Large Racial and Ethnic Gaps Exist In US For Premature Births

Edward R. B. McCabe, MD, PhD Senior Vice President and Chief Medical Officer Professor Adjunct of Pediatrics, Yale University School of Medicine Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine Inaugural Physician-in-Chief, Mattel Children's Hospital UCLA Professor Adjunct of Pediatrics, Yale School of Medicine Chief Medical Officer March of Dimes

Dr. McCabe

MedicalResearch.com Interview with:
Edward R. B. McCabe, MD, PhD
Senior Vice President and Chief Medical Officer
Professor Adjunct of Pediatrics
Yale University School of Medicine
Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine
Inaugural Physician-in-Chief, Mattel Children’s Hospital
Chief Medical Officer March of Dimes

Medical Research: What is the background for this study? What are the main findings?

Dr. McCabe: The March of Dimes Prematurity Campaign was launched in 2003. The goal of the campaign is to lower the rate of premature birth to 8.1 percent of live births by 2020 and to 5.5 percent by 2030.

Premature birth is the leading cause of death for newborns, and a major cause of childhood disabilities. Worldwide, 15 million babies are born preterm, and nearly one million die due to complications of an early birth. The U.S. preterm birth rate ranks among the worst of high-resource nations. Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays.

The US earned a “C” on the 8th annual March of Dimes Premature Birth Report Card which revealed persistent racial, ethnic and geographic disparities within states. The report card provided preterm rates and grades for each state and the largest cities. The report card showed that although some progress is being made in reducing preterm births, not all families are sharing in the success.

State specific information is available at marchofdimes.org/reportcard

Portland, Oregon has the best preterm birth rate of the top 100 cities with the most births nationwide, while Shreveport, Louisiana has the worst, according to the 2015 Report Card. The U.S. preterm birth rate was 9.6 percent in 2014. The report card shows more than 380,000 babies were born too soon last year.

Medical Research: What should clinicians and patients take away from your report?

Dr. McCabe: We can help more babies be born healthy by wider use of the known interventions; and we need more research to identify the unknown causes of preterm birth and ways to prevent it.

Health care providers should talk to their patients of child-bearing age about what they can do to plan their pregnancy and about the importance of a full-term healthy pregnancy to the health of a baby.  They should be up-to-date on effective preventive measures, including:

  • Avoiding early elective (non-medically indicated) deliveries before 39 weeks of pregnancy;
  • Identifying and treating chronic health conditions in women before pregnancy;
  • Offering progesterone treatments for all women with a prior preterm birth, or a short cervix;
  • Following fertility treatment best practices to prevent multiple births;
  • Helping women quit smoking.

Women can also take steps to reduce their risk of having a preterm birth by:

  • Planning their pregnancy:  Getting a preconception checkup to be ready to become pregnant;
  • Spacing births – waiting 18 months between birth and the next pregnancy;
  • Not smoking during pregnancy;
  • Tell their health care provider about all their medications, both prescription and over-the-counter; discuss alternatives as necessary;
  • Going to all their prenatal care appointments, even if they feel well;
  • Getting to a healthy weight before pregnancy and controlling their weight gain during pregnancy;
  • Protecting themselves from infections;
  • Reducing stress;
  • Waiting until at least 39 weeks to deliver their baby, in a healthy pregnancy;

Women should know the signs of preterm labor and call their health care provider if they have any of the warning signs.  Signs of preterm labor include:

  • Contractions (your belly tightens like a fist) every 10 minutes or more often;
  • Change in vaginal discharge (leaking fluid or bleeding from your vagina);
  • Pelvic pressure — the feeling that your baby is pushing down;
  • Low, dull backache;
  • Cramps that feel like your period;
  • Belly cramps with or without diarrhea.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. McCabe: The March of Dimes has created a nationwide network of five prematurity research centers to discover the unknown causes of premature birth. These unique, transdisciplinary centers bring together the brightest minds from many diverse disciplines — geneticists, molecular biologists, epidemiologists, engineers, computer scientists, and others — to work together to find answers to prevent premature birth. The March of Dimes established research centers at Stanford University in California, at major universities and hospitals in Ohio called the Ohio Collaborative, at the University of Pennsylvania, at the University of Washington in St. Louis, and the University of Chicago, Northwestern University and Duke University. The Stanford and Ohio Prematurity Research Centers recently published important new findings furthering our search for the causes of premature birth.

Our team at Stanford found that the body’s microbial communities, called microbiomes, in the reproductive tracts of women who delivered their babies too soon were different from those of women who delivered full term. These findings may be useful in predicting which women are at higher risk of preterm birth.  They also found that the patterns of women’s microbiomes changed immediately after they delivered their babies, and did not revert back to pre-pregnancy patterns in some cases until at least a year later. This may be one reason that birth spacing is best for healthy, full-term pregnancies.

For more information on the microbiome and Pregnancy please click here.

Our team at the Ohio Collaborative found that a mother’s height directly influences her risk for preterm birth.  They found that maternal height, which is determined by genetic factors, helped shape the fetal environment, influencing the length of pregnancy and frequency of prematurity.  This study provides evidence that genetics play some role in preterm birth and adds an additional risk factor to be considered by health care providers.

For more information on a woman’s height and risk of preterm birth please click here.

Citation:

Link to March of Dimes Press Release

8TH ANNUAL MARCH OF DIMES REPORT CARD ON PREMATURE BIRTHS IN THE US

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Edward R. B. McCabe, MD, PhD (2015). Large Racial and Ethnic Gaps Exist For US Premature Births 

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