The goal of pregnancy is to give babies the time they need to develop fully inside their mothers’ bodies. But life and pregnancy do not always go as planned. Although medicine has evolved to where babies now have a fighting chance if they are born much earlier than 40 weeks, it is important to understand preventative steps to help reduce the risk of facing prematurity. As the nation’s largest provider of NICU services and care for premature babies, MEDNAX is committed to taking great care of our patients, including our youngest.
Defining and understanding prematurity
Gestational age refers to the number of weeks of the pregnancy. For classifying premature birth, the following definitions are used, based on the gestational age at birth:
- Full term birth: 39 to 40 weeks
- Early term birth: 37 to 38 weeks
- Preterm birth: Before 37 weeks
- Early preterm birth: Before 34 weeks
- Very preterm birth: Before 32 weeks
- Extremely preterm birth: Before 28 weeks
Babies are also classified according to their birth weight:
- Low birth weight: Less than 2500 grams (5 pounds 8 ounces)
- Very low birth weight: Less than 1500 grams (3 pounds 5 ounces)
- Extremely low birth weight: Less than 1000 grams (2 pounds 3 ounces).
About one in 10 babies in the U.S are born preterm. Although preterm birth is the leading cause of low birth weight, it is possible to have low birth weight in a term baby if the growth has been less than normal. In general, the earlier the gestational age and the lower the birth weight, the higher the risk that the baby will have serious, and sometimes lifelong, health complications.
Preterm birth has a variety of causes. Most often, preterm birth is spontaneous (natural), due to the early onset of labor or a leak in the amniotic sac surrounding the baby. But sometimes the birth is intentionally induced by the physician because of complication with the baby (such as poor growth or another sign of trouble) or complication with the mother (such as dangerously high blood pressure, bleeding or infection).
Ways to reduce the risk of preterm birth
Premature birth can be unpredictable. A woman who does everything right during her pregnancy may still find herself giving birth early, while women with certain risks factors for premature birth may never experience it.
To encourage healthy development, there are certain behaviors, wellness tips and general information to know about risk factors that could lead to premature birth.
Having already experienced preterm birth with a previous pregnancy
Be sure to share this information with your physician because it increases your risk in future pregnancies. If you are at risk, your physician may recommend a preventative medication (hydroxyprogesterone caproate), which reduces the risk of recurrence of preterm birth, and may also recommend special ultrasounds to evaluate the length of your cervix.
Problems with the cervix
Women who have a short cervix are at increased risk for preterm birth. Fortunately, treatments are available to reduce this risk. Vaginal progesterone is a medication the reduces the risk of early preterm birth. Cervical cerclage is a procedure where the cervix is stitched closed until delivery. Another option is a cervical pessary, which is a silicone device placed around the cervix to provide support. Your physician will discuss the advantages and limitations of these three methods and help you decide which, if any, is appropriate to use.
Multiple babies (twins, triplets, etc).
Multiple pregnancy may occur naturally or may be the result of assisted reproductive techniques such as ovulation induction or in vitro fertilization. Women who are considering in vitro fertilization should discuss the number of embryos being transferred due to the risk of prematurity that may arise from multiple pregnancy.
Excessive strain on the body
Strain may be physical and emotional, such as standing for long periods of time, moving heavy objects, high stress or abuse. If you face such situations during your pregnancy, explore ways to receive accommodations or help to keep you and your baby safe.
Chronic health conditions
Long-term illnesses should be uniquely managed for the changes that occur in the body during pregnancy. Be sure to discuss your health conditions early with your pregnancy team, consult any recommended specialists and follow instructions.
Age
Women under 17 years old or over 35 years old have increased risks of preterm birth. However, proper prenatal care and monitoring by a physician may reduce this risk.
Time between pregnancies
While many women carry healthy babies to term even when conceived immediately after each other, it is advisable for a mother to give her body at least 18 months to fully recover from the stress and strain of pregnancy before conceiving another child.
Behavioral choices
As with any pregnancy, women are encouraged to maintain a healthy weight and diet, get enough rest and avoid toxic substances such as smoking or drinking alcohol.
Preterm labor versus preterm birth
Preterm labor is the occurrence of contractions of the uterus, often felt as tightening and sometimes felt as labor pain. Other symptoms such as pressure in the lower abdomen and changes in vaginal discharge or urine symptoms may occur. More than half of the time, preterm labor contractions will stop on their own.
If preterm labor does not stop, your physician will determine the best treatments, considering the health of both the mother and the baby. If preterm birth can be delayed, physicians will usually pursue that course of treatment. Even just a few days or a week extra in the womb can allow for critical steps of growth to occur in the ideal environment of a woman’s body. Certain medications can help stop labor. If delivery is unavoidable, medications may be given to reduce the risk of conditions associated with prematurity, such as magnesium to prevent cerebral palsy or steroid injections to prevent breathing complications.
A woman's body is typically the best place for a baby to develop. That is why all preventative steps and interventions should be considered and used to help infants reach their full growth before coming into the world.