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Preterm birth rate improves, but still below target

Many premature births occur when doctors schedule elective inductions too early based on inaccurate delivery dates, the March of Dimes says.

By Christine S. Moyer — Posted Dec. 9, 2010

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Using an ultrasound to determine a pregnant woman's delivery date -- and not inducing delivery before 39 weeks of gestation -- could help improve the nation's preterm birth rate, according to the deputy medical director of the March of Dimes.

A baby is considered preterm if delivered before 37 weeks. One in eight babies is born prematurely in the U.S. annually, the health organization said.

Although that number has been falling for the past two years, the preterm birth rate still is too high, according to a March of Dimes report issued Nov. 17. Many premature births occur when physicians schedule elective inductions too early because of a woman's inaccurate delivery date, said Diane Ashton, MD, MPH, deputy medical director of the March of Dimes.

She suggests that doctors use an ultrasound, rather than the date of a pregnant woman's last menstrual cycle, to determine the delivery date. The March of Dimes also encourages physicians to follow guidelines by the American College of Obstetricians and Gynecologists for inducing deliveries.

ACOG recommends that doctors not perform elective deliveries before 39 weeks gestation unless continuing the pregnancy poses a medical risk for the mother or baby, said Hal C. Lawrence III, MD, the college's vice president of practice activities. He said infants born earlier than 39 weeks often are not fully developed.

The March of Dimes suggests that physicians educate women about strategies that can reduce the risk of an early birth, such as quitting smoking and receiving regular prenatal care.

"While the [preterm birth rate] is far from the Healthy People 2010 goal, at least it's going in the right direction, and we hope it continues," Dr. Ashton said.

Preterm birth is the leading cause of newborn death, according to the March of Dimes. Babies who survive often have lifetime health complications, including breathing problems, cerebral palsy and intellectual disabilities. Even infants born just a few weeks early have higher rates of hospitalization and illness than full-term babies.

For the report, researchers gathered data from the Centers for Disease Control and Prevention and graded each state by comparing its number of babies born early to the Healthy People 2010 preterm birth rate target of 7.6%. The grades took into account each state's number of uninsured women, women who smoke and late preterm births, which occur between the 34th and 36th week of gestation.

Preterm births decrease

Of the approximately 4.2 million babies born in 2008, 12.3% were delivered before the 37th week of gestation, according to the CDC's most recent data. The figure improved from 2007, when 12.7% of all babies born were premature. In 2006, the preterm birth rate was 12.8%.

This marks the first time in three decades that premature births decreased for two consecutive years, according to the March of Dimes. A majority of the decline occurred among infants born a few weeks too soon. But the report said the preterm birth rate still falls short of the nation's 2010 goal (http://www.modimes.org/downloads/US.pdf).

Based on the findings, the March of Dimes gave the country a "D" on its annual premature birth report card. State grades ranged from a "C," which included states on the West Coast and in New England, to an "F," which involved much of the South.

"There will always be pregnancies that need to be delivered early" due to medical concerns for the mother or child, Dr. Lawrence said. "Prematurity will never entirely go away, but we need to work to make the instance of premature birth as low as we safely can."

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