The NCMHEP will address one maternal and child health issue at a time for a period of 12 to 18 months. The specific length of this focus period will depend on the issue.
The Program’s first focus area is Late Preterm Birth and Elective Term Deliveries. Program activities are described below.
Late Preterm Birth
In the United States, preterm birth—defined as delivery before 37 weeks of pregnancy—is the greatest risk factor for infant death during the first month of life. In 2006, one in eight U.S. infants were born prematurely—a 20 percent increase over the 1990 rate. Most of this increase was due to an increase in
late preterm births, occurring between 34 and 36 full weeks of gestation. Infant mortality rates for late preterm infants are four times higher than rates for term infants (defined as 37 weeks to 41 weeks of pregnancy).
Babies delivered prematurely are often low birth weight—defined as weighing less than 1,500 grams (or about 3 pounds, 2 ounces)—and are at increased risk for mortality and morbidity. Some common medical complications experienced by preterm infants include: respiratory distress syndrome, intraventricular hemorrhage, and infection. These infants also have an increased risk of lifelong complications, such as cerebral palsy, intellectual and developmental disabilities, chronic lung disease, gastrointestinal problems, and vision and hearing loss.
The causes of the increase in preterm birth are complex and multifaceted. Some of the increase results from changes in how pregnancies are managed, with more women undergoing medically indicated or elective induction of labor. Some of the increase can be attributed to the rise in multiple births due to fertility treatments. Ethnic and racial disparities also play a role, especially poor prenatal care and unhealthy behaviors during pregnancy—both of which contribute to preterm birth. African American mothers are 50 percent more likely to have a preterm delivery than Caucasian mothers.
The first Issue-Specific Workgroup was created at the June 2009 Coordinating Committee meeting to address the issue this issue. The Workgroup chose to focus on the issue of elective late preterm delivery decision-making, with a focus on late preterm birth. The research in the field of maternal and child health is consistent and indicates that the rate of late preterm deliveries has been increasing and contributing significantly to the increase in preterm birth. However, the group believed that all maternal-fetal specialists and OB/GYNs may not be fully aware of this significant impact. There is also significant data that indicates that late preterm birth infants, although they may be similar in appearance to term infants, behave very differently and have more long and short term morbidities. These morbidities could potentially be preventable if the pregnancies are allowed to progress to a natural delivery.
Health care providers were chosen as the first audience of the NCMHEP late preterm birth initiative. Educating health care providers about the growing incidence of elective late preterm deliveries and their associated morbidities and cost (short and long term) will help them better inform their patients when faced with the decision to induce delivery prior to their due date. Ultimately this change in practice will help decrease the rate of late preterm birth.
Workgroup and Action Group Members
Resources on Preterm Birth