolences of friends and they would go on to have other children. Modern hospitals have too many people "in the room" to do anything but save every baby."

His implication was that there are not really more defects these days..just that the modern way of having babies makes it imperative that they all survive..at any cost..emotional or financial.

[Name removed]

15. Deleted message

Message removed by moderator. 
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[daleo]

17. International comparisons would have been interesting

Particularly with other western nations with public health care.

[WildClarySage]

19. I don't know about preterm births, but our infant/maternal mortality rate

is something like 12th of industrialized nations reporting stats.

[daleo]

20. Yes, and I think pre-term correlates with mortality

On a population basis, I mean. So, there is probably some connection that might show up from this sort of international comparison.

[fleabert]

22. in 2001 we were 26th..

hard to find the current rankings from the WHO or the March of Dimes...I will work on it.

i found something that mentions our ranking in 1998
>snip<
The infant mortality rate, the rate at which babies less than one year of age die, has continued to steadily decline over the past several decades, from 26.0 per 1,000 live births in 1960 to 6.9 per 1,000 live births in 2000. The United States ranked 28th in the world in infant mortality in 1998.

http://www.cdc.gov/omh/AMH/factsheets/infant.htm

still looking for current data

[MountainLaurel]

31. On average, but if you look at a closer level

You'll find that many pockets in the U.S. are on par with third-world nations. In a med school class I sat in on for first years (I'm a librarian here), the prof showed infant mortality stats for one DC ward. It fell among countries like Afghanistan, Thailand, and Lesotho in the rankings: Somewhere around 95th place.

[mdelaguna2000]

23. UM... 37 weeks requires NO intensive care

Nuts. My daughter was born then - reaching 37 weeks is well into the safety zone for a normal child, normal meaning - needs no intensive care, can breathe on their own just fine, lungs developed, yadda yadda. They should report the stats for < 36 weeks or something like that.

[WildClarySage]

24. Depends entirely on the child and the accuracy of the due date.

37 is a tad on the early side and can require interventions such as administration of oxygen, etc. Yeah, most are just fine, but I've seen babies at 37 who weren't quite 'finished baking' yet- most were born by induction or section. OB's anymore are often determined that babies' birthdates are convenient for *them* and not for moms.

[rainbow4321]

39. And in the rich part of town, it is also done for parental convenience

At our hospital, we will see a spike of of "convenience" c sections or inductions..like on a Friday night, Sat. morning. Then there are the "right before the doc goes on vacation" inductions/c sections. Bad things can happen if you mess with mother nature JUST to have the birth fit into your schedule.
If the baby is NOT ready to come out and there is NO medical threat to mom or baby, LEAVE the kid in there. Something ain't done cooking yet. And that drive-thru Friday night induction/c-section may very well turn into a bigger cramp in the parents' schedule--like a stay in the NICU for weeks at a time!
The very last "skill" a baby "learns" in utero is sucking..no sucking means baby just may be born and not know how to eat---it developments somewhere around 36 weeks in utero. But if the baby for some reason doesn't development it til after 36 weeks, and is "taken" early, we're looking at eating problems which lease to wt problems/jaundice/blood sugar issues after birth. Hell, I've seen 38 weekers NOT know how to suck.

[bleedingheart]

29. not all are finished baking in the uterus at 37 week...it is lung maturity

that is the key factor....

[neverforget]

35. My daughter was born last year at 37 weeks and she was in NICU

for 5 days. She had a hard time swallowing (breath, swallow, breath)and then developed jaundice. We were able to take her home after 5 days because she had finally learned how to eat but we had to take a special light home to fight the jaundice. That lasted about another week.

[bleedingheart]

27. Perhaps this is because many of these births would have been miscarriages

not but a few years back...???

Perhaps the rate of prematurity has increased because of how they are now labeled?

Twenty years ago my sister had a friend who had miscarriage after miscarriage between weeks 18-25...each of those was labeled a miscarriage. Now I don't remember specifics as to whether they were born live or dead...but today a 24 weeker would be in NICU and while survival rates for that gestational age are poor...it can happen.

I have a coworker who lost a baby in her 5th month of pregnancy about 10 years ago...it too was labeled a miscarriage. The boy survived only a day. The loss of that pregnancy was due to an incompetent cervix.

Now I do believe that we should do everything to lower the rate of premature birth but I can't help but wonder if there is more to this.

I myself had a premature baby, but she was 35 weeks and was in the NICU for 10 days due to Respiratory Distress Syndrome...(her lungs were not ready)...she was delivered by c-section because my health was deteriorating due to the pregnancy. Pregnancy and I don't work so well so after two difficult ones I stopped. I was followed by one of the best teams in Pittsburgh through my pregnancy and sometimes in spite of it all...nature has the last say in how things work out. Luckily my daughter survived her ordeal and is very healthy...although she does have asthma.

[lynne]

30. You are 100% correct -

- I am the mother of a 27 week gestation preemie born 26 years ago. She survived and is fine, married, works, etc.

Recently we went back to the NICU for a "Birthday Party" as I thought it would be good for the new preemie mom's to see a preemie that had successfully made it to adulthood with her husband on her arm. We had a great day and I got to visit with her Dr's. that I hadn't seen for at least two decades.

They all confirmed what you say . . . it's not so much that there are MORE pre-term births, but that those very early pre-term births are surviving whereas they had previously been considered "miscarriages". My daughter at 27 weeks was considered a miracle in 1979 - now she would just be average. The earliest consistent survival is successful at 24 weeks - from what they were telling me - but has a higher rate of long term effects, disabilities, etc.

[kaiden]

33. My grandson was in the NICU for two weeks.

I couldn't believe the number of preemies, close to 40, who were being cared for by very dedicated neonatalists and nurses. Whatever those people are getting paid, it isn't enough. When you multiply the number of preemies in one hospital in the city (Denver, in this case) to the number of hospitals in the metro area, premature births are a huge and perplexing problem. What causes this? Environmental toxins? Lack of health care? Fertility drugs? Better technology?

My grandson, at 4.7 lbs., looked like a linebacker compared to the other preemies in NICU. He's almost three now, but he will have some of the long-term developmental problems that others in this thread have talked about.

[rainbow4321]

38. Preemie babies are being born earlier and earlier (23- 24 weekers)

Working in a NICU, I can add that once upon a time that it used to be that 25 weekers were the youngest we would see..now, with medical technology we are caring for 23 weekers who spend 7 months or more in the NICU...most with severe health problems (breathing/vision/**severe** neuro deficits/ long term feeding issues).
There are many times that some of us start to wonder if it is right that just because we CAN keep 23 weekers going, should we? And also can't help to think that maybe the parents have not been given the big picture on what lays ahead for their baby, both over the next 5,6,7 months AND for their entire lifetime...potential for total dependency on caregivers, never getting out of a bed, frequent hospital readmissions, the list goes on and on.
NICU's bring in LOTS and LOTS and LOTS of money for hospitals..the units are the hospital's "cash cows". Can't help to think that is what drives some of 23/24 week "saves". When they are born that young, you are looking are a hospital bill of million dollars or more if it is a multiple birth (twins/triplets in the unit for 5-7 months at a time).

Gives "Million Dollar Baby" a whole new meaning.

[Hyernel]

40. As mercury and toxins flow from the stacks...

...it's no wonder where the effects show up first?