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Puzzling rise in early births

For 20 years, the rate of premature births in the U.S. has climbed. Doctors are still trying to find out why.

January 20, 2003|Jane E. Allen | Times Staff Writer

The United States boasts some of the most sophisticated medical care in the world, capable of curing patients with dread diseases, and yet we're unable to prevent an ever-increasing number of babies from being born prematurely. Many of these infants will struggle with a lifetime of deficits and disabilities -- if they survive at all.

Premature births have risen steadily for two decades, now accounting for 476,000 of the 4 million babies delivered each year in this country. Although prematurity is the leading cause of babies dying in the first month of life, surveys have found that only one in three Americans recognizes prematurity as a problem. Its biological origins remain a mystery.

Even as our neonatal intensive care units get better at pulling tiny 1- and 2-pound babies from the brink of death, the U.S. lags behind Australia, Canada and Britain in providing not only prenatal care but also women's preventive health care in general, before pregnancy.

Access to health care is just one aspect of the problem, because premature births occur in all communities and among all socioeconomic groups -- even among the affluent with generous health insurance benefits. Recent studies have found that premature babies who do survive into adulthood have lifelong aftereffects, including lower IQs, learning disabilities and neurological problems. Blindness, retardation, lung diseases and cerebral palsy are more common in babies delivered weeks short of a full-term, 40-week pregnancy. (A premature birth is defined as one that occurs at less than 37 weeks.)

Premature births have a societal impact that goes beyond the health of the child. For one, there is an economic cost. The hospital bill for a premature infant averaged $58,000 in 2000, contrasted with $4,300 for a routine birth of a full-term baby, according to March of Dimes figures. Children born prematurely also require more medical care, social services and remedial education during their lives. And their families must cope with the emotional turmoil and financial burdens of a special-needs child.

No one knows precisely why prematurity has become such a stubborn problem, and there are fears that cuts in health and social services could make the problem even worse.

To begin lowering rates of prematurity, doctors need to better understand the biology behind it. So much of prematurity stems from silent or invisible conditions. If they could identify and screen for more risks, they might be able to intervene earlier and help women deliver a healthy, fully developed baby.

Some risks of prematurity are well-known. For example, women are more likely to deliver a baby prematurely if they use fertility drugs or undergo in-vitro fertilization, if they smoke or have chronic diseases such as diabetes, anemia, high blood pressure and obesity.

Although some people might link prematurity with poverty or lack of health insurance, it can also affect young, healthy women with good medical benefits.

Alma V. Marquez, 29, of South Gate, carefully planned and timed her first pregnancy so she'd have the summer after finishing graduate school at UCLA to prepare for the baby's arrival. But four days after getting her diploma in 1999, something went wrong. Doctors tried to stop the contractions, but failed. Miquitzli Herrera was born weighing just 1.5 pounds with skin so transparent her bones showed through.

"I was thinking this baby was not going to live," Marquez recalled. "One of the doctors said, 'Don't get attached. She has a 50-50 chance.' "

Today, at age 3, Miquitzli speaks Spanish and English, attends preschool and has been catching up in physical and mental development with her peers.

The U.S. rate of premature births has reached 11.9% of all live births. Among white mothers in this country, the premature birth rate of 10.4% during 1998-2000 is comparable to that of countries such as France. But experts say the U.S. average is affected by elevated premature birth rates among African Americans: 17.5% of births in 1998-2000. As a result, researchers are trying to identify some genetic factors that may make African Americans particularly vulnerable. The premature birth rate among Latino women is 11.4% nationally.

Prematurity is a complex problem, and researchers are trying to identify the biology of why amniotic membranes break down and contractions begin, sending a woman into labor long before her baby is ready for the outside world.

"Nobody understands the chemical cascade that triggers labor," said Jennifer L. Howse, president of the March of Dimes, which is mounting a five-year, $75-million educational and research initiative into premature birth. The Southern California campaign kicked off Thursday; the national effort will be launched Jan. 30. The goal is to reduce prematurity by at least 15% on the way to a national goal of 7.6% set by the federal government in its Healthy People 2010 plan.

One of the problems is that prematurity isn't a distinct disease, like polio or spina bifida, simply fought with . vaccines or folic acid supplements.

According to Dr. Charles J. Lockwood, the chairman of obstetrics at the Yale School of Medicine in New Haven, Conn., researchers see premature birth stemming from several conditions they're making progress in understanding: infections before and during pregnancy; stress; uterine bleeding; and multiple births (such as twins or triplets).

Lockwood believes that identifying the genes that control a woman's response to infection, bleeding or stress "will allow us to identify women at risk even before they get pregnant," and help in the development of therapies to help carry their babies to full term.

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