Friday, July 14, 2006

More babies being born early in U.S.

More babies being born early in U.S.
Economic impact put at $26.2 billion
By Frank D. Roylance
Copyright © 2006, Chicago Tribune
Published July 14, 2006

Each year, a growing percentage of America's babies are born too soon.

More of these premature infants are surviving than ever before--at least 500,000 in 2004. But the survivors face increased risks of cerebral palsy, mental retardation, vision problems, hearing deficits and other developmental and learning issues.

The economic consequences total at least $26.2 billion a year, according to a "conservative" estimate Thursday from a panel of experts assembled by the National Academy of Sciences' Institute of Medicine.

"And yet preterm births have not received the attention and funding necessary to fully understand the causes and consequences and to reduce the numbers," said Dr. Richard Behrman, panel chairman.

In 2005, preterm births accounted for 12.5 percent of all births, a 30 percent increase from 1981. Although African-American mothers are still more likely to deliver preterm babies, Caucasians, Hispanics and Asians are all seeing increases.

Among possible causes: an increase in in-vitro fertilization, higher birth rates among older women and a greater willingness by doctors and mothers to deliberately deliver babies before their normal 40-week term.

"It's very clear that preterm delivery is not just one disease; it's a very complex phenomenon that results from multiple interactions between genes and the environment," said Dr. Marilee Allen, a neuro-developmental pediatrician and professor at Johns Hopkins University School of Medicine who served on the study panel.

The panel called for sustained federal funding of research into the causes and prevention of preterm births, along with new, integrated research centers to tackle the scientific mysteries, track the consequences and find solutions.

It defined "preterm births" as any that occur more than three weeks early--before a pregnancy's 37th week.

One mystery is why African-American women have much higher rates of preterm births than other women.

In 2003, the panel reported, 17.8 percent of births to black women were preterm, compared with 11.5 percent among Caucasians, 11.9 percent among Hispanics and 10.5 percent among Asians.

Such medical disparities are often traced to African-Americans' lower average income and limited access to care. But the difference in preterm births persists even when researchers control for those factors, said Dr. Jay Iams, a panel member and vice chairman of obstetrics and gynecology at Ohio State University.

Another strong risk factor for preterm delivery is a prior such delivery, which doubles a woman's normal risk of having a baby early, the report states.

Multiple births also come with sharply increased risks of preterm delivery.

"Having more than one baby in the uterus incurs a several-fold increased risk for preterm birth," Iams said. "It approaches 40 percent for twins and gets closer to 70 or 80 percent for triplets and beyond."

That has raised questions about in-vitro fertilization technologies that implant multiple embryos in the hope that at least one will survive. Often, several do.

Other contributing factors, the panel said, may include a greater willingness to induce labor in a "medically chosen" preterm birth. These occur when doctors and families decide that other health concerns outweigh the benefits of keeping the fetus in the womb longer.

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