Prematurity: Risk factors and complications associated with preemies

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By Dr. Sara Singh, Paediatrician, Georgetown Public Hospital Corporation

World Prematurity Day
Observed on the 17th November each year to raise awareness of preterm birth and the concerns of the preterm babies and their families worldwide.

Babies are one of life’s greatest joys. For many, the anticipation, hope and excitement are great, but for some, the reality is nothing short of heartbreaking.
Prematurity is the number one cause of death in newborns worldwide. Fifteen million babies are born prematurely and more than one million die as a result of it. Babies that survive often have lifelong problems such as cerebral palsy, vision loss, hearing loss, breathing problems and intellectual disabilities.
World Prematurity Day is observed on November 17 each year to raise awareness of preterm birth and the concerns of the preterm babies and their families worldwide.

What is a premature baby?
This is the term given when a baby is born at least three weeks before its due date, or at less than thirty seven weeks’ gestation. The earlier a baby is born, the more severe his or her health complications are likely to be. Some of these babies may spend days or even months in a Neonatal Intensive Care Unit (NICU) where they receive specialized care until they are strong enough to go home.

What causes premature birth?

An expectant mom can do everything in her power to have a healthy full-term baby, but sometimes something goes wrong and she goes into preterm labour. The best thing to do is be prepared.
Some of the more common causes of preterm delivery are:

  • A previous preterm birth
  • Chorioamnionitis – This is a condition in which bacteria infects the membranes and amniotic fluid that surround the fetus.
  • Low socioeconomic status
  • Health problems in the expectant mother – Pregnancies complicated by diabetes or hypertension are associated with a higher incidence of prematurity.
  • Multiple gestation pregnancies – Preterm birth rates for twins have increased with advances in assisted reproductive technology and infertility treatment.
  • Maternal age – Preterm birth rates increase in women older than forty years old.
  • Ethnicity – Although most black women give birth at full-term, on average, black women are about 60 percent more likely to have a premature baby compared to white women.
  • Tobacco, alcohol and illicit drug use – About 15 to 20 percent of pregnant women smoke cigarettes. This is a risk factor for placenta abruption (separation of the placenta from the wall of the womb during pregnancy, especially when it occurs prematurely) and accounts as a factor for 15 percent of preterm births and 20 to 30 percent of babies born with extremely low birth weights (<1000g).
  • Problems with the uterus or cervix – Cervical incompetence is a medical condition in which a pregnant woman’s cervix begins to dilate and efface before her pregnancy has reached full-term.

Reducing the risk of prematurity
Most preterm babies arrive early without warning. However, some pregnancies are known to be at-risk of ending in preterm birth due to maternal or fetal complications. If such is the case, the team in charge of this delivery will prepare by offering advice and medications that help to improve the outcome for the preterm baby.
In some cases, obstetricians may suggest treatment that may delay birth to give the fetus more time to develop. In other instances, it is safest to deliver the baby preterm. One such example would be if the expectant mother has an infection or problems with blood pressure control. If this is the case, the mother can be given medication to help the baby’s lungs to mature before delivery, if there is sufficient time before delivery.
There are steps that women can take to help minimize the risk factors and complications associated with preterm labour and birth. It is very important to receive all the neonatal care offered. This is the only way a woman’s risk can be assessed beforehand.

A woman can reduce some of the lifestyle factors that are linked to prematurity if they:

  • Stop smoking or using any illicit drugs.
  • Refrain from using alcohol during pregnancy.
  • Use prenatal vitamins.

Good nutrition is very important. Women are at a higher risk of having a baby early if they are undernourished or underweight, particularly if their Body Mass Index (BMI) is less than 19.8 before pregnancy. Obese women (with a BMI more than 30) are at an increased risk for medical intervention that may lead to premature birth. It is unwise to diet during pregnancy but lifestyles can be improved. Being physically active throughout pregnancy will boost a woman’s overall wellbeing and reduce the risk of conditions such as diabetes and hypertension, which can lead to a premature delivery.
Physical abuse or stress from a serious life event can also cause premature delivery. It is important to get help. Confiding in a partner, friend or seeking advice from a doctor can provide the support needed to overcome the stresses that accompanies having a baby.

Taking home a premature baby
Paediatricians would not allow a premature baby to leave the hospital unless they feel that the baby is well enough to stay healthy at home and they are confident that the mother is capable of giving him/her the necessary care.
When a mother is finally told it is time to take her baby home, there is usually a flood of mixed emotion. On one hand, there may be sheer happiness at the prospect that her baby will finally go home with her. On the other, the prospect of taking home and caring for this tiny human can be daunting. The good news is that going home will be highly beneficial for mom and baby. By going home, there is a reduced risk of infection, there is better establishment of a feeding regimen and there is bonding between mother and child.

Article Categories:
Columns · Health · Issue 20 · Publication

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