Latest Causes of Prematurity

Maternal Risks of Prematurity Update

by Candy on June 8, 2010 No comments

preemie 26 wk Last week two stories in the news broke my heart.

The first, from the June issue of Pediatrics, mentions a study which found C-Sections may increase the risk of celiac disease, as opposed to  those infants born vaginally.

Celiac disease is an autoimmune disorder which leads to inflammation of the gut when the person consumes any foods containing gluten (a protein found in wheat, barley and rye). In terms of the western diet, that’s a toughie.

The researchers have no certain understanding of the process at this point, but hypothesize that  perhaps the phenomenon is linked to the fact that infants born via C-Section miss out on the squeeze down the vaginal tract. We know that action helps eliminate fluid in the respiratory tract, but now scientists think perhaps there are other important microbes an infant would ordinarily encounter which trigger some sort of digestive colonization. As in all closed systems,when one part malfunctions, the result has a domino effect.

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Another story, out of the journal, Obstetrics & Gynecology, mentions a study of over 20,000 pregnancies in Scotland spanning a period of 60 years. The results are glum: mothers who were themselves born early (defined as 24-37 weeks gestation) were 60% more likely to have a preterm baby. Although there is no cure at this time, just knowing it,  makes a case for early prenatal care.

Hang in there, mothers. The March of Dimes is working as fast as they can to find a solution.

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CandyMaternal Risks of Prematurity Update

Latest Causes of Prematurity

by Candy on July 3, 2009 No comments

According to the National Center for Health Statistics, preterm birth in this country has risen 36% since the 1980’s, resulting in roughly 540,000 preterm births in 2006. That number rose in 2007 and decreased slightly (0.1%)  in 2008, despite the March of Dimes’ excellent program (began in 2003) highlighting the problem and funding research to combat it.

Certainly, the alarm bell should be sounding, nationwide!  Why is this happening?

For years, it has been known that certain physiological events will trigger a preterm birth: trauma or injury to the mother is one, infection is another, incompetent cervix, a third, congenital anomalies, another (although in the past, those problems were often discovered at time of term delivery). We are only beginning to pull back the curtain on the complete range of possible answers.

For decades, statistics have shown preterm birth happens most frequently among those of African American descent, or women who’ve had a prior preterm delivery. Also, women of low socio-economic status, who lack prenatal care, overexert themselves physically or have stress induced low or high BMI, are more prone to premature delivery. Tobacco, alcohol, drug, or other substance abuse, prior induced abortion, prior cervical surgery, periodontal disease (!) , uterine overdistention (i.e., multiples, polyhydraminos), vaginal bleeding during pregnancy (placenta previa), uterine anomalies, anemia and reproductive tract infections also cause a woman to go into premature labor (Medscape, 2007).

Specifically, the newest studies show three main drivers of prematurity in the U.S.: increased maternal age, increased number of multiples, and increased number of cesarian sections (MOD, 2008). Looking at the list, it is obvious that the first begets the second, and hence the third. Behind the Big Three is the newest cause: Artificial Reproductive Technology (ART). Parents who delay childbearing are now able to conceive after age 35, which has been traditionally known as ‘too late to party.’ Some centers now guarantee a pregnancy by implanting multiple embryos. Some offer “Build a Baby” workshops where specific gender, hair and eyecolor selection is available. Indeed, it is a brave, new world in which we live. Now, don’t get me wrong. I’m not against ART (I’m an artist myself and enjoy the creative process), just cautious. The whole subject raises important questions we need to be asking, like : Have we taken liberty with our ability? Should tougher medical standards be in place? Where do we draw the line between what seems right for one, and what is right for society? Somewhere the call for bioethics sounds like the muffled  drone of the town crier, overtaken by automatic technological invention.

The irony remains that despite our high rate of premature infants, we are a nation of incredible scientific prowess. We can send a man to walk on the moon, we can maintain the lives of infants born so small their skin is transparent and their eyes are fused. (Indeed, I have spent the past 20 years of my career dedicated to these young persons.) But yet, we cannot predict exactly when a baby will be born, or why. Priorities.

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