Thursday, October 11, 2012
Statement of Alan E. Guttmacher, M.D.Director, Eunice Kennedy ShriverNational Institute of Child Health andHuman DevelopmentNational Institutes of Health
Preterm births have fallen for the fifth straight year in a row, reported the National Center for Health Statistics of the Center for Disease Control and Prevention, in one of its recent National Vital Statistics Reports (PDF - 311 KB). This welcome decline was seen for all groups, and for each stage of pregnancy.
Preterm infants-- those born before 37 completed weeks of pregnancy-- are at increased risk for infant death and a number of serious health concerns, including intellectual and developmental disabilities, cerebral palsy, and visual impairment. In later life, preterm infants are at increased risk for heart attack, stroke, high blood pressure and diabetes.
In 2011, the preterm birth rate was 11.72 percent, down 2 percent from the 2010 rate of 11.99 percent, a full 8 percent lower than the 2006 high of 12.8 percent. Although there are disparities in the preterm birth rate between groups, all groups experienced a decline. Since 2006, the preterm rate has declined 8 to 9 percent for non Hispanic white and non-Hispanic black infants, and 5 percent for Hispanic infants. Moreover, declines were seen among infants delivered early preterm (before 34 weeks) and late preterm (34 to 36 weeks).
Preterm birth is not fully understood and preterm delivery can occur among apparently healthy women. Throughout its history, the NICHD has investigated the causes of preterm birth, sought ways to prevent it, and to identify interventions during pregnancy, labor and delivery, and after birth, to improve the health of both mothers and their infants.
One NICHD study found a drug that could reduce the risk of preterm birth in a certain category of high risk women. Last year, the U.S. Food and Drug Administration approved the use of 17 alpha-hydroxyprogesterone caproate (17P), a drug that reduces the chances of preterm delivery in a high risk group. A study in NICHD’s Maternal Fetal Medicine Units Network had earlier showed that the drug, a synthetic form of the hormone progesterone, could reduce the risk of giving birth prematurely among women who had given birth prematurely in a previous pregnancy.
NICHD’s Genomics and Proteomics Network brings together experts to apply advances in genomics and proteomics to the field of preterm birth research. This group has been studying the genetic and environmental causes and mechanisms of spontaneous preterm birth, with the goal of identifying biomarkers of increased risk of preterm delivery, and the ultimate hope of designing effective prevention strategies. Large studies in this network include a genome-wide association study to analyze the DNA of premature infants and another that is attempting to identify a common biomarker for prematurity in women who have had a previous preterm birth.
While we await the results of these and other promising NICHD research efforts now underway, there are steps women can take to maximize the chances that their pregnancies will be healthy and proceed to term.
The best time to start preparing for pregnancy is before the pregnancy even occurs. About half of all pregnancies, in fact, are unintended. So it is really important for women of child bearing age to optimize their health.
All women of child-bearing age should consume 400 micrograms of folic acid each day, either as a supplement or in a vitamin fortified breakfast cereal. The vitamin reduces the chances that a baby will have a neural tube defect, a class of birth defects resulting in partial paralysis or damage to the baby’s brain. Vitamin B12 is also important for reducing the chances of neural tube defects. Women who eat little or no animal products are at high risk for B12 deficiency and so might consider a supplement containing B12.
Similarly, women of child bearing age shouldn’t smoke or take illicit drugs, which are not good for a pregnant woman or her baby. Smoking and exposure to smoke also increases the risk for preterm birth and for small babies. Similarly, drinking alcohol during pregnancy could cause birth defects that include mental retardation, learning deficits, and a complex of specific facial characteristics.
Women should eat a varied, healthy diet and try to maintain a healthy weight. Proper nutrition is important for both mother and baby and obesity can complicate a pregnancy. Information on proper nutrition during pregnancy is available at http://www.choosemyplate.gov/. Regular exercise is also important.
Women contemplating pregnancy should make sure their immunizations are up to date. It is best to do this prior to pregnancy because some vaccinations are best given before pregnancy begins. Women should notify their doctors as soon as they know they’re pregnant, so they can schedule a time to be seen. They should let their doctors know if they have any medical conditions. Ideally, it’s best to get medical conditions under control before pregnancy.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s Web site at http://www.nichd.nih.gov/.
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