ANN ARBOR, MI - Everyone knows that pregnancy lasts nine months, right?

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From their lungs and hearts to their brains and eyes, premature babies start life with a range of health problems that may never get better. Fortunately, many women who are pregnant or planning to get pregnant can do a lot to keep their babies from being born too early, says a University of Michigan expert.

By eating right, quitting smoking and drinking, seeing a doctor regularly, and even keeping their teeth healthy, mothers-to-be can cut their chances of giving birth to a premature baby, says Timothy Johnson, M.D., the chair of the U-M Health System’s Department of Obstetrics and Gynecology. Premature babies are those born more than a month before their due dates, or before 37 weeks in the womb.

Not every premature birth can be prevented, Johnson explains. But many can — especially among women who have a higher risk of giving birth too soon because of their health history, race or ethnicity, or because they’re carrying twins or triplets.

“For a lot of women, preventing prematurity is realistic,” Johnson says, “if women and their doctors work together to understand the risks and take preventive steps.”

And prevention is sorely needed. Across the U.S., 476,000 babies were born early in 2001 — including many in Michigan. The rates are especially high in some cities: 17 percent of Detroit babies and 14 percent of Saginaw babies were born prematurely.

Thankfully, doctors have made great strides in recent years in treating premature babies, and making sure they have the best chance at a healthy life. At the U-M’s C.S. Mott Children’s Hospital and other major centers, high-tech breathing machines and new medicines help babies who were born months too soon. This specialized care means that more premature babies than ever survive and thrive.

Even still, technology can’t save every premature baby, or make up for the gains they would have made in the womb. “The major reason that newborns die in the United States is because of prematurity,” Johnson says. “And the earlier they’re born and the less they weigh, the higher their risk of both death and long-term problems.”

Among those problems: lungs so weak that machines called ventilators have to breathe for the babies for weeks or months; blood vessels so fragile that babies experience bleeding in their brains that can cause permanent damage; and eyes so under-developed that their vision is harmed. Premature babies are at a higher risk for heart defects, digestive problems, cerebral palsy, and for other developmental and learning problems that will last a lifetime.

The special care that these babies need in their first weeks, and throughout their lives, can cost their parents extra time, money and energy. And their medical bills cost society billions of dollars.

The problem of prematurity is so serious, and so hard to fight, that the national March of Dimes organization, and major doctors’ groups, are spending millions of dollars to raise awareness about steps women can take before and during pregnancy to reduce the risk of premature birth.

Johnson and his colleagues are eager to help the effort. Every year, they help hundreds of women fend off early labor — and treat hundreds of babies born too soon and too small. UMHS is a major center for the treatment of low birth-weight babies (those who weigh 5 1/2 pounds or less), very low birth-weight babies (3 1/3 pounds or less) and even extremely low birth-weight babies (2 pounds or less). But the U-M team would rather see fewer of these kinds of patients.

So, Johnson offers the following tips for women on how to know if they have a higher-than-normal risk of giving birth prematurely, and steps to take to cut that risk:

Steps to take before pregnancy:

Before you plan a pregnancy:
Even women who aren’t thinking about getting pregnant should take some easy steps to prevent premature delivery, since many pregnancies aren’t planned, Johnson says. Women in their childbearing years should make sure to get the full daily dose of a vitamin called folic acid, which is found in foods like spinach and oranges, as well as breakfast cereals and vitamin pills.

While you’re trying to get pregnant:
Some key steps for any woman who is planning a pregnancy are to stop smoking, drinking alcohol or taking illegal drugs, Johnson notes. Not only can these habits harm a fetus and raise the chance of premature birth, they can also interfere with conception.

Women who want to get pregnant should also talk with their doctor or other health care provider about their overall health. This includes their weight — women who are underweight or overweight before getting pregnant have a higher risk of giving birth too early.

All women planning a pregnancy should also get checked and treated for infections in their genital area, which can affect their pregnancy. They should get their teeth checked, because serious gum disease can lead to infections that can cause a baby to be born too early.

African-American women, women under 20 years of age or over 35 years of age, and women with diabetes, clotting disorders or a history of giving birth prematurely have special risks for premature delivery. So do women who have had surgery on their cervix, or who get pregnant within nine months of giving birth.

When you’re pregnant:
The top piece of advice Johnson has for pregnant women is to see their doctor or midwife regularly, to make sure the pregnancy is going well. “Optimally, to decrease the likelihood of premature birth, women should get in early and often to make sure any treatments or therapies they need are taken care of,” he says. These regular visits, which doctors call prenatal care, offer the opportunity to catch problems and risks early.

Women should make sure they follow a balanced diet and gain a healthy amount of weight during their pregnancy, Johnson advises — 20 to 35 pounds for most women, but more or less for others according to their health care provider’s instructions.

Pregnant women who have had a premature baby before may now be able to get weekly injections of a hormone called progesterone that can keep their pregnancy going longer. “A recently released study funded by the National Institutes of Health showed that progesterone seems to reduce the risk of having another preterm delivery,” says Johnson. “And that’s really the first data that has come out in the last 25 years to suggest that we may have a therapy that can be targeted to women in certain high-risk categories.”

A growing factor — twin and triplet pregnancy:
“ Increasingly, one of the major causes of prematurity is the high number of twins being born,” Johnson explains. Fertility treatments and other reproductive technologies are leading to more of these “multiple pregnancies” — twins, triplets, and beyond. So, any woman carrying more than one fetus should get special attention to keep her pregnancy going as long as possible.

The bottom line, says Johnson, is that while not every premature birth can be prevented, we know more than ever about how to identify women who have the highest risk of delivering prematurely, and how to advise lower-risk women about things they can do.

“The reality is that prematurity is a problem that we still cannot do a lot about, for many women,” because it often occurs in women without known risk factors, he says. “But for certain women, we can. We also can advise every woman about steps we know can cut the risk. And we can make sure that research is done to find more good strategies to reduce the risks of prematurity.”

Facts and figures on premature birth:

• A normal pregnancy lasts about nine months, or 40 weeks. Babies who are born before they have been in the womb 37 weeks are considered premature, and those born before 32 weeks are considered very premature. Babies under 5½ pounds are low birth-weight.
• More than 476,000 American babies were born prematurely in 2001, or 11.9 percent of births. About 7.7 percent of babies were born with a low birth-weight.
• In Michigan, more than 15,800 babies were born prematurely in 2000. Detroit had the highest rate of premature birth, with 17 percent of babies born too soon, followed by Saginaw, Pontiac, Southfield and Taylor.
• Many premature babies die within a few weeks, although new technologies, medications and specialized medical teams have improved survival.
• Premature birth can cause a wide range of health problems, some of which last a lifetime. These include heart, lung, digestive, brain, learning and nerve disorders.
• In 2000, hospital bills for babies with conditions related to prematurity totaled $11.9 billion.
• Among the things that can put a woman at risk of giving birth prematurely are: a previous premature birth, a multiple pregnancy, smoking, unplanned pregnancy, overweight or underweight, infections and poor nutrition.
• Babies born to women under 20 years or over 35 years are more likely to be premature.
• African-American women have the highest rate of premature birth, followed by Native Americans, Latinos, whites and Asians.

Learn more on the World Wide Web at:

March of Dimes - Prematurity page:
www.marchofdimes.com/prematurity

UMHS - Getting ready for pregnancy: www.med.umich.edu/1libr/aha/aha_precon_crs.htm

UMHS - Prenatal care:
www.med.umich.edu/1libr/womens/pg12.htm

The Right Start: National Newborn Statistics: http://www.aecf.org/kidscount/rightstart2003/

Written by: Kara Gavin

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