Premature Births

For the first time in three decades, the rate of premature births in the United States has declined for two years in a row, a finding that suggests the country is finally beginning to make some progress in the battle against prematurity. The declines were widespread and encompassing, including babies of mothers in all age groups under 40, all ethnicities, singleton and multiple births, vaginal and caesarean births, and every state except Hawaii, according to the report issued Tuesday by the government's National Center for Health Statistics.

A simple, safe, relatively inexpensive hormone treatment might help some high-risk pregnant women carry their babies longer, a new study  suggests, while improving the outlook for their infants. Such a treatment has been long sought. Even better, the newest one would appear unlikely to cost $690 a dose — unless drug makers are slow learners. Federal researchers, working with colleagues at 44 medical centers, found that administering vaginal progesterone to women with a short cervix — a risk factor for premature delivery — cuts the rate of delivering before 33 weeks by 45%. The reduction applies only to women with a short cervix (between 1 centimeter and 2 centimeters)

With recent advances in treatment, more than half of the babies born weighing less than two pounds will survive and lead normal lives, pediatricians say. But little progress has been made at reducing the incidence of premature births. In 1984, 6.7% of all babies born in the United States were low birth-weight babies, weighing less than 5 pounds, 8 ounces, according to the Children's Defense Fund in Washington. Twelve out of 1,000 were very low birth-weight babies, born at less than three pounds.

The price of a drug used to delay birth in women at high risk of delivering prematurely is going to skyrocket following Food and Drug Administration approval of a prescription form of the product, a synthetic form of the hormone progesterone. Since 2003, the American Congress of Obstetricians and Gynecologists has recommended that doctors offer the progesterone shots to high-risk women. But because there has not been a commercial product available, women have obtained the drug from so-called compounding pharmacies, which make it to order.

Microbes in the wrong place at the wrong time -- a woman's amniotic fluid during pregnancy -- may play a role in causing premature births, according to a study published in the online journal PLoS ONE. Using sensitive molecular techniques, researchers found a greater quantity and variety of bacteria and fungi in a significant portion of women who gave birth prematurely. The more severe the infection, the earlier the women were likely to give birth. The amniotic sac, which surrounds a fetus, has long been considered a protected, almost inviolable, site.

Obstetricians have identified the first medical treatment that can prevent premature births in large numbers of high-risk pregnant women, a discovery that could halt the spiraling increase in early deliveries in this country. A nationwide team of researchers has found that administering a form of the hormone progesterone weekly during the mid to late stages of pregnancy can reduce premature births by a third.

A premature baby tethered to life support systems has become an increasingly common symbol of America's front-line assault on infant deaths. But that expensive, high-tech approach has major shortcomings, according to federal and private study groups who are calling for more emphasis on reducing the number of premature births.

When Sandra Beigal heard the sound of her newborn daughter crying for the first time, her own tears welled up. The pregnancy had been a difficult one, with her body stubbornly resisting the medication intended to prevent her triplets from arriving prematurely. "I was so relieved when I heard her, and it was a wonderful surprise because I was expecting three boys," she said this week while adding the footprints of her daughter and two sons to the family album.

More than 12% of U.S. babies were born prematurely in 2003, a record high, as women delayed motherhood and doctors took steps such as inducing labor in some older women, the National Center for Health Statistics said. The teenage birthrate, meanwhile, continued to decline to 41.6 births per 1,000 females 15 to 19 years old, a decline of 3%. About 499,000 infants in 2003 were born after fewer than 37 weeks' gestation.

Rates of premature birth and low birth-weight babies showed the first decline since the early 1980s, according to a report released Wednesday by the National Center for Health Statistics. The pre-term birth rate, defined as infants delivered at less than 37 weeks of pregnancy, fell to 12.7% of all births. The rates of low birth-weight babies declined slightly to 8.2%. Births to teenagers increased for the second straight year, now accounting for 42.5 of every 1,000 U.S. births, and births to unmarried women rose to nearly 40% of all births.

The Food and Drug Administration on Thursday issued its strongest warning against the use of a drug prescribed off-label to prevent preterm labor, saying it appears to be ineffective at delaying premature births and poses serious health risks for pregnant woman who take it for longer than 72 hours. The warning comes less than two weeks after the FDA approved a new drug , called Makena, to reduce the risk of premature delivery. One in eight babies born in the U.S. each year -- 543,000 -- is born prematurely, says the March of Dimes . Terbutaline , commercially marketed as Brethine and Bricanyl, is a drug approved for the treatment of asthma and chronic obstructive pulmonary disorder, sometimes called emphysema.

For the first time, the Food and Drug Administration on Friday approved a drug to reduce the risk of premature delivery, although it required the manufacturer to conduct more studies to demonstrate the drug's efficacy. The agency gave the nod to a synthetic form of the hormone progesterone, which is normally produced during pregnancy, that can be injected into women who have already had a spontaneous preterm birth. The weekly injections, to be marketed under the name Makena, are for use only in women who are carrying a single fetus and who have no other risk factors for an early delivery.

For the first time in three decades, the rate of premature births in the United States has declined for two years in a row, a finding that suggests the country is finally beginning to make some progress in the battle against prematurity. The declines were widespread and encompassing, including babies of mothers in all age groups under 40, all ethnicities, singleton and multiple births, vaginal and caesarean births, and every state except Hawaii, according to the report issued Tuesday by the government's National Center for Health Statistics.

Aiming to cut down on the high number of premature births across the nation, a new program will offer words of advice for pregnant women in a place that will be hard to miss: on their cellphones. The free text messages will be sent every week and will include information about such things as seeing the doctor, avoiding alcohol and cigarettes, and eating properly. Although it's just rolling out, the program — called text4baby — already has more than 18,000 women signed up for what's expected to be the largest nationwide health initiative using mobile phones.

Bill and Marcia Stlaske's first pangs of fear coincided with her labor pains. Stlaske, 31, had given birth to two healthy sons, both delivered somewhat early. But their third, Tyler, was on the way nearly a month before his January due date. Doctors tried to stave off delivery but found Stlaske's amniotic fluid too low. "They said they had to take him early," said Marcia Stlaske, a second-grade teacher from Crystal Lake, Ill. "It was terrifying." Not long ago, Tyler's birth on Dec. 30 at 36 weeks' gestation would have been considered skirting the edge of prematurity, defined as being born before 37 weeks.

An infection of the uterine cavity during pregnancy combined with premature birth doubles the risk that an African American child will develop asthma, researchers have found. The combination also increases risk for some other ethnicities, though less severely. About 8% of pregnancies are marked by such bacterial infections, called chorioamnionitis, but it is not yet clear what proportion of asthma is induced by them, said the lead author, Dr. Darios Getahun of Kaiser Permanente's Department of Research and Evaluation in Pasadena.

Although an infection called bacterial vaginosis is associated with premature birth, treating infected mothers with antibiotics, surprisingly, does not reduce pre-term births, researchers from the University of Oklahoma report in today's New England Journal of Medicine. Bacterial vaginosis affects about 800,000 pregnant U.S. women each year, and about 10% of them give birth prematurely. Dr.

Pediatricians who specialize in the treatment of premature infants have made remarkable gains. Twenty years ago, a baby born 12 weeks early in the United States would have had little chance of surviving; today, that baby's chances of survival are more than 90%. In spite of this progress, the issue of prematurity remains a great concern because the number of children born too early is on the rise. Between 1981 and 2002, the rate of premature births in the United States increased almost 30%.

After an emergency cesarean with her first baby, Ruby Wales was holding out for a vaginal birth with her second one. With a toddler underfoot, the 33-year-old Mission Viejo woman wanted a faster recovery. But finding a physician to deliver her second child wasn't easy. Her first obstetrician turned her down flat. "She said, 'No -- no way,' " Wales recalled. Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine.

Taking folic acid supplements for a year before conception reduces the risk of very premature birth by at least 50%, researchers reported Monday. Shorter courses of the supplement were not as effective, according to the study of nearly 35,000 women reported in the Public Library of Science journal PLoS Medicine. Folic acid's effectiveness in reducing the risk of neural-tube and other birth defects -- even without such a long course -- is long established.