When a baby is born before 37 weeks of pregnancy, it is called preterm labor or premature birth. The earlier the birth, the more serious the health risks for the baby. The most common risks are breathing problems and difficulty maintaining temperature.
Here’s what you need to know about premature birth.
Causes of premature birth
In most cases, the cause of preterm birth remains unknown, despite a number of factors, including sociodemographic factors (e.g. age under 25 and over 35 years, socio-economic factors such as family burden, income, education level), nutritional (lack of micronutrients) biological (genetics, infections, non-communicable diseases, obesity, substance abuse), environmental factors (environmental toxins, household pollution, smoking) and maternal stressors (stress, psychological problems, depression, anxiety) are examined.
In approximately one-third of preterm births, the decision for early delivery had to be made by the medical team due to the condition of the mother and/or baby (e.g., mother with high blood pressure or diabetes or other medical condition that necessitated early delivery ). of the baby, for example a twin pregnancy)
Can causes be detected and addressed early?
Yes and no. Yes, in the sense that preventing premature birth is possible to some extent. Good health before becoming pregnant is encouraged. This is called preconception care.
Balanced diet with micronutrient supplementation, screening for infections including sexually transmitted infections, avoidance of harmful substances such as smoking and alcohol consumption, mental well-being, social support, weight management, birth spacing of at least more than 24 months, assessment of long-term illness or medications are all necessary before a woman becomes pregnant.
The ability to access high-quality antenatal care and follow-up/referral to higher level facilities may reduce the occurrence of preterm birth. Despite all these preparations and precautions, a woman can still give birth prematurely, because in most cases no cause can be identified.
Trends in preterm birth
Overall, we are seeing an increase globally, with certain parts of the world being hit harder than others. Globally, the preterm birth rate was approximately 10 percent in 2000, with a slight increase over the years. Africa (North Africa – 13.4 percent, Sub-Saharan Africa – 12 percent) and Asia (10.4 percent) have the highest burden of preterm birth, although increases have also been observed in developed countries such as the US (11.2 percent in 2014).
In Kenya, the 2014 Kenya Demographic and Health Survey estimated the preterm birth rate at 12 per 100 live births. According to recent studies, this could have been as high as 14 per 100 live births.
There are many determinants of preterm birth, including limited access to quality antenatal care for many mothers in low- and middle-income countries, nutritional problems both before and during pregnancy, an increased burden of infectious diseases, and a recent increase in non-communicable diseases such as diabetes and hypertension.
Furthermore, adolescent pregnancies and short birth intervals (less than 24 months) could contribute to the observed increase in preterm births. In the US, for example, racism-related stress has been linked to observed increases and racial disparities in the rate of preterm births.
Other factors being investigated in both developing and developed countries include maternal stress, depression and anxiety, the use of artificial technologies to promote conception, environmental and household pollution, obesity, smoking and substance abuse.
Challenges faced by mothers of premature babies
Every mother’s dream is to have a healthy, full-term baby in a normal way. So, when a baby is born prematurely, the mother is psychologically affected and struggles to figure out the reason why this happened to her. This can lead to poor maternal health with physical, emotional and mental consequences.
Premature babies will require extra care, both in hospital (intensive care, medications, special diets, repeated hospital visits, etc.) and at home (feedings, warmth, infection prevention, special care for disabilities, etc.) and this will lead to economic problems. and social exhaustion, both for the mother and her family.
The survival rates of premature babies
Overall survival depends on the gestational age at which the baby is born and varies widely between developed and developing countries. The chance of survival when a baby is born after a gestational age of less than 28 weeks (baby weighing less than 1 kg) is low compared to, for example, a baby born between 32 and 37 weeks of pregnancy (baby weighing 1.8 kg to 2.5 kg). .
In developed countries, 80 to 90 percent of premature babies are likely to survive, compared to only 10 to 20 percent in developing countries.
The reasons for this disparity are attributed to issues surrounding differences in the quality of care during labor and the quality of care offered to premature newborns. Simple, low-cost interventions such as Kangaroo Mother Care (KMC) can improve the survival of premature babies.
Care for premature babies
Very early premature babies, especially those born under 28 weeks (less than 1 kg), require intensive care and expertise in the hospital to limit short- and long-term complications. Incubators for 24/7 temperature monitoring are a necessity for these types of premature babies. Nutritional techniques, medications, infection prevention strategies, blood and blood products, and oxygen support will improve survival.
A majority (85 percent) of premature babies are born between 32 and 37 weeks (1.8 kg to 2.4 kg). With better quality of care, this category of premature babies should survive because they may not need very advanced care. Mothers of such preemies can learn how to feed the baby with expressed breast milk, temperature management including Kangaroo Mother Care and infection prevention strategies.
Challenges faced by premature babies
Compared to full-term babies, premature babies are at greater risk of dying at birth and for several weeks afterwards. Premature babies can also face a wide variety of challenges, both short and long term.
Short-term problems include breathing difficulties, infections, feeding problems and seizures, with long-term challenges including cerebral palsy, abnormal growth of the lungs, visual and hearing problems and learning difficulties. Research has also shown problems later in life (allergies, attention deficit disorders) and adulthood (asthma, heart disease, diabetes, behavioral and social-emotional problems).
If I have a premature birth, am I likely to repeat the same thing in my subsequent deliveries?
It is not believed that this will be the case again in subsequent deliveries, but the chance of being born prematurely again is slightly higher than for a woman who has given birth to a full-term baby. About a 15 percent chance that you will have a premature baby in the next pregnancy, but an 85 percent chance that you will have a full-term baby!
Dr. Musana is a consultant obstetric gynecologist at the Aga Khan University Hospital, Nairobi
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