The number of American babies born prematurely has been creeping up, and nobody knows entirely why. The Institute of Medicine of the National Academies convened a panel of experts to study the problem. They conclude that preterm births cost the nation at least $26 billion a year. They are calling for a major national effort to reduce the number of preemies.
A Growing Problem
"Prematurity is one of the very few childhood health problems that's on the rise," warns Dr. Jennifer Howse, president of the March of Dimes and a cosponsor of the new 600-page analysis.
The study indicates the rate of premature births has been going up year by year, a 30 percent rise over the past 25 years. Now, says Howse, 500,000 births out of 4 million babies a year are affected. She says the report is an overdue call for more research on what causes 12.5 percent of American babies to be born early.
"The report makes no bones about the fact that we haven't, as a nation, really invested very much in this area," she says.
Dr. Jay Iams of Ohio State University was on the expert panel. He says the success in saving preemies is one reason the problem has been neglected.
"The phenomenon of 'Isn't it wonderful what they can do with these little babies!' translates into: 'It's no big deal to have my baby born early,'" Iams says. "Of course it is a big deal, and a much bigger deal than most people realize until they're actually involved in it."
Many parents of premature infants discover the emotional and financial strains and a lifetime of worry about their children's development. Almost half of the nation's cerebral palsy cases, 25 percent of cases of mental retardation in children, and a quarter to a third of cases of hearing and vision loss at birth are linked to premature birth.
Causes of Preterm Births
African Americans are by far at highest risk for preterm birth, but, Iams says, contrary to popular opinion, research shows it's not just because they don't get early prenatal care.
"The best, most promising theory has to do with perhaps the chronic stress of being an African American woman throughout your life and the effect that might have on how your body responds to various stimuli that might trigger premature labor," Iams suggests, stressing that it remains only a theory. In any case, Caucasian mothers account for most of the increase in preterm births since 1990.
Experts say maybe 10 to 15 percent of preemies result from the dramatic increase in fertility treatments and in vitro fertilization, or test tube babies. These have often led to twins, triplets or other multiple fetuses, which are far more likely to be born premature. The new report says fertility specialists should transfer fewer embryos into a woman's uterus — only one when possible — and to restrict what's called "superovulation," the use of drugs that cause women to release multiple eggs at one time.
Dr. Richard Scott, a New Jersey fertility specialist, says he and his colleagues are working on the problem.
"We've already gone a long way to reducing the prevalence of multiple pregnancy through treatments of fertility," Scott says, And the occurrence of triplets is "already down by two-thirds or more and we're making small headway in dealing with twins."
He says many couples resort to superovulation because insurance companies won't pay for in-vitro fertilization, which allows more control over the number of embryos.
But, he notes, it is sometimes the only option available to couples. Scott says these couples are not going to give up on having a family because a committee of experts says it will increase their risk of twins and preterm births.