Preemies' Problems May Last a Lifetime

What can women actually do to help prevent premature births?
Especially for a woman who's never had a pregnancy before, it's really hard to know. We're planning to do a study on the woman who's never had a baby before. We have right now a solicitation, a request for applications for people to participate in this study. It will hopefully start in the end of 2009.

What about smoking and other things that women can control?
We know cigarette smoking makes your baby small and can make you deliver preterm. If I see a woman right now, what do I say to her? It's important to get good prenatal care and be healthy. If you have any medical condition, get that under control. If you have high blood pressure, get on a medication that's safe for pregnancy before you get pregnant. Start your prenatal vitamins early. Even if you're not ready to get pregnant, start taking a complex vitamin. There was an interesting abstract presented looking at preconceptual folate. Women who supplemented their diet with folate before they became pregnant had lower rates of preterm birth, so I would encourage women to take their folate. Eat a well-balanced diet. Be healthy going into pregnancy. Once you're pregnant, get good prenatal care. Know what your dates are so you know your due date so the baby can be followed better, to know if the baby is growing normally.

What bad habits, other than smoking, increase the risk of premature delivery?
Certain drugs such as cocaine cause the placenta to separate from the wall of the uterus. You could deliver early. Alcohol is strongly associated with fetal alcohol syndrome and fetal alcohol spectrum disorder, which affects the baby's ability to learn. I strongly recommend to my patients to abstain from alcohol from the moment they decide they want to become pregnant.

Does age make a difference?
Women who are at the extremes of age do have higher risks of premature birth. We don't know why. It may be that their uterus isn't conducive to having the placenta develop as well. We don't really know why. It simply may be that for the very young, it hasn't developed to the point that it's ready to carry a baby. Teen moms and older moms are more at risk of pre-eclampsia, which is thought to be due to the placenta not growing into the wall of the uterus as well as it could. Pre-eclampsia is one of the indicated causes of premature birth. It's also known as toxemia. It's when the woman will develop high blood pressure, their kidneys will get affected and spill protein into her urine. She can get other side effects. Her liver can get affected. In the worst-case scenario, she can have seizures. Your highest risk is going to be with your first baby and again, if you have other complications such as high blood pressure or diabetes.

What about obesity?
That's an interesting question. The studies are a little bit conflicting. The majority of the studies would suggest obesity may be a bit protective against preterm birth. But there are so many other problems associated with obesity with pregnancy. It's difficult to monitor, there are much higher risks of heart and congenital abnormalities like spina bifada. Obesity itself is a much greater risk than your potential risk of preterm birth.

What about multiple births?
You want to minimize multiples. Work with the infertility doctor to try to reduce the chances of having multiples.

What else do you wish women knew about premature births?
It's a public-health problem. It affects the baby in the short term and in the long term. Babies who are born preterm don't have optimal fetal development. If we could do more to understand this, we'd improve the health of the nation. If women have the chance to participate in a study to try to understand it, they should do it. Check out the NICHD Web site or talk to their doctor.

© 2008