Preterm Birth: The Nation's Leading Killer of Newborns

Health advocates seek federal legislation to coordinate research

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By Janice Billingsley
HealthDay Reporter

FRIDAY, Nov. 18, 2005 (HealthDay News) -- Stephanie Smith, a 41-year-old New Yorker, was a model mother-to-be when she became pregnant three years ago.

A dancer and massage therapist, she'd always been extremely fit and health conscious and was diligent in her pre-natal care.

So she was stunned when her son, Max, was born premature at 29 weeks and six days and weighed 2 pounds, 13 ounces.

"I was shocked. I never expected to go into premature labor," Smith said. "I did everything right."

Normal gestation is approximately 40 weeks, and a birth before 37 weeks is considered premature.

Max, now 3, was born with multiple health problems as a result of his prematurity. And Stephanie and her husband, Bernie Yee, struggled to take care of him through months of at-home care that initially included oxygen supplementation and tube feeding, a re-hospitalization for respiratory distress and a collapsed lung, with an induced coma needed to stabilize him.

"Everything that saved his life also caused other problems," Smith said.

Now Max is in school, and Smith is pleased with his progress, but noted that he lags behind other children his age in stamina.

Smith spoke Tuesday St. Mary's Healthcare System for Children in Queens, N.Y., a stop on a March of Dimes tour throughout New York City to highlight Prematurity Awareness Month.

March of Dimes President Dr. Jennifer L. Howse said Max's problems highlight the importance of focusing attention on the debilitating and often ongoing problems resulting from premature delivery, the cause of which is largely unknown.

On Tuesday, the U.S. Centers for Disease Control and Prevention reported that the number of preterm births increased by 2 percent from 2003 to 2004. More than 500,000 babies were born before 37 weeks of gestation in 2004, and there has been an 18 percent increase in preterm births since 1990, the agency said.

"We are so saddened by the increase because it means that more babies are going to have to struggle and more families will have a lifetime of health consequences to deal with," Howse said.

The CDC report was released on the third annual Prematurity Awareness Day, which the March of Dimes hopes will serve as a springboard for passing federal legislation to coordinate efforts on finding the causes for premature births and decreasing their numbers, the nation's leading killer of newborns.

According to Howse, there's no known cause for approximately half of the nation's preterm births.

"A mom can do everything right -- nutrition, diet, exercise and have no previous history of prematurity," Howse said, and still deliver a baby too soon.

Known reasons for preterm births include obesity; a lack of pre-conception and pre-natal care, which is common among women with no health insurance; and the use of fertility drugs, she said.

Howse said that twins have a 50 percent greater chance of being born prematurely, and that triplets and higher numbers of babies born together have a 90 percent chance of a too-early birth that brings high risks of often severe health problems. Those problems include neurological, learning, hearing and vision problems and cerebral palsy.

When women take fertility drugs, Howse said, it's very important that they get good medical advice. Often with assisted-reproduction technology, women will have four or five eggs implanted, raising the risk of multiple births, she said.

"It's a delicate area," Howse said, because a woman wants to have a baby, and if her doctor advises her that more eggs will increase the likelihood of success, she might do that without understanding the medical risks of premature delivery.

Another issue is that technology has enabled doctors to save the lives of ever-younger premature babies, resulting in more complex medical problems facing these infants and the doctors who treat them. St. Mary's offers long-term care for the continuing health problems of premature babies as they grow. Smith's son has been treated there.

"We've never had such tiny babies," said St. Mary's president Dr. Burton Grebin, who reported that the hospital's preterm baby population has doubled since its nursery opened in 1984.

"We have seen a dramatic impact because we have to adapt with increased technology, new equipment and more staffing. Some of these problems are subtle and go on for years," he said.

Howse said the federal government presently has no concerted plan to address the problems of premature births. She urged passage of a bill now before Congress that would create a federal agenda to research prematurity.

"We need to raise public awareness and gain the political will to focus on this problem," she said.

More information

For information about premature delivery, visit the March of Dimes.

SOURCES: Jennifer L. Howse, M.D., president, March of Dimes, White Plains, N.Y.; Burton Grebin, M.D. president and CEO, St. Mary's Healthcare System for Children, Bayside, N.Y.; Stephanie Smith, New York City

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