Surgeon general seeks plan to prevent premature births

Near-term babies fuel 2-decade rise

The government's strategy is particularly aimed at "late preemies," those born weeks, not months, early. (Jaime Aron/associated press/file 2002)

WASHINGTON - One in eight babies - well over half a million a year - are born premature, a toll that has risen steadily for two decades with no sign of stopping.

The government this week begins an unprecedented push to figure out why, with special aim at preterm births that may be lowered: so-called late preemies, those born weeks, not months, early.

"The average woman should be thinking about this," said Steven Galson, acting surgeon general, who opened a two-day conference yesterday on developing a national strategy to prevent premature birth. "We really need to redouble our efforts."

There are some steps mothers-to-be can take to reduce their risk, if only more got the message.

A full-term pregnancy lasts from 38 to 42 weeks. Babies born before completion of week 37 are premature. Scientists know far too little about what triggers early labor, or how to stop it. Especially for preemies born before 32 weeks who, despite advances in the neonatal ICU, are most likely to die or suffer devastating disabilities. On the other hand, there are troubling signs that a portion of the increase in late preemies, those born between 34 and 37 weeks, may be because of unnecessary caesarean sections.

If slightly early birth sounds like no big deal, consider: A baby's brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks, says a dramatic "brain card" developed by the March of Dimes to educate women. Also, being even a few weeks early can cause initial breathing problems if lungs are not mature enough. "Most women are not really aware of how two to three weeks can make a big difference in the full development of the baby," said Dr. Jennifer Howse, the March of Dimes president. These near-term babies make up 70 percent of all premature births and they, not very early preemies, are fueling the two-decade rise, said a recently published study from the federal Centers for Disease Control and Prevention and the March of Dimes.

"What's driving that is where we're going to get our biggest bang for the buck," said Dr. Catherine Spong, pregnancy chief at the National Institute of Child Health and Human Development.

C-sections soared in that time frame, too, and the new study links the two. Researchers examined nine years of singleton births and found that C-sections accounted for almost all the increase in late preemies.

There are clear guidelines that a C-section should not be scheduled before full-term unless there is a medical need. But uncomfortable moms-to-be sometimes request delivery before their due date. There also can be confusion about the fetus's exact age, prompting the Institute of Medicine in 2006 to urge that more pregnant women receive a first-trimester ultrasound exam. Having a firm conception date will allow for better delivery decisions months later. Smoking and lack of prenatal care are the top preventable risks. To push health authorities to address those, the March of Dimes this fall will begin grading states on their rates of preterm birth and pregnant women's access to smoking cessation programs.