Report demands investigation into rise in preterm births
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7560.169-a (Published 20 July 2006) Cite this as: BMJ 2006;333:169Data supplement
US report demands investigation into rise in preterm births
New York
Janice Hopkins Tanne
The rate of preterm births in the United States has increased by more than 30% since 1981, says a report from the US Institute of Medicine, part of the National Academy of Sciences. In 1981, 9.4% of US babies were born before 37 weeks’ gestation. By 2004, this had risen to 12.5%—about 500 000 infants.
Children born prematurely are at higher risk of death and health and developmental problems. The report estimates the cost to US society of births before 37 weeks is $26bn (£14bn; €21bn) a year, or $51 600 an infant. It includes medical care for the mother and the infant, lost household income and labour productivity, early interventions, and special education. It does not include costs after the age of 5 years or care for lifelong disabilities.
The report calls for an urgent national investigation into the causes, diagnosis, and prevention of preterm births. Although infants born before 32 weeks are at greatest risk for disease and death, those born between 32 and 37 weeks have more complications than infants born at term.
"One half of cerebral palsy cases are preterm. One quarter of mentally retarded infants are preterm. One quarter of those with hearing disabilities, and one quarter of those with vision disabilities are preterm," said Dr Norman Waitzman, an economist at the University of Utah in Salt Lake City.
Researchers said that the problem has not received attention because the people affected are young families with little political clout. Furthermore, miracle stories of tiny preterm babies who have survived have led people to think that "it’s no big deal."
African-American women have the highest rate of preterm deliveries. In 2003, 17.8% of pregnant African-American women gave birth to a preterm baby, compared with 11.9% of Hispanic women, 11.5% of white women, and 10.5% of Asian women. Even when levels of education and income were controlled for, African-American women were more likely to give birth early.
The report’s expert committee said that preterm birth has many causes, some of which overlap. These include individual behavioural and psychosocial factors, neighbourhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors, and genetics.
Women who have previously given birth prematurely or who were themselves born prematurely are at higher risk.
Infertility treatments such as implantation of multiple embryos and the use of drugs that stimulate ovulation contribute to the problem. About 62% of twins and 97% of triplets are born prematurely. The report recommends that guidelines be issued to reduce the number of multiple births resulting from infertility treatments.
The report, PretermBirth: Causes, Consequences, and Prevention, is available at www.iom.edu.
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