Born Too Early
Expert information and advice about premature births.
by Mary Jane Minkin, M.D

PARENTGUIDE News May 2006

•How does prenatal care factor into a woman’s risk of having a baby prematurely?
Proper prenatal care can help increase women’s chances of having a full-term birth. Studies show that the sooner you start to take care of yourself when pregnant, the better your chances to deliver a full-term baby. I think most doctors agree that the sooner a pregnant woman begins taking care of herself, the better. Doctors can advise women on healthy practices to help ensure full-term pregnancies.

•Why should women find out as soon as possible if they are pregnant?
It is important that women understand how critical early pregnancy detection and care is for the health of the developing fetus. Many crucial stages in a baby’s development occur before a woman may realize she is pregnant, even before she misses her first period. Many people are surprised to learn that several crucial organ systems, including the brain and spinal cord, have already begun to develop even before most women realize they are pregnant.
Also for many women, the trigger to lessen their alcohol and caffeine intake is seeing a positive pregnancy test result.

•If you want to know you are pregnant as soon as possible, when should you start testing?
Most women use an at-home pregnancy test to find out if they are pregnant. However, not all tests are the same. Look for at-home pregnancy test kits that specifically say you can test several days before your missed period. These are the tests that, for many women, are sensitive enough to detect low levels of the pregnancy hormone days before your expected period.

•Why are so many babies being born prematurely in the country?
According to a survey sponsored by First Response, in conjunction with a partnership with the March of Dimes, one-fifth (20 percent) of women who have been pregnant say they did not visit their doctors for early prenatal care (within the first three months of pregnancy). Engaging in early proper prenatal care betters your chances of having a healthier, full-term pregnancy— something a large demographic of women are missing out on, as the survey indicates.
Furthermore, scientists have not yet developed fully effective ways to help prevent premature deliveries, despite the advances in care for premature babies.

•What are the causes of premature births?
One out of every eight babies is born too soon. Premature birth is the number one killer of newborns and takes an enormous emotional and financial toll on families.
According to the March of Dimes, the cause for nearly half of premature births is unknown. Studies suggest that there are four main factors that can lead to premature labor.
-Maternal or fetal stress can result in changes in hormones involved in pregnancy and labor, such as corticotropin-releasing hormone (CRH). CRH may stimulate production of other hormones that can cause uterine contractions and premature delivery.
-Premature labor can result from the body’s immune system fighting off bacterial infections. Infections can vary from genital and urinary tracts to fetal membranes. Periodontal disease may also contribute to premature birth.
-If the uterus begins bleeding as a result of placental abruption, for example, the bleeding can trigger the release of proteins that help to clot the blood, which may stimulate uterine contractions.
-An overstretched uterus can prompt the release of chemicals that stimulate uterine contractions. The uterus can become overstretched when a mother is carrying multiples, such as a twin pregnancy, causing excessive amounts of amniotic fluid and/or unusual developments in the uterus or placenta.

•What sort of things are discussed or done at early prenatal visits?
Your practitioner will discuss your physical and emotional state and any concerns or questions you may have. Your practitioner will measure your weight, blood pressure and abdomen, and assess general health. Based on these standard procedures and any additional tests that may be necessary, your practitioner will discuss any implications from your test results, in addition to explaining what you should be experiencing in the coming weeks before your next visit. Your practitioner should also advise you of any warning signs of preterm labor that may occur and the proper steps to take should they occur. Finally, your doctor should inform you of optional prenatal tests that can help determine risk for birth defects your baby might have developed.

•Besides getting this early care are there any other steps pregnant women can take to decrease their chances of having a baby born premature?

In addition to paying regular visits to physicians, women should follow healthy diets and lifestyles. Healthy practices include watching your diet— ingesting more protein and iron and limiting any harmful foods like undercooked meat, taking standard prenatal vitamins containing folic acid, exercising regularly, getting proper rest, cutting back on caffeine and avoiding all alcohol, drug and cigarette smoke intake. Any chronic illnesses should be treated. Women should discuss any prescription, over-the-counter or herbal medications with their obstetric provider. Additionally, regular visits to the dentist are important because dentists can monitor for bacterial infections that develop in the gums that increase risk for preterm birth.

•Why do you think premature births are on the rise?
With many couples starting families later in life and/or facing fertility problems, in vitro fertilization as a treatment has resulted in multiple gestations (twins, etc.), the majority of which are born too soon.
There are also many women who are not taking the best care of themselves during pregnancy. Among women who have been pregnant, half (55 percent) say their pregnancy was unplanned (according to the survey mentioned earlier). Having an unplanned pregnancy can delay pursuit of a healthy lifestyle. Obesity is another factor. As our country faces an obesity epidemic, mothers should be aware that the more obese they are, the more susceptible they are to hypertension and other complications that can lead to early delivery.

•What is the biggest message you’d like to get out to women this year?
Seek prenatal care right away. The sooner women learn they are pregnant, the earlier they can begin engaging in healthy activities that will enhance their opportunity for a healthy, full-term pregnancy.

Mary Jane Minkin, M.D., is a board-certified obstetrician/gynecologist in private practice in New Haven, CT, and a clinical professor of obstetrics and gynecology at Yale University School of Medicine. Here, she helps us understand premature births and how they could be prevented.