Preterm Births – Risks, Implications and Preventions

Each year, there are 15 million babies worldwide born prematurely (this equates to 1 in 10 babies), and in Australia 27,000 babies are born preterm every year which equals 9% of all births. “Born too Soon” is the theme of World Prematurity Day 2020 and is an opportunity to raise awareness of the challenges and impacts associated with preterm birth. As well as the ongoing health risks to the children associated with preterm births, preterm births can also take an emotional toll on families and become a financial burden. While some pregnancies are planned to be preterm due to other factors, this article discusses spontaneous preterm births, the risks and if possible – risk reductions.

What is a preterm birth?

A full-term pregnancy is regarded as being 39 – 40 weeks in duration. There are different classifications of preterm births defined by WHO which are based on weeks of gestational age. These are:

·       Preterm birth: before 37 weeks of pregnancy

·       Early preterm: before 34 weeks of pregnancy

·       Very preterm: between 28- 32 weeks of pregnancy

·       Extremely preterm: before 28 weeks of pregnancy

What ongoing health risks are related to preterm birth ?

Complications associated with preterm births include:

·       Preterm birth complications resulting in death and ongoing disability especially in babies born before 32 weeks

·       Underdeveloped brain, lungs and liver which takes the final weeks of pregnancy

·       Difficulty in regulating body temperature

·       Poor feeding and weight gain

·       Breathing problems

·       Ongoing nursery care and medication

·       Developmental delay

·       Cerebral palsy

·       Vision problems

·       Hearing problems

·       Surgical procedures

Who is at risk of a preterm birth?

Although it is not always known what causes preterm birth, there are some medical factors that increase risk as well as some modifiable lifestyle factors.

Medical history risk factors include:

·       A previous premature birth or a family history of premature birth

·       A multiple pregnancy (you are pregnant with twins, triplets or more)

·       Problems with your uterus (womb) or cervix

·       Certain health conditions such as connective tissue disorders, diabetes, high blood pressure and preeclampsia, infections (including sexually transmitted infections) and thrombophilia (cause of blood clots)

·       Specific foetal and maternal genotypes

Other medical risk factors include:

·       Receiving late or no prenatal care. This is often related to poor socio-economic factors

·       Lack of enough weight gain during pregnancy which can include eating disorders such as anorexia or bulimia

·       Vaginal bleeding in the second or third trimester

·       Premature rupture of the amniotic sac around the baby (your water breaks) prior to labour

·       Pregnancy from IVF

·       Pregnant with a baby who has certain birth defects such as spina bifida or heart defects

Demographic risk factors

There are some demographic risk factors associated with premature birth. These include:

·       Low socioeconomic factors such as education, job, income

·       Being younger than 17 and older than 35 years of age

·       Lower risk for white and Asian mothers -  higher risk for Indigenous, Black, and Hispanic mothers. It is unknown why race plays a role in premature births and researchers are working to learn more about this

Modifiable risk factors

There are also lifestyle risk factors that are associated with preterm birth which are considered modifiable and reduce the risk of early delivery. These are:

·       Smoking, drinking alcohol, abuse of prescription drugs, using illicit street drugs

·       High stress levels

·       Domestic violence including physical, sexual, and  emotional  abuse

·       Long working hours or work that includes standing a lot

·       Exposure to air pollution or chemicals found present in paint, plastics, and second-hand smoke

Can the risk of preterm labour and premature birth be reduced?

Yes. Although there are some risk factors you cannot change such as previous premature birth or other medical history, there are some pro-active steps you can take to reduce the risk of preterm labour before becoming pregnant. These include:

·       Quit smoking

·       Do not drink alcohol, use illicit drugs, or abuse prescribed medications

·       Get to a healthy weight before your pregnancy and gain the right amount of weight during your pregnancy

·       Wait at least 18 months before giving birth ad becoming pregnant again

·       Get treatment for any present chronic health conditions including high blood pressure, diabetes, depression, and thyroid conditions to better manage and control the condition before becoming pregnant

When you have learnt you are pregnant, what should you do? 

It is important to arrange for your first prenatal care check-up as soon as you learn you are pregnant and to continue with regular check-ups during your pregnancy even if you feel well. This allows us to ensure both you and your baby are healthy throughout your pregnancy.

Keep yourself protected from infections. When you come to your prenatal check-up, speak to us about vaccinations that help to protect from certain infections. Practice good hygiene such as regular hand washing after toileting or blowing your nose. 

Watch your diet. Do not eat raw meat, fish, or eggs. Eat healthy foods including green leafy vegetables, avoid over processed foods and don’t over-eat.

Practice safe sex.

Reduce your stress levels and keep active. Undertake some suitable activity every day such as walking, yoga or Pilates. Speak to your boss about what can be done to modify your stress levels at work or if you are in an environment that could be damaging to your health.

Be pro-active about making good choices before becoming pregnant and during your pregnancy

Overall, practicing good lifestyle habits that focuses on diet, exercise and reducing stress together with ensuring early and regular check-ups to your obstetrician during your pregnancy allows you to take positive steps during your pregnancy with a focus on reducing the likelihood of preterm labour.