The Fight Against Infant Mortality and Premature Births
By Fritz Lenneman
November 20, 2009
Two recent reports highlight the precarious standing of the most vulnerable members of American society—premature babies.
A statistical analysis by the National Center for Health Statistics (NCHS) released in early November 2009 shows a link between the large number of premature babies in the United States (which is twice the rate of some industrialized countries) and our infant mortality rate (which is as much as two-and-a-half times the rate of other Western countries).
An article about the study in The New York Times summarizes the link: "Premature infants in the United States are more likely to survive than those elsewhere. Yet they are still more likely to die than full-term babies, and the sheer numbers born prematurely in the United States—more than 540,000 per year—drive up infant mortality." The key to reducing infant mortality, therefore, is in reducing preterm labor.
In that article, the author of the NCHS study, Dr. Marian F. MacDorman, says there are several reasons the United States has such high rates of premature birth. For instance, the use of medically assisted reproduction methods like in vitro fertilization and ovary stimulation have lead to an increase of pregnant women carrying multiple fetuses—twins, triplets and more. These pregnancies are much more likely to result in premature births. Regulations in other countries are more restrictive about the number of embryos allowed to be implanted, so multiple births resulting from in vitro fertilization are uncommon.
Another reason cited for the high rate of premature babies is the common use of labor-inducing drugs and Caesarean sections, many of which are performed before babies are full term. Doctors are not supposed to induce or do a C-section unless it is medically necessary. "There sort of has been this shift in the culture. Fifteen or 20 years ago, if a woman had high blood pressure or diabetes, she would be put in the hospital, and they would try to wait it out. It was called expectant management," Dr. MacDorman told The New York Times . "Now I think there's more of a tendency to take the baby out early if there's any question at all."
Just weeks after the NCHS report was published, the March of Dimes issued its annual report card on efforts in the United States to reduce premature births—and almost no states did well. Vermont earned the best grade with a B, but the United States' overall grade was a D. The March of Dimes has a state-by-state breakdown of scores on their website.
Aside from multiple births and the risks of medically assisted reproduction, the March of Dimes points to other factors in premature births such as mothers smoking during pregnancy and access to prenatal care.
Dr. Jennifer L. Howse, president of the March of Dimes, points to four key ways to reduce the preterm birthrate that the NCHS report says could cut the infant mortality rate by one-third.
Improve access to prenatal healthcare to address such chronic conditions as obesity and high blood pressure
Continue efforts to curb smoking by pregnant mothers. "Twenty percent of preterm births are associated with smoking," Dr. Howse says.
Prevent unnecessary early inductions and C-sections.
Encourage use of progesterone hormone supplements by eligible women. The March of Dimes says progesterone can help delay preterm labor in some women.
Despite the low performance grades around the country, Dr. Howse says progress is being made. Nine states—Arizona, Indiana, Missouri, Idaho, Massachusetts, Utah, Wisconsin, Ohio and Oklahoma—have improved their grades since 2008.
"We did see a very small decline in the preterm birth rate, from 12.8 to 12.7 percent of live births in 2007. Also, fewer women of childbearing age are smoking, and the nation's late preterm birth rate also declined, although very, very slightly," she says. "I am optimistic that as we see reductions in the risk factors, we will see a reduction in the rate of preterm birth."