Q. My older sister had a premature baby four years ago, and the child has experienced many problems. Now that I am ready to begin a family, I wonder how the risk of premature birth can be minimized?
A. Yearly, more than 450,000 babies are born prematurely in the U.S., and the rate has increased by 25% in the last 20 years. Premature birth, defined as less than 37 weeks of gestation, is the No. 1 cause of illness and death among newborn babies. About one in three premature babies who survive have behavioral and psychiatric problems, and difficulties increase with decreasing birth weight. Problems in the other extreme, shyness and withdrawn behavior, are also more frequent. Unfortunately, there is some evidence that behavior problems in premature babies may worsen with age, although this is not yet established.
Health status before pregnancy matters much more than people realize. Women should prepare for their future children by eating well and getting appropriate physical exercise. A leading cause of premature birth appears to be dieting for weight loss prior to conception, for fear of being unable to lose weight later. Naturally, human research in this area is unethical, but new research conducted on sheep is raising disturbing questions. Underfeeding just prior to mating, designed to make the sheep lose about 15% of their bodyweight and defined as mild to moderate nutrient restriction, caused ewes to give birth one week early, equivalent to about two weeks prematurely for humans.
American women are often deficient in the omega-3 fats that are prevalent in fish. A study of nearly 9,000 pregnant women in Denmark found that those who said they currently ate no fish were around three times more likely to have a premature delivery than those who ate the most fish. A word of caution: Seafood is a major source of mercury in America. Nearly all fish, especially the larger varieties, are contaminated with mercury. Fortunately, there are many sources of fish oil available that are free of mercury and PCBs, and these can safely provide the important omega-3 fats that are the key to preventing so much unnecessary grief and suffering in this country.
Evidence is scant regarding some other potential risks to premature births, but the following need to be considered. There are the obvious possibilities such as use of illicit drugs, smoking, and certain vaginal infections that are associated with premature birth. One study concludes that gum disease may be associated with 18% of all cases of premature births. The currently most widely prescribed antidepressant medication, Selective Serotonin Reuptake Inhibitors, used anytime during pregnancy, will slightly increase the risk that a baby will be delivered early.
The natural nonprescription hormone progesterone has been shown to prevent premature labor, although for women already in premature labor no treatment has been able to delay birth for more than two days.
Taking a few precautions prior to pregnancy would go a long way toward reducing the pain and suffering that result from premature birth and the mental/emotional problems that often follow.
This article appears in November 7 • 2003.