Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to the usual 40 weeks. These babies are known as preterm babies or premature babies. Premature infants are at greater risk of developing cerebral palsy, delays in development, hearing problems and sight problems. Actually, the earlier the preterm delivery, the greater the risks. Preterm birth complications also happen to be the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015 alone; although these deaths could be prevented with current, cost-effective interventions.
Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. WHO statistics show that across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. Most of these premature births occur due to preterm labour. Symptoms of preterm labour include uterine contractions which occur more often than every ten minutes or when the pregnant woman starts leaking fluid from the vagina.
Causes and Risk Factors of premature birth
The exact cause of a premature birth can be difficult to identify. However, certain factors are known to increase a woman’s risk of going into labour earlier than normal. Knowing what these factors are can help you or your doctor predict possible preterm birth when pregnant and plan properly to prevent or manage the outcome effectively.
Although preterm birth can happen to any pregnant woman, black women are more likely to have premature babies than women of other races for reasons unknown. Generally, a pregnant woman with any of the following conditions is more likely to have a preterm birth:
Other pregnancy-related factors associated with premature birth include:
- Poor nutrition before and during pregnancy.
- Smoking, using illegal drugs, or drinking too much alcohol during pregnancy.
- Certain infections, such as urinary tract and amniotic membrane infections.
- Premature birth in a previous pregnancy.
- An abnormal uterus.
- A weakened cervix opening early.
- Pregnancy with twins, triplets or other multiples.
- An interval of less than six months between pregnancies.
- Conceiving through in vitro fertilization.
- Being underweight or overweight before pregnancy.
- Stressful life events, such as the death of a loved one or domestic violence.
- Multiple miscarriages or abortions.
- Physical injury or trauma
Pregnant women also have an increased chance of delivering early if they are younger than 17 years or older than 35 years.
Supportive Care and Management for Premature Babies
On a general note, doctors define premature babies as being born alive before 37 weeks of pregnancy are completed. There are however, 3 sub-categories of preterm birth, based on gestational age the baby is actually born. They are:
- Extremely preterm (less than 28 weeks).
- Very preterm (28 to 32 weeks)
- Moderate to late preterm (32 to 37 weeks).
Babies born within these gestational ages will require special support and care after delivery to maximize their survival. There are several specialized supportive care systems used by doctors in management of preterm birth. They include:
- Incubation : Your baby will probably stay in an enclosed plastic bassinet (incubator) that’s kept warm to help your baby maintain normal body temperature. You will also be shown a particular way to hold your baby known as “kangaroo care” which involves direct skin-to-skin contact.
- Monitoring vital signs : Sensors may be taped to your baby’s body to monitor blood pressure, heart rate, breathing and temperature. A ventilator may be used to help your baby breathe.
- Feeding tube : At first your baby may receive fluids and nutrients through an intravenous (IV) tube. Breast milk may be given later through a tube passed through your baby’s nose and into his or her stomach (nasogastric, or NG, tube). When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible.
- Replenishing fluids : Your baby needs a certain amount of fluids each day, depending upon his or her age and medical conditions. The medical team will closely monitor your baby’s fluids, sodium and potassium levels to make sure that everything stays on target. If fluids are needed, they’ll be delivered through an IV line.
- Bilirubin lights : To treat infant jaundice, your baby may be placed under a set of lights known as bilirubin lights for a period of time. The lights help your baby’s system break down excess bilirubin, which builds up because the liver can’t process it all. While under the bilirubin lights, your baby will wear a protective eye mask to rest more comfortably.
- Blood transfusion : Your preterm baby may need a blood transfusion to raise blood volume especially if your baby has had several blood samples drawn for various tests.
How You Can Prevent Premature Births
Getting prompt and proper antenatal care significantly reduces your chances of having a premature birth. Another important preventive measure you can take is eating a healthy diet before and during your pregnancy. Make sure to eat lot of whole grains, lean proteins, vegetables, and fruits. Taking folic acid and calcium supplements is also highly recommended.
You should be in the habit of drinking lots of water every day. The recommended amount is eight glasses per day, but you’ll want to drink more if you exercise. If you have any chronic illness like hypertension, diabetes, heart disease e.t.c, work closely with your doctors and co-operate with them through out the pregnancy period.
In addition, quitting smoking, alcohol, using illegal drugs, or overusing certain prescription drugs is very important. These activities during pregnancy may lead to a higher risk of certain birth defects as well as miscarriage.
- Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027-35.
- Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth. The Lancet, June 2012. 9;379(9832):2162-72. Estimates from 2010