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Preemies Cost $26 Billion a Year

Government report suggests infertility treatments are part of the problem

THURSDAY, July 13, 2006 (HealthDay News) -- The growing number of premature births in the United States costs at least $26 billion a year, a new government report says, so doctors should think twice before trying the popular infertility treatments that often lead to problematic multiple births.

In 2005, 12.5 percent of all babies born in America were born at least three weeks ahead of their delivery date, the study from the Institute of Medicine of the National Academies found. And although infertility treatments are responsible for some of that percentage, the researchers noted they are still at a loss to explain why there are significant racial and ethnic differences in premature birth rates.

"The rate of preterm births has increased by more than 30 percent since 1981," said Dr. Richard Behrman, chairman of the committee that wrote the report and executive chairman of the pediatric education steering committee of the Federation of Pediatric Organizations. "Infants delivered preterm are at greater risk for a variety of health and developmental problems. The birth of a preterm baby can result in emotional and economic costs for both families and communities," Behrman said.

The report, which was made public Thursday, offered a detailed, multidisciplinary agenda to address the problem. In conjunction with the release of the report, the March of Dimes called for passage of federal legislation to address the issue.

Pediatricians wholeheartedly endorsed the program. "It's a great agenda item for the country, because if children are disabled, they have a significant impact on society," said Dr. Adam Aponte, medical director of North General Hospital's Diagnostics and Treatment Center in New York City.

"We think it's important and necessary that the Institute of Medicine pay attention to this health problem, which affects several hundred thousand children and families per year in the U.S.," added Dr. F. Sessions Cole, director of newborn medicine at St. Louis Children's Hospital and a consultant on the report. "It's a health issue which has 70 years worth of ramifications and counting. This is actually one of the largest health impacts of anything. It's bigger than cancer, bigger than heart disease," Cole added.

The biggest issue is how to prevent preterm births.

"We've made very little progress on prevention, although we've made substantial progress on the treatment of premature infants to permit them to survive," Cole said.

While some women are genetically predisposed to deliver prematurely, many preterm births result from assisted reproductive technologies, including in vitro fertilization. In particular, these technologies have resulted in a surge of multiple births that carry with them an increased risk of preterm birth.

"Advanced reproductive technology is like the frontier of the Wild West," Cole said. "There is no systematic education of families by neonatologists or pediatricians about the outcomes of the pregnancy. Families think three babies is three times as good, but I can tell you it ain't. It substantially increases the risk of adverse outcomes."

The report also noted troubling disparities in preterm birth rates among different racial, ethnic and socioeconomic groups. In 2003, the rate for black women was 17.8 percent, vs. 11.5 percent for white women and 11.9 percent for Hispanic women, Behrman said.

"We cannot fully explain why these disparities exist," Behrman added.

Of all preterm births in the United States, the greatest number are "near-term" or "late-preterm," born between 32 weeks and 36 weeks. Although babies born before 32 weeks have the greatest risks, all preterm babies face potential problems.

The closer to the expected delivery date the baby is, the lower the chances of problems, especially death.

"Mortality is not that bad past 34 weeks," said Dr. Rick Stafford, director of neonatology at Northern Westchester Hospital in Mt. Kisco, N.Y. "But these babies have a lot of problems, including longer hospital stays and health-care costs, respiratory distress, they frequently don't feed very well, they frequently don't maintain a normal temperature, so they need incubators, and they have a higher risk of jaundice," he noted.

Some babies end up in neonatal intensive care for two weeks. They could also face lifelong hearing loss, blindness, cerebral palsy, seizures and more, Cole added.

"The message for pregnant women and for their doctors is that preterm births remain the single greatest cause of having a disappointing outcome for pregnancy. Beyond the first trimester, it is the leading cause of death and of acute and chronic health-care problems for the baby," said Dr. Jay D. Iams, also a member of the committee that wrote the report and a professor of obstetrics and gynecology at Ohio State University College of Medicine.

More information

The March of Dimes has more on premature babies.

SOURCES: F. Sessions Cole, M.D., director, newborn medicine, and head, neonatal intensive care unit, St. Louis Children's Hospital; Rick Stafford, M.D., director, neonatology, Northern Westchester Hospital, Mt. Kisco, N.Y., and clinical instructor, pediatrics, Columbia Presbyterian Medical Center, New York City; Adam Aponte, M.D., medical director, Diagnostics and Treatment Center, North General Hospital, New York City; July 13, 2006, teleconference with Richard E. Behrman, M.D., executive chairman, Pediatric Education Steering Committee, Federation of Pediatric Organizations Inc., Menlo Park, Calif. and Jay D. Iams, M.D., professor and vice chairman, department of obstetrics and gynecology, Ohio State University College of Medicine, Columbus; Preterm Birth: Causes, Consequences, and Prevention
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