Nation Ignores Preterm Birth Risks
Institute of Medicine Calls for Research to Explain Racial Disparity in Preterm Birth Rates
July 13, 2006 -- The U.S. has largely ignored the consequences of a rapidly rising rate of preterm births, causing health risks and costing the nation billions of dollars, an Institute of Medicine (IOM) report concluded Thursday.
Premature births are up 30% in the last 25 years, though the reasons why remain to a large extent shrouded in mystery, the institute says. Experts urge a broad new program of research and early detection that could help control a condition that affects one in eight live U.S. births and costs an estimated $26 billion per year in medical care and lost productivity.
"It's absolutely a floor in terms of a [cost] estimate," says Norman J. Waitzman, PhD, a professor of economics at the University of Utah and a member of the panel issuing the report.
Experts placed part of the blame on assisted reproductive technologies that greatly increase the likelihood of twins, who carry a higher risk of preterm birth. They called for stricter professional standards reigning in "superovulation" and other techniques that promote multiple births.
The report praises treatment advances credited with improving the survival of preterm infants. But experts warned that improved treatment has masked the health consequences of preterm birth, including cerebral palsycerebral palsy, mental retardation, and hearing and vision deficits.
"That translates into 'it's not a big deal to have my baby born early.' And it is a big deal," says Jay D. Iams, MD, a professor of obstetrics and gynecology at Ohio State University and a member of the IOM panel.
"This is a problem that is not appreciated by the public in the United States and that's a reason it has not received the kind of research support it deserves," he told reporters.
Spotting Pregnancy Trouble Early
Delivering prematurely -- earlier than 37 completed weeks of gestation -- in a woman's first pregnancy increases the risk of preterm births later on. But warning symptoms of a preterm birth are hard to spot and are often missed by first-time mothers and their doctors, experts say.
Any persistent feelings of pelvic pressure discomfort are a warning sign, but women who experience symptoms are often reluctant to contact their doctors, Iams warned. "It's very hard to pick this up, especially when it's in the first pregnancy," he says.
The report calls for increased use of early ultrasound exams to help doctors spot risky pregnancies as early as possible.
The report also strongly urged a redoubled research effort to figure out a perplexingly large racial disparity in preterm birth rates. While black women run an 18% risk of a preterm delivery; whites and Hispanics have just a 12% risk.
Economic conditions and varying rates of disease explain some of the difference but not all of it. "We cannot fully explain why these disparities exist," says Richard E. Behrman, MD, the chair of the IOM committee.
One theory suggests chronic stressstress could be a major contributor to increased preterm birth rates in blacks, Iams says.
The March of Dimes says the report proves a need for increased federal research funds toward preventing premature births.
"Today's report underscores the need to address premature birth in our country with the same sense of urgency and focus that has been brought to other threats to children's health," says Jennifer Howse, MD, president of the March of Dimes.