Complied by Sara Ellis Simonsen, RN, MSPH, and Michael Varner, MD
Preterm birth, defined as the birth of an infant at less than 37 completed weeks of gestation, is a serious public health problem in Utah and the United States. Infants born prematurely are at increased risk for morbidity and mortality when compared to infants born at term. Neonatal and infant mortality rates increase proportionally with decreasing gestational age, and preterm birth is the leading cause of infant mortality in the United States for non-anomalous liveborns. In Utah, approximately 80% of neonatal deaths occur in premature infants.
Preterm births are on the rise in both Utah and the United States, as illustrated by data in Figure 1. In Utah, preterm birth occurs less frequently than in the United States.
Healthy People 2010’s goal regarding preterm birth is that no more than 7.6% of deliveries should occur prior to 37 weeks gestation; in Utah, 10.8% of live births were preterm in 2004, as compared to 8.9% in 1994. Thus, the preterm birth rate increased by 21.3% in Utah between 1994 and 2004. More importantly, when accounting for the increasing number of overall deliveries each year in Utah (38,271 in 1994 and 50,653 in 2004), the number of babies born prematurely increased by 60.9% during the same interval.
Risk factors for preterm birth include maternal health status, obstetric and family history, gynecologic health, multiple gestations, low pre-pregnancy weight/BMI, preeclampsia, presence of a birth defect, maternal tobacco, alcohol, and drug use, minority race/ethnicity, low socioeconomic status, chronic stress, young/advanced maternal age, marital status, and occupational and environmental exposures. In Utah, preterm birth occurs most frequently among African American and American Indian/Alaskan Native women. The proportion of preterm births occurring in Utah African American women is 44% greater than the proportion occurring in Utah Caucasian women, a finding consistent with national statistics (see Figure 2). Teenage mothers and women with advanced maternal age are also at increased risk for preterm birth (see Figure 3). Data for Figures 2 and 3 is from the Utah Department of Health’s Indicator Based Information System for Public Health Birth Query Module.
The complications associated with preterm birth cost billions of dollars in direct costs and unrealized potential each year in the United States alone. The economic burden associated with preterm birth in 2005 was $26.2 billion, with an average cost of $51,600 per premature infant. These figures do not include long-term burdens or lost potential. Prevention of preterm birth is imperative if we are to reach the Healthy People 2010 goal. Risk factors for preterm birth that are most likely to be impacted by public health interventions include inadequate prenatal care, smoking, drug and alcohol use, inadequate weight gain, and poor diet.
- March of Dimes. Ten Leading Causes of Infant Mortality. Available online at http://www.marchofdimes.com/aboutus/1529.asp. Accessed July 20, 2006.
- National Center for Health Statistics. Preliminary Births for 2004: Infant and Maternal Health. Available online at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths04/prelimbirths04health.htm. Accessed July 20, 2006.
- U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2010. Available online at: http://www.health.gov/healthypeople/. Accessed July 20, 2006.
- Utah Department of Health. IBIS-PH Birth Query Module. Available online at http://ibis.health.utah.gov/query/module/selection/ birth/BirthSelection.html. Accessed December 12, 2006.
- March of Dimes. Peristats. Available online at http://www.marchofdimes.com/peristats/. Accessed December 12, 2006. 6. Institute of Medicine. Preterm Birth: Causes, Consequences and Prevention. 2006. The National Academies Press, Washington D.C. Available at: http://www.nap.edu/catalog/11622.html. Accessed July 20, 2006.