US preterm birth rate worst among developed nations

Robin Wulffson MD's picture
preterm birth, infant mortality, health problems, prevention, treatment
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The bad news is that the premature birth rate in the US is the worst among developed nations. The good news is that at present, the preterm birth rate appears to be on the decline.

Worldwide, approximately 15 million infants (more than 1 in 10) are born prematurely each year. To analyze this situation, the March of Dimes, the World Health Organization (WHO), and others prepared the first nation-by-nation global comparison of premature births. The report was released on May 2, 2012. Not surprisingly, the report found that more than 60% of the preterm births occurred in sub-Saharan Africa and south Asia; however, the premature birth rate for the United States is among the 10 highest worldwide (others include Brazil, India, and Nigeria).

The US preterm birth was found to be approximately 12%: a percentage far greater than that of Europe and other developed nations. For example, the rate in Canada is 9.2%, that of Australia is 7.6%, and the rate for Japan is half the US rate: 5.9%. Furthermore, the report noted that the preterm birth rate is on the rise in almost all nations from which reliable data could be obtained.

The report defined preterm birth as birth before 37 weeks of gestation or less notes that prematurity is the leading cause of newborn deaths (the first four weeks of life) and is the second leading cause of death after pneumonia in children under the age of five years. The report noted an ethnic variation in the rate; for example, in 2009, the rate was 17.5% for African Americans, compared to 10.9% for Caucasian Americans. The infants that survive being born prematurely do not always have a rosy future. A number of them will face a lifetime of significant disability.

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The report notes that a significant decline of infant deaths occurred among developed nations during the early and middle 20th Century. It attributed the decline primarily to improvements in socioeconomic, sanitation, and educational conditions. Another major factor was population health, most significantly a reduction in malnutrition and infectious diseases. Currently, many developing nations are experiencing a similar transition to a decreased infant mortality due to similar factors as above.

Countering the gloomy US statistics is a report released by the March of Dimes last November, which noted that preterm birth rates declined in almost every state between 2006 and 2009 in several states the change was more than 10%. The statistics presented by the March of Dimes in its “2011 Premature Birth Report Card.” “The three-year improvement in the U.S. preterm birth rate means that 40,000 more babies were given a healthy start in life and spared the risk of life-long health consequences of an early birth,” said Dr. Jennifer L. Howse, president of the March of Dimes. She added, “It means that, nationwide, we saved at least $2 billion in healthcare and socio-economic costs. Now we owe it to the other half a million infants who were born too soon to work together to give them the same chance.”

According to the report card, California, three states and Puerto Rico received an “F,” 11 states and the District of Columbia earned a “D,” 19 states got a “C,” 16 states received a “B,” and only Vermont earned an “A.” Overall, the U.S. received a “C” based on comparing the nation’s 2009 preliminary preterm birth rate of 12.2% with the March of Dimes new 2020 goal of 9.6% of all live births. According to the March of Dimes, the improvement in the preterm birth rate is due to a variety of health interventions. For more than two years, the March of Dimes has been working with hospitals and health policy experts to identify and promote quality improvement initiatives that have reduced the number of medically unnecessary cesarean sections and inductions scheduled before 39 weeks of pregnancy. Furthermore, new treatments, such as progesterone, which has been shown to prevent some preterm births in medically eligible women, has helped lower the preterm rate.

Take home message:
The United States currently has an excellent record for saving infants born preterm; however, it has a poor record at prevention. Increasing the risk of prematurity is poor lifestyle choices such as smoking and abuse of other harmful substances including both illegal and prescription drugs. Obesity, which is of epidemic proportion in the US, increases the risk of preterm birth and pregnancy complications including gestational diabetes. In the US, many women are postponing childbearing until they are older. Having children at an older age increases the risk of preterm birth and complications. The statistics are best for women who have their children between the ages of 20 and 30. Fertility treatment increases the risk of multiple births, which are much more likely to be born preterm. Fertility specialists are addressing this issue by limiting embryo transfer to one in for many women. In summary, to minimize the risk of prematurity engage in healthy lifestyle choices and, if possible, complete your childbearing by age 30.

References:
Born Too Soon: The Global Action Report on Preterm Birth
March of Dimes 2011 Premature Birth Report Card

See also:
Drug addicted newborns: a national disgrace
Sad statistics regarding fetal harm from maternal drug use
Sad statistics regarding fetal harm from maternal drug use
New CDC report: Twin birth rate soaring in U.S.
Moderate prematurity associated with behavioral problems

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