Preterm birth: Here’s all you need to know

When a baby is born before 37 weeks of pregnancy, it’s called premature or preterm birth. The earlier the birth, the more serious the health risks to the baby. The common risks include breathing problems and trouble maintaining temperature.

Here’s what you need to know about preterm births.

In a majority cases the cause of preterm birth remains unknown though a number of factors including sociodemographic (e.g age less than 25 and more than 35, socio-economic factors such as household strain, income, educational levels), nutritional (lack of micronutrients) biological ( genetics, infections, non-communicable diseases, obesity, substance abuse) environmental factors ( environmental toxins, household pollution, smoking) and maternal stressors (Stress, psychological distress, depression, anxiety) are under investigation.

In about one third of the preterm births, the decision for an early delivery had to be taken by the medical team due to the mothers’ and/or baby’s condition (e.g. a mother with high blood pressure or diabetes or other medical condition necessitating early delivery of baby, for example twin pregnancy)

Yes, and No. Yes in the sense that prevention of a preterm birth is possible, to some extent. Good health before going into pregnancy is encouraged. This is called pre-conception care.

Balanced diet with micronutrient supplementation, screening for infections including sexually transmitted infections, avoiding harmful substances e.g. smoking and alcohol intake, mental well-being, social support, weight management, birth spacing at least more than 24 months, review of any long term illness or medications are all necessary before a woman gets pregnant.

Ability to access early quality prenatal care and follow up/referral to higher level facilities has potential to reduce occurrence of preterm birth. Despite all these preparations and precautions, a woman can still deliver preterm since in a majority of cases no single cause can be identified.

Generally, we are seeing an increase worldwide with certain parts of the world being more affected than others. Worldwide the preterm birth rate was around 10 percent in 2000, with a slight increase over the years. Africa (North Africa- 13.4 percent, Sub-Saharan Africa- 12 percent) and Asia (10.4 percent) have the highest burden of preterm births, though increases have also been observed in developed countries such as the US (11.2 percent in 2014).

In Kenya, the preterm birth rate was estimated to be 12 per 100 live births in 2014 Kenya Demographic and Health Survey, this could have increased up to rates of 14 per 100 live births according to recent studies.

There are many determinants of preterm birth including limited access to quality pregnancy care for many mothers in low and middle income countries, nutritional challenges both before and during pregnancy, increased burden of infectious diseases, and a recent increase of non-communicable diseases such as diabetes and hypertension.

Additionally, adolescent pregnancies and short birth intervals (less than 24 months) could be contributing to the observed increase in rates of preterm birth. In the USA for example, stress associated with racism has been implicated in the observed increase and racial disparities of preterm birth rate.

Other factors being explored both in developing and developed countries include maternal stress, depression and anxiety, use of artificial technologies to enhance conception, environmental and household pollution, obesity, smoking and substance abuse.

Every mother’s dream is to have a healthy term baby delivered normally. Hence when a baby is born preterm the mother gets psychologically affected and struggles to find the reason why it happened to them. This can lead to poor health for the mother with physical, emotional and mental consequences.

Babies born premature will require extra care both in hospital (intensive care, medicines, special feeds, repeat hospital visits etc.) and at home (feeds, warmth, infection prevention, special care in case of disabilities etc.) and this will cause economic and social exhaustion both for the mother and her family.

Overall survival depends upon the gestation the baby is born and varies greatly between developed and developing countries. The odds of survival when a baby is born at less than 28 weeks of pregnancy (less than 1 kg baby) is low compared for example to a baby born between 32 and 37 weeks of gestation (1.8kg to 2.5kg baby).

In developed countries, 80 to 90 percent of babies born preterm are likely to survive as compared to only 10-20 percent in developing countries.

The reasons for this disparity have been attributed to issues around differences in quality of care during labour and delivery and quality of care offered to the newly born preterm. Simple inexpensive interventions such as Kangaroo Mother Care (KMC) can improve survival of babies born preterm.

Very early preterm babies especially those born below 28 weeks (less than 1 kg) require hospital intensive care and expertise to mitigate against the short-term and long-term complications. Incubators for 24/7 temperature control is a necessity for these types of preterm babies. Feeding techniques, medicines, infection prevention strategies, blood and blood products and oxygen support will improve survival.

A majority (85 percent) of preterm babies are born between 32 and 37 weeks (1.8 kg to 2.4 kg) and with improved quality of care this category of preemies should survive because they might not need very advanced type of care. Mothers of such preemies can be taught how to feed the baby with expressed breast milk, temperature control including Kangaroo Mother Care and infection prevention strategies.

Compared to term babies, preterm babies are at a higher risk of dying at birth and up to a few weeks thereafter. Preterm babies can also suffer a wide variety of both short-term and long-term challenges.

Short term challenges include difficulties in breathing, infections, feeding difficulties and seizures with long term challenges including cerebral palsy, abnormal growth of lungs, visual and hearing problems and learning problems. Research has also demonstrated problems later on in childhood (allergies, attention deficit disorders) and adult hood (asthma, heart disease, diabetes behavioral and socio-emotional difficulties).

If I have a preterm delivery, is it given that I’m likely to have a repeat of the same in my subsequent deliveries?

It is not given that you will have a repeat of the same in the subsequent deliveries but you have a slightly higher chance of delivering a preterm again compared to a woman who has given birth to a term baby. Approximately you have about a 15 percent chance of giving birth to a preterm baby in the next pregnancy but 85 percent chance that you will deliver a term baby!

Dr Musana is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi