tag:theconversation.com,2011:/au/topics/preterm-birth-29381/articlesPreterm birth – The Conversation2024-02-21T13:13:43Ztag:theconversation.com,2011:article/2223022024-02-21T13:13:43Z2024-02-21T13:13:43Z80% of premature baby deaths happen in poorer countries. Five simple measures that can help save them<p>Worldwide in 2020 a baby died every <a href="https://sasog.co.za/wp-content/uploads/2023/05/Born-Too-Soon-2023.pdf">40 seconds</a> because of complications of prematurity. Preterm birth is the <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">leading cause of death</a> among children under 5 years old. </p>
<p>The burden of preterm birth is <a href="https://sasog.co.za/wp-content/uploads/2023/05/Born-Too-Soon-2023.pdf">heavier in in low- and middle-income countries</a>, where around 80% occur. The countries with the highest recorded preterm rates in Africa are Malawi, South Africa, Ethiopia, the Democratic Republic of Congo and Botswana. In Ethiopia <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(23)00878-4.pdf">12.9%</a> of babies were born preterm in 2020. In Nigeria the figure was <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(23)00878-4.pdf">9.9%</a>.</p>
<p>Preterm birth occurs when a baby is born before 37 weeks’ gestation. Preterm babies are more at <a href="https://pubmed.ncbi.nlm.nih.gov/18207020/">risk</a> of severe neurological problems, like cerebral palsy, poor lung function and long-term problems with their guts. But around 95% of babies born preterm are born <a href="https://sasog.co.za/wp-content/uploads/2023/05/Born-Too-Soon-2023.pdf">after 28 weeks</a>. They often survive with relatively less complex medical interventions. </p>
<p>Given the scale of the problem, the preterm birth committee of the <a href="https://www.figo.org/">International Federation of Gynaecology and Obstetrics</a> selected five key interventions known to save lives. </p>
<p>We co-authored a recent <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15269">paper</a> in which we discussed the five measures. There are many other interventions that may improve outcomes at the time of labour and after preterm birth. But the five selected are clinically effective and relatively inexpensive options that can be practised in most settings.</p>
<h2>Five interventions</h2>
<p>The five interventions are:</p>
<p>1.) Giving a <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15269">course of steroids</a> before the baby is born. This triggers changes in the baby’s lungs, allowing them to expand, and so makes breathing easier. Additionally, it reduces the risk of brain bleeds, bowel complications and death. </p>
<p>A study run by the World Health Organization in low- and middle-income countries estimated <a href="https://www.emro.who.int/child-adolescent-health/newborn-health/prematurity.html">370,000 babies</a> could be saved each year if steroids were administered. </p>
<p>The drug is on the WHO <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.03">List of Essential Medications</a>. It is relatively easy to administer and carries a low risk of causing the mother any problems. It is also heat stable and does not require refrigeration, which is very important for environments where electricity is in short supply. </p>
<p>2.) Mothers can be given <a href="https://www.ncbi.nlm.nih.gov/books/NBK554553/">magnesium sulphate</a> soon before delivery. This is known to <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004661.pub3/full">stabilise cell membranes</a> in the baby. This protects neurons and therefore reduces brain damage. Magnesium sulphate given to a mother in preterm labour can be <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004661.pub3/full">lifesaving</a>.</p>
<p>This drug is also on the WHO <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.03">List of Essential Medications</a> and appropriate for low income environments.</p>
<p>3.) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641757/">Delayed cord clamping</a> for at least a minute postnatally at delivery. </p>
<p>When a baby is born their umbilical cord is clamped and then cut. However, a delay of around a minute before clamping is associated with a <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15269">reduction in neonatal death</a>. It also reduces the need for medications to support blood pressure in the baby – something that cannot be offered outside highly specialist medical facilities. </p>
<p>4.) Encouraging breast feeding within one hour of delivery.</p>
<p>Breastfeeding is particularly beneficial for premature babies, reducing the risks of serious complications of prematurity like severe infection or a serious bowel condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK513357/">necrotising enterocolitis</a> that often requires surgery as a lifesaving measure. </p>
<p>5.) Strongly encouraging immediate “kangaroo care”. </p>
<p><a href="https://www.who.int/publications/i/item/9241590351">Kangaroo care</a> involves a baby being placed skin-to-skin on the chest of its mother or another family member for extended periods of time – at least eight hours a day, but for as long as possible. </p>
<p>Premature babies are very prone to getting very cold. Kangaroo care <a href="https://pubmed.ncbi.nlm.nih.gov/34038632">reduces the risk</a> of death. This has been found to be the case even if there aren’t other options to stabilise the baby. </p>
<p>Kangaroo care also reduces the <a href="https://pubmed.ncbi.nlm.nih.gov/37277198/">risk of infection</a> and improves rates of breastfeeding. </p>
<p>Beyond the benefits for the baby, both kangaroo care and breastfeeding play an important part in involving parents in the care of their infant, and in reducing rates of <a href="https://pubmed.ncbi.nlm.nih.gov/37265678/">maternal postnatal depression</a>. </p>
<p>The risk of postnatal depression is known to be higher following a preterm birth. </p>
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Read more:
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<h2>Looking to the future</h2>
<p>All these interventions have a track record of being effective in low- and middle-income settings. But there has been no coordinated effort to make them better known worldwide. </p>
<p>Using multimedia and other training methods, the <a href="https://www.figo.org/news/new-ijgo-publication-effective-and-simple-interventions-improve-outcomes-preterm-infants">FIGO PremPrep-5 initiative</a> provides initial training to national obstetrics and gynaecology societies so that they can pass on the skills to other professionals.</p>
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<figcaption><span class="caption">Five simple ways to prevent preterm deaths.</span></figcaption>
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<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Preterm babies born after 28 weeks can often survive with relatively simple medical care. Here is how.Andrew Shennan, Professor of Obstetrics at King’s College London and chair of the FIGO Preterm Birth Committee (2012-23)., King's College LondonMegan Hall, Clinical Research Fellow, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103012023-11-20T14:36:06Z2023-11-20T14:36:06ZEarly births – between 34 and 37 weeks – for moms with pre-eclampsia can reduce baby and mother deaths<p>About <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790089/">half a million</a> babies die each year as a result of pre-eclampsia, an aggressive and potentially life-threatening problem in pregnancy. Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790089/">46,000 women also die each year due to the disorder</a>.</p>
<p>The condition – a high blood pressure (hypertension) disorder – can affect multiple organs in the woman’s body, including the liver, kidneys, heart, brain and blood clotting system, as well as the growth and development of the foetus. If severe, and untreated, it can lead to the placenta detaching from the womb (placental abruption), seizures, stroke, maternal death and stillbirth.</p>
<p>Pre-eclampsia can be difficult to predict, and it can progress rapidly. The only treatment is delivery. </p>
<p>In a <a href="https://cribs-i.org/wp-content/uploads/2023/07/Lancet-Planned-Delivery.pdf">recent paper</a> we found that planned early birth reduced the risk of stillbirth and improved most outcomes for mothers and babies. We concluded that clinicians can routinely deliver babies for mothers who have pre-eclampsia, from 34 weeks – even in a low resource setting. </p>
<p>We recommend that planned early delivery is implemented to reduce adverse pregnancy outcomes in late preterm pre-eclampsia, particularly stillbirth. We argue that the intervention should form part of a concerted global effort to end all maternal and perinatal deaths from preventable causes.</p>
<h2>When to deliver</h2>
<p>Deciding when to offer birth requires careful balancing of risks and benefits. Early preterm delivery (before 34 weeks’ gestation) is only recommended if severe complications of pre-eclampsia have developed, where the benefit of delivery outweighs the risk of potential complications of early preterm birth for the baby (for example, breathing or feeding difficulties). </p>
<p>For the period between 34 and 37 weeks, there has not been enough research to guide women and clinicians as to whether it is better to routinely offer late preterm birth to all women with pre-eclampsia, or to watch and wait until either 37 weeks’ gestation is reached, or complications develop. </p>
<p>We set out to answer this question in a trial which we carried out in India and Zambia.</p>
<p>The <a href="https://vimeo.com/amanifilms/cradle-4trial">Cradle-4 trial</a> was a randomised controlled trial which compared planned delivery (initiating delivery within 48 hours of trial entry) to usual care (watching and waiting until 37 weeks, or the development of complications needing delivery). Women who agreed to participate were randomly allocated to either planned delivery, or to usual care. A total of 565 women with pre-eclampsia, between 34 and 37 weeks of pregnancy, without an immediate indication for delivery, took part. The trial was conducted across nine sites in India and Zambia.</p>
<p>The study found that planned delivery significantly reduced the risk of stillbirth – by 75%. In addition, planned delivery did not increase the risk of the baby needing to go to the neonatal unit. Neither did it increase the risk of short-term complications after birth, such as breathing or feeding difficulties. This is an especially important finding for clinicians working with limited neonatal resources, who can be reassured that planned early birth is safe. </p>
<p>Encouragingly, planned delivery reduced the risk of severely high blood pressure in the woman, compared to usual care. Rates of other complications such as eclampsia and placental abruption (where the placenta detaches from the womb) were also lower in the planned delivery group. Mothers who delivered early were as likely as those in the usual care group to achieve a vaginal birth, and spent less time in hospital. </p>
<h2>Next steps</h2>
<p>The current maternal mortality rate in the world is 223 per 100,000. The aim under the Sustainable Development Goals is to reduce that to <a href="https://www.un.org/sustainabledevelopment/health/">70 per 100,000 live births by 2030</a>.</p>
<p>But this won’t happen unless there is a focus on interventions that address the major causes of maternal death in regions where they are most needed. These include sub-Saharan Africa and south Asia, <a href="https://www.who.int/publications/i/item/9789240068759">according to the World Health Organization</a>.
Our findings show that one such intervention should be to incorporate planned delivery from 34 weeks into routine care. </p>
<p>But this won’t be easy, particularly in low- and lower-middle income settings, due to over-stretched, under-staffed healthcare systems, where access to key resources may be variable. </p>
<p>To progress the idea, a number of steps need to be taken.</p>
<p>Firstly, early delivery should be incorporated into national and international guidelines across the globe. For this to happen there must an increased understanding around pre-eclampsia via community engagement. Women need to be better informed about what to look out for and what action to take, and need to be able to access healthcare facilities.</p>
<p>Community engagement is critical to translating research into impact and creating awareness about ways to alleviate this health issue. </p>
<p>This has already been initiated in some countries. For example, our research group has developed community engagement tools including docu-dramas designed alongside communities in Zimbabwe, Haiti and Sierra Leone. </p>
<p>A recent dynamic awareness campaign about pre-eclampsia was launched in Sierra Leone. It included creating competitions at universities to produce poems and videos about pre-eclampsia, putting stickers on taxis and motorbikes and putting up posters. </p>
<p>In Zambia, a national television broadcast encouraging women to attend antenatal care and recognise the danger signs of pre-eclampsia was shown on World Pre-eclampsia Day. </p>
<p>Secondly, planned delivery needs to be implemented alongside a range of interventions. Medical practitioners need to be enabled to provide early risk stratification, prediction of pre-eclampsia, safe labour and delivery care, and postnatal follow-up. </p>
<p>Thirdly, more research needs to be done in resource-stretched settings. Currently, only <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30539-8/fulltext">2% of clinical trials</a> take place in sub-Saharan African countries and even fewer address the most important causes of maternal mortality. </p>
<p>The <a href="https://vimeo.com/amanifilms/cradle-4trial">Cradle-4 Trial</a> acts as an important example of how this can be changed, and demonstrates the power of locally-driven evidence.</p><img src="https://counter.theconversation.com/content/210301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Beardmore-Gray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Planned early delivery is a key component of reducing child and maternal mortality.Alice Beardmore-Gray, Cradle 4 Trial Coordinator, Department of Women's Health, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061822023-11-09T01:26:42Z2023-11-09T01:26:42ZIt’s hard to find a surrogate in Australia. But heading overseas comes with risks<figure><img src="https://images.theconversation.com/files/532120/original/file-20230615-27-n0wdqe.jpg?ixlib=rb-1.1.0&rect=21%2C133%2C4656%2C3331&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/FqqaJI9OxMI">Unsplash/Kelly Sikkema</a></span></figcaption></figure><p>Surrogacy offers the chance of parenthood for those who can’t carry a pregnancy for medical or social reasons. </p>
<p>In a surrogacy arrangement, a surrogate gives birth to a baby for the intended parents to raise. Most intended parents are heterosexual or gay couples, but single people can also use surrogacy to have a child. </p>
<p>In the 2021–2022 financial year, <a href="https://www.homeaffairs.gov.au/foi/files/2022/fa-220800210-document-released.PDF">213</a> Australian babies were born through international surrogacy – an arrangement between Australian intended parents and a foreign surrogate. Just <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">100</a> surrogacy births were reported by Australian and New Zealand fertility clinics in 2021. </p>
<p>Australian surrogacy laws and <a href="https://www.nhmrc.gov.au/about-us/publications/art">ethical guidelines</a> aim to protect the interest of everyone involved with surrogacy. They also recognise the most important consideration of all is the welfare of the children born.</p>
<p>However, children born through international surrogacy aren’t protected by Australian laws because they’re born overseas. Our new <a href="https://doi.org/10.1080/14647273.2023.2270157">research</a> shows this can increase the physical and psychological risks to the child. </p>
<p>Making surrogacy easier to access in Australia could protect future children born through surrogacy. </p>
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Read more:
<a href="https://theconversation.com/becoming-a-parent-through-surrogacy-can-have-ethical-challenges-but-it-is-a-positive-experience-for-some-167760">Becoming a parent through surrogacy can have ethical challenges – but it is a positive experience for some</a>
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<h2>How does international surrogacy impact children?</h2>
<p>We surveyed more than 300 Australians who were parents through surrogacy, or were planning on having a child via surrogacy. We asked if they had picked international or domestic surrogacy and why, and we asked about the fertility treatment they and their surrogate received.</p>
<p>Respondents who had a child through international surrogacy commonly reported using two fertility treatments currently <a href="https://www.nhmrc.gov.au/about-us/publications/art">banned</a> in Australia: multiple embryo transfer and anonymous egg donation. </p>
<p>Surrogates sometimes supply their own egg, but mostly the egg is supplied from one of the intended parents or a donor. Once the egg has been fertilised, the resulting embryo is then transferred to the surrogate.</p>
<p>In Australia, only one embryo can be transferred to surrogates at a time. This is because multiple embryo transfer <a href="https://doi.org/10.1080/14647273.2020.1785643">increases the risk</a> of twin, or even triplet, pregnancies. These pregnancies are linked to higher rates of complications for the pregnant woman and the baby, including preterm birth. Preterm birth is when a baby is born before 37 weeks of pregnancy and is the <a href="https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth">main cause</a> of death in children below the age of five.</p>
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<img alt="Dad carries his twins in a field, while an older child runs ahead" src="https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Multiple births are more likely with international surrogacy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/O-RKu3Aqnsw">Unsplash/Juliane Liebermann</a></span>
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<p>Of the survey respondents who had completed international surrogacy, 37% reported multiple embryos had been transferred to their surrogate. Some 27% of parents through international surrogacy had a preterm baby and 11% had twins or triplets. In contrast, just 11% of parents through surrogacy in Australia had a preterm baby and none had twins or triplets. </p>
<p>If a donor egg is used in Australia, the donor-conceived person can access information about their donor once they turn 18. Anonymous donation is <a href="https://www.nhmrc.gov.au/about-us/publications/art">not allowed</a> because research shows many people born through egg or sperm donation <a href="https://pubmed.ncbi.nlm.nih.gov/22908619/">want to know</a> the identity of their donor. </p>
<p>Of the respondents who used donor eggs in international surrogacy, 47% said the identity of the donor was anonymous. Australians born through international surrogacy with anonymous egg donors may never know who their genetic mother is.</p>
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Read more:
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<h2>Why choose international surrogacy?</h2>
<p>The most popular reasons for picking international surrogacy were that surrogacy in Australia is long and complicated and it is difficult to find an Australian surrogate. </p>
<p>Most Australian surrogacy arrangements occur between <a href="https://sarahjefford.com/australian-surrogacy-statistics/">friends and family members</a>. If this is not possible, intended parents can join online communities to meet potential surrogates. However, the number of intended parents in these communities far <a href="https://www.surrogacyaustralia.org/surrogacy-process-chart/">outweighs</a> the number of surrogates.</p>
<p>For those lucky to find an Australian surrogate, they must complete a series of legal requirements as part of the arrangement. These requirements protect the interests of surrogacy participants and include legal advice, counselling and a court order to transfer parentage from the surrogate to the intended parents.</p>
<p>With international surrogacy, commercial agencies or brokers can match intended parents to a surrogate and the various Australian legal requirements may not be needed. </p>
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<span class="caption">In some countries, you don’t have to go to court for legal parentage of babies born via surrogacy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/WI-x1wo_Jm4">Unsplash/Omurden Cengiz</a></span>
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<h2>How can the risks of international surrogacy be reduced?</h2>
<p>Intended parents considering international surrogacy should choose single embryo transfers and, if required, a known donor. </p>
<p>However, intended parents may not always be equipped with the information or resources to make this choice. Known donors may not always be available overseas and some of our respondents said they transferred multiple embryos because they were following the advice of their doctor. </p>
<p>Most respondents said they would prefer to complete surrogacy in Australia if it were possible. This means if surrogacy was more accessible in Australia, fewer people might go overseas and more babies might be born in Australia where regulations protect the child’s physical and psychological health.</p>
<p>To make surrogacy more accessible, surrogacy laws should be reviewed by an inquiry by the Australian Law Reform Commission. The House of Representatives Standing Committee on Social Policy and Legal Affairs <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Social_Policy_and_Legal_Affairs/Inquiry_into_surrogacy">recommended</a> such an inquiry in 2016. This was never undertaken, but we don’t know why.</p>
<p>The Law Commission of England and Wales and the Scottish Law Commission <a href="https://www.lawcom.gov.uk/project/surrogacy/">recently published</a> recommendations for surrogacy law reform in the United Kingdom. One recommendation removes the need for a court to grant intended parents legal recognition. This is a <a href="https://www.lawgazette.co.uk/news/family-lawyers-welcome-revolutionary-surrogacy-recommendations/5115585.article">welcome</a> step forward. </p>
<p>However, the recommendations have also been <a href="https://www.progress.org.uk/law-commissions-proposals-wont-achieve-surrogacy-modernisation/">criticised</a> for not allowing surrogate compensation, which could discourage some people from becoming surrogates. Compensation is financial acknowledgement of the time and effort involved with the surrogacy pregnancy and is currently not allowed in Australia.</p>
<p>Law reform in Australia must address all barriers for domestic surrogacy, including the shortage of surrogates, to protect the welfare of children born through surrogacy.</p>
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<p class="fine-print"><em><span>Ezra Kneebone receives funding from the Australian Government Department of Education. </span></em></p><p class="fine-print"><em><span>Karin Hammarberg works for the Victorian Assisted Reproductive Treatment Authority. </span></em></p><p class="fine-print"><em><span>Kiri Beilby does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children born through international surrogacy aren’t protected by Australian laws.Ezra Kneebone, PhD Candidate, Monash UniversityKarin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityKiri Beilby, Course Coordinator (Graduate Diploma of Reproductive Science), Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037452023-08-03T12:25:11Z2023-08-03T12:25:11ZUS preterm birth and maternal mortality rates are alarmingly high, outpacing those in all other high-income countries<figure><img src="https://images.theconversation.com/files/537367/original/file-20230713-19-6sry09.jpg?ixlib=rb-1.1.0&rect=183%2C15%2C4928%2C3395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Maternal and infant health crises are growing worse in the U.S.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/black-mother-cuddling-sleeping-baby-son-on-sofa-royalty-free-image/758282421?phrase=african+american+baby+sleeping&adppopup=true">LWA/Dann Tardif/Digital Vision via Getty Images</a></span></figcaption></figure><p>Every two minutes, in about the time it takes to read a page of your favorite book or brew a cup of coffee, a woman dies during pregnancy or childbirth, according to a <a href="https://www.who.int/publications/i/item/9789240068759">February 2023 report</a> from the World Health Organization. The report reflects a shameful reality in which maternal deaths have either increased or plateaued worldwide between 2016 and 2020.</p>
<p>On top of that, of every 10 babies born, one is preterm – and every 40 seconds, <a href="https://www.who.int/news/item/09-05-2023-152-million-babies-born-preterm-in-the-last-decade">one of those babies dies</a>. Globally, preterm birth is the <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth#">leading cause</a> of death in children under the age of 5, with complications from preterm birth resulting in the death of 1 million children under age 5 each year. </p>
<p>The WHO has designated preterm birth an “<a href="https://www.who.int/news/item/15-11-2022-who-advises-immediate-skin-to-skin-care-for-survival-of-small-and-preterm-babies">urgent public health issue</a>” in recognition of the threat it poses to global health. </p>
<p>Those numbers reflect a worldwide problem, but the U.S. in particular has an abysmal record on both preterm births and maternal mortality: Despite significant medical advancements in recent years, the U.S. suffers from the <a href="https://tcf.org/content/commentary/worsening-u-s-maternal-health-crisis-three-graphs/">highest maternal mortality rate</a> among high-income countries globally. And the 2022 March of Dimes Report Card, an evaluation of maternal and infant health, gave the United States <a href="https://www.marchofdimes.org/peristats/reports/united-states/report-card">an extremely poor “D+” grade</a>. That data also revealed that the national preterm birth rate spiked to 10.5% in 2021, representing a record 15-year high. </p>
<p>We are maternal <a href="https://physiology.med.wayne.edu/profile/ad8024">fetal medicine experts</a> and <a href="https://womenshealth.wayne.edu/about/leadership/">scholars of women’s health</a> who focus on treatments and programs to help women have better maternal health, especially those that reduce preterm birth.</p>
<p>Our <a href="https://womenshealth.wayne.edu/">Office of Women’s Health</a> leads the <a href="https://today.wayne.edu/medicine/news/2023/07/11/wsu-leads-statewide-network-to-combat-high-rates-of-pre-term-birth-53745?wonderplugin-box-action=READ+PRESS+RELEASE">SOS Maternity Network</a>, which stands for the Synergy of Scholars in Maternal and Infant Health Equity, a research alliance of maternal fetal medicine physicians across the state of Michigan. </p>
<p>Maternal and infant death are the <a href="https://doi.org/10.1016/S2352-4642(20)30369-2">worst possible outcomes of pregnancy</a>. These numbers make clear just how crucial it is to change this trajectory and to ensure all Americans have practical access to quality reproductive health care.</p>
<h2>Dire state of maternal health care</h2>
<p>Tori Bowie, an elite Olympic athlete, <a href="https://www.npr.org/2023/06/13/1181971448/tori-bowie-an-elite-olympic-athlete-died-of-complications-from-childbirth">tragically lost her life</a> at just age 32 because of complications of pregnancy and childbirth. </p>
<p>Bowie’s story drives home the devastating state of maternal health in the U.S. Maternal mortality is a sad and unexpected ending to the often beautiful journey of pregnancy and childbirth. It means that a baby has to go without its mother’s love, care and comforting touch and at the same time the family has to mourn the sudden loss of their loved one. Unless substantial progress is made for lowering maternal deaths, the lives of over <a href="https://www.who.int/publications/i/item/9789240068759">1 million more women</a> like Bowie could be at risk by the year 2030, if current trends continue. </p>
<p>Unfortunately, the <a href="https://www.marchofdimes.org/peristats/reports/united-states/report-card">maternal and infant health crises are worsening</a> in the U.S., and this association is far from being an unfortunate coincidence. There is an important link between infant health and maternal health, as they both rely on the <a href="https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending">accessibility and quality of health care</a>. These U.S. rates have been increasing since 2018, when improved reporting of maternal deaths was adopted. </p>
<p>In 2020, the U.S. maternal mortality rate was 23.8 deaths per 100,000 live births – nearly three times as high as the country with the next-highest rate of 8.7 deaths per 100,000 live births, France.</p>
<p>The number of women who died within a year after pregnancy <a href="https://doi.org/10.1001/jama.2023.9043">more than doubled in the U.S.</a> over the 20-year period of 1999 to 2019. And there are significant racial disparities in this statistic: The highest number of pregnancy-related deaths were recorded among Black women, increasing from 26.7 per 100,000 births to 55.4 per 100,000 during that same time period. </p>
<p>Worse yet, the Centers for Disease Control and Prevention has determined that about <a href="https://www.cdc.gov/reproductivehealth/maternal-mortality/docs/pdf/Pregnancy-Related-Deaths-Data-MMRCs-2017-2019-H.pdf">84% of such maternal deaths</a> <a href="https://theconversation.com/more-than-4-in-5-pregnancy-related-deaths-are-preventable-in-the-us-and-mental-health-is-the-leading-cause-193909">are preventable</a>.</p>
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<figcaption><span class="caption">The U.S. maternal mortality rate for Black women is nearly three times higher than that of white women.</span></figcaption>
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<h2>Tragic rates of infant mortality and preterm birth</h2>
<p>Notably, in 2020 the U.S. also experienced the <a href="https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending">highest infant mortality rate</a> of all high-income countries. The U.S infant mortality rate was 5.4 deaths per 1,000 live births, in contrast to the 1.6 deaths per 1,000 live births in Norway, the country with the lowest infant mortality rate. </p>
<p>You may have heard the term “preemie” before, perhaps when a loved one delivered a baby more than three weeks before the expected due date. A premature birth is one that occurs before the 37th week of pregnancy. Preterm-related causes are responsible for <a href="https://www.marchofdimes.org/peristats/reports/united-states/prematurity-profile">35.8% of infant deaths in the U.S</a>. </p>
<p>Preterm babies are often not fully physiologically prepared for delivery, which can result in a range of medical complications. While preterm births lead to rising infant mortality rates, even those who survive can face health problems such as breathing difficulties, problems with feeding, significant developmental delay and more <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm#">throughout their lives</a>. Preterm birth also presents additional risks for the mother, as women who deliver preterm are at higher risk for cardiovascular complications later in life.</p>
<p>Thus, preterm birth <a href="https://doi.org/10.1002/14651858.CD007235.pub4">takes a significant toll</a> on families and their communities, with serious ramifications in medical, social, psychological and financial contexts. </p>
<h2>Maternal care during pregnancy is key</h2>
<p>Maternal care appointments and screenings are essential to prevent prenatal complications and a women’s increased risk for developing <a href="https://doi.org/10.1161/CIR.0000000000000961">long-term complications such as cardiovascular disease</a>. For that reason, patients should secure prenatal care as early as possible in the pregnancy and continue to regularly have prenatal care appointments. </p>
<p>Preterm birth can occur unexpectedly in an otherwise normal-seeming pregnancy. It looks no different from the early signs of a typical labor, except that it occurs before 37 weeks of pregnancy. The symptoms of premature labor can include contractions, unusual vaginal discharge, the feeling of pressure in the pelvic area, low dull backache or cramps in the uterus or abdomen. A person who experiences these symptoms during pregnancy should seek medical attention.</p>
<p>Some people are more predisposed to preterm birth based on individual risk factors like substance use, multiple pregnancy – such as twins – infections, race, a medical history of prior preterm delivery and heightened stress levels. Our research team and others have shown that <a href="https://doi.org/10.1080/14767058.2023.2199343">COVID-19 is a known risk factor</a> for preterm birth.</p>
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<figcaption><span class="caption">Be aware of the risk factors for preterm birth.</span></figcaption>
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<p>It’s important to speak with your primary care provider to assess how your current health may affect future pregnancy and whether lifestyle changes – such as adopting a healthy diet and active lifestyle and avoiding smoking and drinking alcohol – can improve your likelihood of a full-term delivery.</p>
<h2>Preterm birth prevention</h2>
<p>The more that pregnant women take ownership of their health and ask their doctors to perform a simple cervical length screening during their pregnancy, the earlier preterm birth can be detected and prevented and the more lives will be saved.</p>
<p>Evidence has shown that patients with a short cervix face a greater risk of the <a href="https://doi.org/10.1002/uog.7673">cervix’s opening too early</a> in pregnancy, resulting in preterm birth and other adverse outcomes. The cervix is the lower section of the uterus, which connects to the vaginal canal. As pregnancy progresses, it stretches, softens and ultimately opens in the process of normal childbirth.</p>
<p>All patients – even those who are seemingly low risk – should ask their doctors to have their cervical length checked by transvaginal ultrasound during pregnancy between 19 and 24 weeks. A short cervical length indicates a high risk of a premature delivery. Luckily, there are treatments available, such as vaginal progesterone, which can prevent preterm birth in women found by ultrasound to have a short cervix. This treatment can <a href="https://doi.org/10.1002/uog.9017">reduce the risk of preterm birth by more than 40%</a>.</p>
<p>We are optimistic that with greater awareness of these issues and a shift in the focus to evidence-based practices coupled with increased access to vulnerable populations, the U.S. can begin to give women like Bowie and so many others the health care they and their infants deserve. </p>
<p><em>This article has been updated to highlight the most recent trends in maternal mortality that were reported on July 3, 2023, and to highlight the stark racial disparities.</em></p><img src="https://counter.theconversation.com/content/203745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonia Hassan receives funding from Wayne State University. The Office of Women's Health receives funding from the Total Health Care Foundation and the Detroit Medical Center Foundation. </span></em></p><p class="fine-print"><em><span>Hala Ouweini does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A March of Dimes report gave the US a grade of D+ for maternal and infant health care, highlighting that the national preterm birth rate hit 10.5% in 2021, a record 15-year high.Sonia Hassan, Professor of Obstetrics and Gynecology and Maternal Fetal Medicine, Wayne State UniversityHala Ouweini, Research Associate in Women's Health, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092612023-07-20T18:06:04Z2023-07-20T18:06:04ZMental illness in fathers may increase the risk of preterm birth – new research<figure><img src="https://images.theconversation.com/files/538283/original/file-20230719-17-ovqac7.jpg?ixlib=rb-1.1.0&rect=18%2C0%2C5988%2C4007&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-stress-man-sitting-on-bed-1178105212">MiniStocker/Shutterstock</a></span></figcaption></figure><p>Mothers with a mental illness are more likely to give birth too early, according to <a href="https://pubmed.ncbi.nlm.nih.gov/32671543/">research</a>.</p>
<p>But the risk of preterm birth can also be affected by a father’s mental health.
In our <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004256">new study</a> published in the journal PLOS Medicine, we found that fathers’ mental illness increases the risk of preterm birth and that the risk is even greater when both parents are affected.</p>
<p>Preterm birth refers to <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">delivery before 37 weeks</a> of pregnancy, and is associated with a greater risk of negative health outcomes for the child. For example, babies born preterm have higher rates of neurodevelopmental conditions such as <a href="https://pubmed.ncbi.nlm.nih.gov/32960896/">autism spectrum disorder</a>. The earlier the baby is born, the higher the risk of complications.</p>
<p>Growing evidence suggests that risks of adverse health outcomes are elevated not only for infants born preterm, but also for infants born “<a href="https://pubmed.ncbi.nlm.nih.gov/32960896/">early term</a>” (at 37 to 38 weeks of pregnancy).</p>
<h2>1.5 million babies</h2>
<p>We included data on 1.5 million infants born in Sweden between 1997 and 2016. We obtained information about the parents’ mental health from the <a href="https://pubmed.ncbi.nlm.nih.gov/21658213/">National Patient Register</a>, which records all psychiatric diagnoses by clinical specialists in Sweden. We ascertained length of pregnancies in weeks (gestational age) from the <a href="https://pubmed.ncbi.nlm.nih.gov/36595114/">Medical Birth Register</a> where all Swedish births are recorded.</p>
<p>Some 15% of the infants had at least one parent with a mental health disorder. Children of parents with mental illness tended to have a shorter gestational age.</p>
<p>Compared with children where neither parent had a mental illness, infants whose fathers but not mothers had a mental illness had a 12% increased risk of being born preterm, whereas the risk increased by 31% if only the mother had a mental illness. If both parents did, the risk increased by 52%.</p>
<p>In absolute numbers, for parents without mental illness, one in 17 children were born preterm. A diagnosis in fathers increased the risk to one in 16, in mothers to one in 14, and in both parents to one in 12 children. We observed a similar pattern of risk for infants born at early term.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/perinatal-anxiety-one-in-five-women-experience-it-but-many-still-suffer-alone-before-or-after-childbirth-133667">Perinatal anxiety: one in five women experience it – but many still suffer alone before or after childbirth</a>
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<p>Of all the mental health conditions we looked at, stress-related disorders, such as post-traumatic stress disorder, were associated with the highest risk of preterm birth. The risk increased by 23% if the father had a stress-related disorder, 47% if the mother suffered from a stress-related disorder, and 90% if both parents had a diagnosis, compared with children where neither parent had a stress-related disorder.</p>
<p>The risk was also increased if parents had multiple different psychiatric disorders. For example, children of a mother with depression were 25% more likely to be born preterm compared to children of a mother without a psychiatric disorder. When the mother had depression and schizophrenia at the same time, the risk increased by 39%. If the mother had depression, schizophrenia and anxiety disorder, the risk increased by 65%. </p>
<p>Similar patterns were seen when the father had multiple disorders.</p>
<figure class="align-center ">
<img alt="A premature baby girl in an incubator." src="https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537540/original/file-20230714-16-ttindx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Being born early increases the risk of health complications for the baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-newborn-baby-girl-hospital-incubator-396467248">OndroM/Shutterstock</a></span>
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<h2>Why the link?</h2>
<p>Previous studies have linked mental illness in <a href="https://pubmed.ncbi.nlm.nih.gov/32671543/">mothers</a> with an increased risk of preterm birth, but we’ve known much less about the father’s role in this regard. Our study demonstrates the significance of a father’s mental illness in the risk of preterm birth.</p>
<p>The underlying mechanism is likely to be complex – we can only really speculate on what is behind these trends. </p>
<p>Maternal stress has been linked to higher levels of stress hormones, which may induce <a href="https://pubmed.ncbi.nlm.nih.gov/20147718/">premature contractions</a>. Suffering from a mental illness, or having a partner with a mental illness, will probably be a source of stress for an expectant mother.</p>
<p>Research suggests that a father’s <a href="https://pubmed.ncbi.nlm.nih.gov/20066551/">support during pregnancy</a> can moderate the effects of maternal stress. In one study, women with chronic stress who had better support from the baby’s father (including emotional and financial support) had a lower risk of preterm delivery. When both parents have a mental illness, such support is probably more likely to be lacking.</p>
<p>Also, some social and environmental disadvantages that increase the risk of preterm birth, such as <a href="https://pubmed.ncbi.nlm.nih.gov/31811316/">substance abuse</a>, smoking, and <a href="https://pubmed.ncbi.nlm.nih.gov/20147718/">low socioeconomic status</a>, may cluster in families where one or both parents <a href="https://pubmed.ncbi.nlm.nih.gov/28219896/">have a mental illness</a>. These factors may play a role in the association between parental mental illness and preterm births.</p>
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<strong>
Read more:
<a href="https://theconversation.com/why-maternal-deaths-in-the-uk-are-rising-194885">Why maternal deaths in the UK are rising</a>
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<p>Roughly <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders">one in eight people</a> in the world have a mental disorder. Future studies should examine whether additional social support and prenatal care for families with mental illness could lessen the risk of preterm birth, as well as the potential effects of psychiatric medications and treatments.</p><img src="https://counter.theconversation.com/content/209261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study from Sweden looked at around 1.5 million births.Weiyao Yin, Postdoctoral researcher, Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetJonas F. Ludvigsson, Professor, Department of Medical Epidemiology and Biostatistics. Senior Pediatrician, Örebro University Hospital., Karolinska InstitutetSven Sandin, Associate Professor, Icahn School of Medicine at Mount Sinai, New York, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1785872022-03-21T18:54:18Z2022-03-21T18:54:18ZResearch dispels myth that COVID-19 vaccines cause infertility, but misinformation persists<figure><img src="https://images.theconversation.com/files/453231/original/file-20220321-19-10uqz5z.jpg?ixlib=rb-1.1.0&rect=714%2C14%2C4191%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Misinformation about COVID-19 vaccines affecting fertility have no realistic basis.</span> <span class="attribution"><span class="source"> (AP Photo/John Locher)</span></span></figcaption></figure><p><a href="https://theconversation.com/the-fault-in-our-stars-aaron-rodgers-reminds-us-why-celebrity-shouldnt-trump-science-171648">Misinformation</a> about <a href="https://www.npr.org/sections/health-shots/2021/07/20/1016912079/the-life-cycle-of-a-covid-19-vaccine-lie">COVID-19 vaccines and fertility</a> has propagated online despite the vaccines’ <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html">clear safety profile</a>. </p>
<p>Fortunately, those considering having kids can relax when it comes to these crucial shots. These claims <a href="https://doi.org/10.1001/jama.2022.2404">lack any realistic basis</a>. As a medical doctor and a COVID-19 genetics researcher, I’d like to discuss what the evidence says.</p>
<h2>Misinformation about fertility</h2>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>Some sources of <a href="https://www.factcheck.org/2021/06/scicheck-research-rebuts-baseless-claims-linking-covid-19-vaccines-to-male-infertility/">misinformation claim that the COVID-19 vaccines cause male sterility</a>. For this to be true, the vaccines would have to damage sperm quality, drastically reduce sperm count or interfere with the mechanisms inherent in male ejaculation. Quality clinical evidence has demonstrated that none of these parameters are affected by the vaccine, so men are not being made sterile. </p>
<p>A <a href="https://doi.org/10.1001/jama.2021.9976">study in Florida</a> recruited around 45 men and compared their sperm measures before and after receiving a COVID-19 vaccine. Interestingly, the study found that men who received the vaccine had more sperm, greater semen volume, and sperm more able to move around and fertilize an egg.</p>
<p>Pregnancy can be an exciting time but can also <a href="https://www.anxietycanada.com/articles/common-worries-during-pregnancy/">provoke worry</a> about the the safety of anything that enters the body, including vaccines. Fortunately, the COVID-19 vaccines are safe during pregnancy. </p>
<p>Sources of misinformation have claimed that COVID-19 vaccines can lead to loss of pregnancy, <a href="https://www.bbc.com/news/health-57552527">with vague references to antibody responses or other concepts that sound scientific</a>. However, the COVID-19 vaccines will not make a pregnant woman any more likely to have a miscarriage. </p>
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<img alt="A pregnant woman sitting a table across from a health-care worker in scrubs and a face mask who is preparing to give her a shot." src="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">COVID-19 vaccines do not increase the risk of miscarriage.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>A group of physicians spanning the United States <a href="https://doi.org/10.1001/jama.2021.15494">studied the pregnancy outcomes for over 100,000 pregnancies</a>. When the study was done, around 14 per cent of everyone investigated had received at least one dose of the COVID vaccine. They found that women who had the shot were no more likely to have a miscarriage than those who did not. </p>
<p><a href="https://doi.org/10.1001/jama.2022.2404">There are other misinformation claims along the lines of antibodies attacking the placenta, shots equating with infertility or interference with hormones</a>. Unsurprisingly, all of these have been debunked.</p>
<h2>The real danger is COVID-19 infection</h2>
<p>While there is no evidence that the COVID-19 vaccine can impact fertility or pregnancy, there is evidence that a COVID-19 infection can cause harm. At its extreme, the disease can be fatal — <a href="https://doi.org/10.1136/bmj.m3320">an outcome that is more likely if COVID-19 infection happens during pregnancy</a>. </p>
<p><a href="https://doi.org/10.1371/journal.pone.0255994">Multiple studies have also documented an increased risk of miscarriage following a COVID-19 infection</a>. However, miscarriage is not the only risk. The respiratory distress that can come with COVID-19, as well as the inflammation, can affect fetal growth, which could lead to <a href="https://doi.org/10.1016/j.brainres.2011.01.032">health and developmental problems</a> in a baby carried to term. </p>
<p>Carried to term is an important point here because pregnant women with COVID-19 are more likely to <a href="https://doi.org/10.1136/bmj.m3320">deliver their babies early</a>. This is associated with health risks for the baby, including an increased risk of <a href="https://www.ncbi.nlm.nih.gov/books/NBK11385/">requiring intensive care</a>.</p>
<h2>The case for COVID-19 vaccination</h2>
<p>It makes sense to get a COVID-19 vaccine. The risk of developing COVID-19 still exists and is still dangerous. This remains true while the case counts have trended downwards in North America to the tens of thousands from nearly one million a day in January. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line graph showing decreasing COVID-19 cases since the end of December 2021 until March 19, 2022." src="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">As COVID-19 remains a danger, vaccination remains the best protection.</span>
<span class="attribution"><span class="source">(Johns Hopkins University CSSE COVID-19 Data)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Fortunately, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">vaccine offers excellent protection</a> against developing an infection. It also dramatically decreases the chance of severe disease if infection does occur. When considering what poses the greatest danger to a pregnant woman or a couple looking to have children, severe illness poses the most significant risk of causing fertility or pregnancy problems.</p>
<p>COVID-19 misinformation is not going to go away. Previous vaccine misinformation has lingered despite a complete lack of evidence. For example, <a href="https://dx.doi.org/10.1503/cmaj.109-3179">the myth of a vaccine-autism link was debunked in 1998</a>, but vaccine hesitancy has persisted despite copious amounts of clinical evidence that these claims lack any sound basis. Articles like this one will not change some people’s minds, but ultimately that is not the goal. </p>
<p>The goal of sharing medical information from a physician’s point of view is to provide people with the knowledge that they need to make an informed health-care decision. While I strongly recommend the vaccine to everyone, individuals are the ones who choose what they seek to do with their bodies. </p>
<p>Public health can appropriately guide individuals towards making decisions in their and their community’s best interests, as with vaccine mandates. Individuals still maintain their autonomy, even if accompanied by consequences like employment issues. If one reflects on what is best for a baby, the evidence is clear. It is an individual’s prerogative on what to do with that information.</p><img src="https://counter.theconversation.com/content/178587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Daniel Sunday Willett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some of the most persistent myths about COVID-19 vaccination have been false rumours that it can affect fertility in men or women. There has never been any evidence to support this misinformation.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1433532020-07-30T01:39:49Z2020-07-30T01:39:49ZIt’s tempting to believe good news. But are there really fewer premature babies in lockdown? We’re likely clutching at straws<figure><img src="https://images.theconversation.com/files/350066/original/file-20200729-35-1qu7dqh.jpg?ixlib=rb-1.1.0&rect=4%2C5%2C994%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-premature-infant-baby-neonatal-intensive-1138674578">Shutterstock</a></span></figcaption></figure><p>Amid the <a href="https://www.theguardian.com/world/live/2020/jul/27/coronavirus-live-news-us-sees-5000-deaths-in-five-days-as-dr-birx-urges-some-states-to-close-bars">horrific stories</a> of coronavirus deaths and disease around the world, researchers <a href="https://www.nytimes.com/2020/07/19/health/coronavirus-premature-birth.html?referringSource=articleShare">have reported</a> a ray of light.</p>
<p>Almost simultaneously, two independent groups in Europe <a href="https://www.afr.com/policy/health-and-education/far-fewer-premature-babies-during-covid-19-20200721-p55e11">noticed</a> their neonatal intensive care units seemed quieter during the pandemic.</p>
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<p>Was this a coincidence? Or were there actually fewer babies born prematurely who needed intensive care? And if fewer premature babies were being born, why?</p>
<p>So, the researchers studied what was going on to try to get a <a href="https://www.tandfonline.com/doi/full/10.1080/14767058.2020.1781809">fuller picture</a> of how COVID-19 affects pregnant women and their newborns.</p>
<h2>Here’s what they found</h2>
<p>In Denmark, <a href="https://www.medrxiv.org/content/10.1101/2020.05.22.20109793v1">there was</a> a significant drop (around 90%) in the rate of babies born extremely premature (under 28 weeks gestation) during the nationwide lockdown, compared with a stable rate in the previous five years.</p>
<p>However, the researchers did not see a drop in the rate of other preterm babies born (at greater than 28 weeks but under 37 weeks). </p>
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Read more:
<a href="https://theconversation.com/coronavirus-while-pregnant-or-giving-birth-heres-what-you-need-to-know-133619">Coronavirus while pregnant or giving birth: here's what you need to know</a>
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<p>Irish researchers thought lockdown was an opportunity to measure whether non-medical, community-based, social factors were associated with a reduction in preterm birth. When they ran a <a href="https://www.medrxiv.org/content/10.1101/2020.06.03.20121442v1">similar study</a> to the Danish team, they found similar results.</p>
<p>Over the past two decades, women were on average 3.77 times more likely to have a very low-birthweight baby (under 1,500g) than during the recent lockdown, in the study region of the Irish study. This was about a 73% reduction in very preterm births. </p>
<h2>What could explain this?</h2>
<p>There is a certain irony about these findings. </p>
<p>Pregnant women are <a href="https://www.today.com/parents/pregnant-women-covid-19-pandemic-feel-lonely-anxious-t187828?cid=sm_npd_nn_tw_ma">sharing stories</a> of increased stress, fear and anxiety during the pandemic. And there’s <a href="https://pubmed.ncbi.nlm.nih.gov/25765470/">strong evidence</a> stress, fear and anxiety during pregnancy is associated with preterm birth.</p>
<p>So we’d potentially see an overall increase in preterm birth, which we’ve yet to measure or see.</p>
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Read more:
<a href="https://theconversation.com/pregnant-in-a-pandemic-if-youre-stressed-theres-help-138825">Pregnant in a pandemic? If you're stressed, there's help</a>
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<p>Yet, pregnant women’s response to lockdown measures may indeed reduce other stressors. They may be spending less time commuting to work and facing stressful workplace dynamics. This may allow them to get more rest and increased access to family support.</p>
<p>Physically demanding work or demanding shiftwork, <a href="https://pubmed.ncbi.nlm.nih.gov/31276631/">known to increase risk of preterm birth</a>, may also have been eliminated or reduced. </p>
<p>Another theory relates to the removal of pregnant women from busy workplaces and community activities, reducing their exposure to pathogens generally.</p>
<p>Inflammation and other immune-related responses are thought to <a href="https://pubmed.ncbi.nlm.nih.gov/32339092/">contribute to the risk of preterm birth</a>. And we know rates of some infectious diseases, including influenza, have <a href="https://wwwnc.cdc.gov/eid/article/26/8/20-1229_article">reduced</a> during the pandemic, as we physically isolate, wash hands and wear masks. </p>
<p>Lockdown has also caused a reduction in <a href="https://www.sciencedirect.com/science/article/pii/S0306987713005719">air pollution</a> said to act together with other biological factors to induce inflammation and influence the duration of pregnancy.</p>
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Read more:
<a href="https://theconversation.com/during-covid-19-women-are-opting-for-freebirthing-if-homebirths-arent-available-and-thats-a-worry-142261">During COVID-19, women are opting for 'freebirthing' if homebirths aren't available. And that's a worry</a>
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<h2>Hang on a minute</h2>
<p>Authors from both studies attributed this significant decrease in extreme preterm birth to the sum total of social and environmental changes during lockdown. They did not pinpoint one specific factor.</p>
<p>In fact, their studies were not designed to demonstrate which specific factor caused what, so we need to interpret their findings with caution.</p>
<p>And their studies are “pre-prints”, meaning they have not been formally peer- reviewed.</p>
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Read more:
<a href="https://theconversation.com/researchers-use-pre-prints-to-share-coronavirus-results-quickly-but-that-can-backfire-137501">Researchers use 'pre-prints' to share coronavirus results quickly. But that can backfire</a>
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<p>While these studies offer some interesting discussion points, we have some reservations about how they should inform future work.</p>
<p>Ideally, other researchers would want to replicate a given exposure or intervention to see if they come up with similar results. But how do we ethically replicate the drastic social-environmental change pregnant women have had to face once the pandemic is over?</p>
<p>Can we really expect future pregnant women to stay home, not work so hard on their feet, and limit social interaction so we can see what happens? It may have the exact opposite effect on their well-being.</p>
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<a href="https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sad woman sitting on floor staring out window" src="https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350072/original/file-20200729-31-11nlbfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ethically, how could we ever repeat this ‘experiment’ to verify the researchers’ results?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-thoughtful-girl-sit-alone-on-1523325014">from www.shutterstock.com</a></span>
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<p>Some neonatal intensive care units may have seen an increase in preterm births during the pandemic. But this may not have been studied formally, published or reported as news.</p>
<p>We have also peer-reviewed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104131/">published studies</a> showing an increased risk of preterm birth if women are diagnosed with a coronavirus related illness. That’s <a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome">SARS</a> (severe acute respiratory syndrome), <a href="https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)">MERS</a> (Middle-East respiratory syndrome) or COVID-19.</p>
<p>Once the full impact of this pandemic is revealed, we may well see an overall increase in preterm births related to coronaviruses.</p>
<p>Perhaps we are clasping at straws, trying to visualise some possible benefit to the most significant disruption the world has undergone in recent years. But we are cautious to say we have found it here. </p>
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Read more:
<a href="https://theconversation.com/coronavirus-with-a-baby-what-you-need-to-know-to-prepare-and-respond-133078">Coronavirus with a baby: what you need to know to prepare and respond</a>
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<img src="https://counter.theconversation.com/content/143353/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Kearney receives funding from the Wishlist Health Foundation, Sunshine Coast for a number of specific externally funded research grants. </span></em></p><p class="fine-print"><em><span>Kendall George receives funding from the Wishlist Health Foundation, Sunshine Coast for a number of specific externally funded research grants.</span></em></p>We still don’t know if being in lockdown during the pandemic really does lead to fewer premature babies, as some people report. Maybe we’re trying too hard to find some good news.Lauren Kearney, Senior Lecturer, Nursing and Midwifery, University of the Sunshine CoastKendall George, Lecturer, Nursing and Midwifery and Midwifery Program Leader, University of the Sunshine CoastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1293492020-01-08T18:50:17Z2020-01-08T18:50:17ZPregnant women should take extra care to minimise their exposure to bushfire smoke<figure><img src="https://images.theconversation.com/files/308938/original/file-20200108-107219-kvwdju.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C2986%2C1998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnant women should try to stay inside when the air pollution is high.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Smoke haze from Australia’s catastrophic bushfires is continuing to affect many parts of the country.</p>
<p>Although there’s no safe level of air pollution, the health hazards tend to be greatest for vulnerable groups. Alongside people with pre-existing conditions, smoke exposure presents unique risks for pregnant women. </p>
<p>Research shows prolonged exposure to bushfire smoke increases the risk of pregnancy complications including <a href="http://www.mdpi.com/resolver?pii=ijerph16193720">high blood pressure</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204222/">gestational diabetes</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Ebisu+berman+bell+weight">low birth weight</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=basu.+Pearson+delivery+california">premature birth</a> (before 37 weeks).</p>
<p>These conditions can have short-term and lifelong effects on <a href="https://ukhealthcare.uky.edu/wellness-community/health-information/short-long-term-effects-preterm-birth">a baby’s health</a>, with increased risk of conditions including cerebral palsy and visual or hearing impairment. Even babies born only a few weeks early can experience learning difficulties and behavioural problems, and have an elevated risk of heart disease in later life.</p>
<p>So it’s especially important pregnant women protect themselves from exposure to bushfire smoke.</p>
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Read more:
<a href="https://theconversation.com/how-does-poor-air-quality-from-bushfire-smoke-affect-our-health-126835">How does poor air quality from bushfire smoke affect our health?</a>
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<h2>Why are pregnant women at higher risk?</h2>
<p>Pregnant women breathe at an increased rate, and their hearts need to <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.115.06667">work harder</a> than those of non-pregnant people to transport oxygen to the fetus. This makes them particularly vulnerable to the effects of air pollution, including bushfire smoke.</p>
<p>We often measure poor air quality by the presence of ultra-fine particles called PM2.5 (small particles of less than 2.5 micrometres in size). These particles are concerning because they can penetrate into <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248967/">our lungs</a>, and into blood and tissue to cause inflammation throughout the body.</p>
<p>Importantly in pregnant women, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468584/">environmental pollutants</a> can cause <a href="https://academic.oup.com/humupd/article/12/6/747/624349">inflammatory damage</a> to the placenta’s blood supply. This can interfere with the placenta’s development and function, which can in turn compromise the growth of the fetus.</p>
<h2>What the evidence says</h2>
<p>Many studies have linked poor air quality, particularly high <a href="https://www.sciencedirect.com/science/article/abs/pii/S0013935118303700?via%3Dihub">PM2.5 levels</a>, to poor pregnancy outcomes. Data from 183 countries showed in 2010, an estimated <a href="https://www.sciencedirect.com/science/article/pii/S0160412016305992?via%3Dihub">2.7 million premature births</a>, 18% of the total, were associated with PM2.5 pollution.</p>
<p>A 2019 <a href="http://www.mdpi.com/resolver?pii=ijerph16193720">study</a> of more than 500,000 pregnant women from Colorado looked at the effect of bushfire smoke on pregnancy outcomes. The authors analysed data on air quality, fire incidence and pregnancy and birth records from 2007-2015, during which time Colorado was regularly affected by smoke from fires burning in California and the Pacific Northwest.</p>
<p>The study found PM2.5 due to bushfire smoke was linked to spikes in <a href="http://www.mdpi.com/resolver?pii=ijerph16193720">premature birth</a>, especially in women exposed during the second trimester. </p>
<p>In women exposed to smoke during the first trimester, <a href="http://www.mdpi.com/resolver?pii=ijerph16193720">birth weight was lower than average</a>. Further, exposure during any trimester increased the chance of <a href="http://www.mdpi.com/resolver?pii=ijerph16193720">gestational diabetes and high blood pressure</a>. </p>
<p>The effects were detectable even with low exposure to smoke and small increases in PM2.5. For every 1 microgram/m³ increase in average daily exposure to PM2.5 during the second trimester of pregnancy, the risk of premature birth <a href="http://www.mdpi.com/resolver?pii=ijerph16193720">increased by 13%</a>. </p>
<p>To put this into context, in Canberra in the first week of January, <a href="https://www.health.act.gov.au/about-our-health-system/population-health/environmental-monitoring/monitoring-and-regulating-air">PM2.5 levels</a> averaged more than 200 micrograms/m³, compared with the typical background concentration of 5 micrograms/m³. EPA Victoria classifies PM2.5 levels above 25 micrograms/m³ as <a href="https://www.epa.vic.gov.au/for-community/environmental-information/air-quality/pm25-particles-in-the-air">unsafe</a> for vulnerable people.</p>
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Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>In another large study, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=klepac+kukec+pollution">a 24% increase in premature birth</a> was seen after 10 micrograms/m³ increase in PM2.5.</p>
<p>As well as PM2.5, bushfire smoke contains larger PM10 particles, nitric oxides, carbon monoxide and other gases and toxic chemicals. These all have potential to impair lung and heart function in the mother, activate inflammation, and directly affect fetal and placental development.</p>
<h2>Smoke threatens fertility, too</h2>
<p>Air quality is also a factor for couples <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311303/">attempting to conceive</a> or <a href="https://www.ncbi.nlm.nih.gov/pubmed/28754128">dealing with infertility</a>. </p>
<p>Population studies suggest air pollution compromises human fertility by reducing <a href="https://www.endocrine-abstracts.org/ea/0063/ea0063p311">ovarian reserve</a> (the number of eggs in the ovary) and affecting <a href="https://dx.doi.org/10.1021/acs.est.8b06942">sperm number</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19217100">movement</a>.</p>
<p>Direct exposure to <a href="https://www.ncbi.nlm.nih.gov/pubmed/21991169">fire, burns</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/29241080">fire retardant chemicals</a> can also negatively impact fertility.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-monitor-the-bushfires-raging-across-australia-129298">How to monitor the bushfires raging across Australia</a>
</strong>
</em>
</p>
<hr>
<h2>Precautions to take if you’re pregnant</h2>
<p>The best strategy is to reduce smoke exposure as much as possible. Recommendations from <a href="https://www.health.nsw.gov.au/environment/air/pages/bushfire-smoke.aspx">NSW Health</a> include staying inside on high-risk days, sealing the house to prevent smoke infiltration and using air conditioning to keep cool.</p>
<p>Avoid creating smoke by cigarette smoking, burning candles, or frying and grilling. Use PM2 (N95) masks and air-filtering devices if possible, and avoid exposure to ash, which contains particulate material you can inhale.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308941/original/file-20200108-107255-pvj5e7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Studies have shown when women are exposed to bushfire smoke during pregnancy, the rates of premature birth increase.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Pregnant women in a fire region should carefully follow emergency services’ direction. It’s better to evacuate early, with an <a href="https://www.qld.gov.au/emergency/dealing-disasters/prepare-for-disasters/emergency-kit">emergency supply kit</a> containing clothes, medications, water and food you don’t need to cook. </p>
<p>Make sure your medication and prenatal vitamins are accessible, continue to take them, and stay well hydrated. Inform authorities and shelters you are pregnant and need to maintain your antenatal care. </p>
<p>Be aware of the <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-premature-labour">signs of premature labour</a> including abdominal cramps or contractions, a heavy vaginal discharge, loss of fluid or vaginal bleeding, pelvic pressure and low backache. Seek help if you think you may be going into labour. </p>
<p>Given what we know about the consequences of poor air quality on pregnancy outcomes, it’s critical pregnant women are given top priority when it comes to bushfire relief and health care support.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-face-masks-to-air-purifiers-what-actually-works-to-protect-us-from-bushfire-smoke-128633">From face masks to air purifiers: what actually works to protect us from bushfire smoke?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/129349/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Robertson receives funding from the National Health and Medical Research Council of Australia, and the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Louise Hull receives funding from the National Health and Medical Research Council of Australia and the Medical Research Futures Fund, a grant from the Australasian Gynaecologic and Endoscopic Society and the Adelaide Women's and Children's Research Foundation. Associate Professor Louise Hull has ownership in Embrace Fertility an independent fertility and IVF practice which is affiliated with REPROMED.</span></em></p>Pregnant women exposed to bushfire smoke face a higher risk of complications including gestational diabetes, high blood pressure and giving birth prematurely.Sarah Robertson, Professor and Director, Robinson Research Institute, University of AdelaideLouise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1067772018-11-15T19:00:09Z2018-11-15T19:00:09ZOmega-3 supplements in pregnancy reduce the risk of premature birth<figure><img src="https://images.theconversation.com/files/245688/original/file-20181115-172710-26v6xs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The earlier a baby is born, the greater the risk of poor health.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/XcMtMSlYZmo"> Cassidy Rowell</a></span></figcaption></figure><p>Pregnant women who increase their intake of omega-3 long-chain fatty acids are less likely to have a premature birth, according to a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003402.pub3/full?highlightAbstract=omeg%7Comega%7C3">Cochrane Review</a> published today. </p>
<p>Most pregnancies last between 38 and 42 weeks, but if a baby arrives before 37 weeks, the chances of poorer health for that baby increase. <a href="https://www.aihw.gov.au/getmedia/7a8ad47e-8817-46d3-9757-44fe975969c4/aihw-per-97.pdf.aspx?inline=true">One in 12 babies</a> in Australia are born prematurely – before 37 weeks. </p>
<p>The earlier a baby is born, the higher the risk of poor health, and a small number of babies don’t survive. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mums-and-dads-of-very-preterm-babies-more-likely-to-be-depressed-62545">Mums and dads of very preterm babies more likely to be depressed</a>
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</em>
</p>
<hr>
<p>Some premature babies have to spend the first weeks or months of life in special intensive care units in hospital. Premature babies can develop conditions that last a lifetime, including problems with their lungs, gut, and immune system, and vision and hearing loss. </p>
<p>Problems with behaviour and learning are also more common in children born too early. These consequences result in substantial costs to health care systems and to families of premature babies. </p>
<h2>What did we find?</h2>
<p>The Cochrane Review, led by our research team at the South Australian Health and Medical Research Institute, included 70 randomised trials with nearly 20,000 women. </p>
<p>It found increasing the daily intake of omega-3 long-chain fatty acids during pregnancy:</p>
<ul>
<li><p>lowers the risk of having a premature baby (birth before 37 weeks) by 11%, from 134 per 1,000 to 119 per 1,000 births</p></li>
<li><p>lowers the risk of having an early premature baby (birth before 34 weeks) by 42%, from 46 per 1,000 to 27 per 1,000 births.</p></li>
</ul>
<p>Most of the trials were conducted in high-income countries (Australia, the United States, England, The Netherlands and Denmark) and included women who were both at normal and high risk for poor pregnancy outcomes. Most women studied were pregnant with one baby. </p>
<p>The trials generally used supplements containing the omega-3 long-chain fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/245690/original/file-20181115-194497-i1828h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Omega-3 supplements reduce the risk of an early premature birth from 46 per 1,000 to 21.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/5zp0jym2w9M">Aditya Romansa</a></span>
</figcaption>
</figure>
<h2>Risk of premature birth</h2>
<p>The causes of premature birth are still not well understood. But we know that when a pregnant woman’s labour starts, powerful hormones called prostaglandins take hold. </p>
<p>Sometimes <a href="https://www.omicsonline.org/fish-oils-as-a-population-based-strategy-to-reduce-early-preterm-birth-2161-038X.1000116.php?aid=12479">women produce high amounts of prostaglandins</a>, and those produced from omega-6 fats can make birth come too early. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/despite-new-findings-the-jury-is-still-out-on-whether-omega-3-supplements-reduce-heart-attacks-106861">Despite new findings, the jury is still out on whether omega-3 supplements reduce heart attacks</a>
</strong>
</em>
</p>
<hr>
<p>So where does omega-3 come in? </p>
<p>In the 1980s, <a href="https://www.ncbi.nlm.nih.gov/pubmed/2874370">researchers noticed</a> women in Denmark had shorter pregnancies and more premature babies than their neighbours in the Faroe Islands who eat much more fish. The omega-3 long-chain fatty acids in fish seemed to be responsible – they are thought to help prevent premature birth by reducing the potency of prostaglandins that can trigger early birth.</p>
<p>Our review shows supplementation with omega-3 long-chain fatty acids during pregnancy is one of the few safe and effective strategies capable of preventing early labour and premature birth. </p>
<h2>Fish or supplements?</h2>
<p>Most of the trials included in this Cochrane review that reported on premature birth used omega-3 supplements, rather than dietary changes. </p>
<p>It is difficult to get the amount of the omega-3 long-chain fatty acids used in the many trials from food alone, unless you regularly eat fatty fish such as salmon, sardines or mackerel. To get the recommended amount of DHA that was used in many trials, you would need to eat at least two to three 150g serves of salmon every week.</p>
<p>The advice for pregnant women expecting a single baby is to consume daily fish oil supplements containing at least 500mg of DHA, starting at 12 weeks of pregnancy. The supplement does not need to contain more than 1000mg DHA+EPA. There appears to be no extra benefit of higher doses.</p>
<p>This advice is currently being integrated into national clinical practice pregnancy guidelines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-cant-rely-on-fish-oil-supplements-in-pregnancy-to-make-your-children-smarter-74697">You can't rely on fish oil supplements in pregnancy to make your children smarter</a>
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</p>
<hr>
<img src="https://counter.theconversation.com/content/106777/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippa Middleton receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Maria Makrides receives funding from National Health and Medical Research Council. She is President Elect of International Society for the Study of Fatty Acids and Lipids (ISSFAL). </span></em></p><p class="fine-print"><em><span>Jamie De Seymour and Lucy Simmonds do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new review of 70 studies involving nearly 20,000 women found taking omega-3 supplements in pregnancy reduces the risk of premature labour.Philippa Middleton, Associate Professor, South Australian Health & Medical Research InstituteJamie De Seymour, Translation Research Officer, Healthy Mothers, Babies And Children, South Australian Health & Medical Research InstituteLucy Simmonds, Research fellow, South Australian Health & Medical Research InstituteMaria Makrides, Professor and Theme Leader, Healthy Mothers, Babies and Children , South Australian Health & Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/950482018-04-26T08:00:22Z2018-04-26T08:00:22ZPregnant women are at increased risk of domestic violence in all cultural groups<figure><img src="https://images.theconversation.com/files/216426/original/file-20180426-175074-q6jr9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women having a subsequent baby are more likely to disclose domestic violence than first time mothers.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1059281756?src=CyQd4Z4-wdqBDSLlvqiEtA-1-99&size=medium_jpg">Vyshnova/Shutterstock</a></span></figcaption></figure><p>Domestic violence occurs across all age groups and life stages. Rather than reducing during pregnancy, expecting a child is a <a href="https://aifs.gov.au/cfca/publications/domestic-and-family-violence-pregnancy-and-early-parenthood">key risk factor for domestic violence beginning or escalating</a>. </p>
<p>Our research, <a href="http://bmjopen.bmj.com/content/8/4/e019566">published today in the journal BMJ Open</a>, found that 4.3% of pregnant women due to give birth in Western Sydney disclosed domestic violence when asked about it by a midwife at her first hospital visit. The study examined more than 33,000 ethnically diverse women who gave birth between 2006 and 2016, and found that these disclosures spanned all cultural groups. </p>
<p>Domestic violence in pregnancy not only causes distress and trauma for the mother and baby, it increases the risk of the baby having a low birth weight (very small baby) or being born prematurely (before 37 weeks), which is linked to jaundice, anaemia and respiratory distress in infancy, and diabetes and heart disease later in life. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/midwives-can-help-detect-domestic-violence-heres-how-37918">Midwives can help detect domestic violence – here's how</a>
</strong>
</em>
</p>
<hr>
<h2>Abuse and trauma</h2>
<p>Depending on the state or territory, women may receive a <a href="http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2010_004.pdf">“psychosocial” assessment</a> from midwives when they first book into a public hospital during pregnancy. This screens for depression, anxiety, childhood abuse, domestic violence, support and stress.</p>
<p>Using these assessments, we found that 4.3% of women disclosed domestic violence overall, but rates were higher among women having a subsequent baby, compared with first-time mothers. </p>
<p>We’re unsure if this is because violence has escalated for these women with subsequent pregnancies; if they trust health providers more to disclose the violence; or if they seek help because they’re becoming more aware of the impact of domestic violence on their children. </p>
<p>We found a strong link between the disclosure of childhood abuse and the disclosure of domestic violence. Nearly 24% of women disclosing domestic violence had also disclosed childhood abuse. </p>
<p>This doesn’t mean that one causes the other, but women who experience childhood abuse are more vulnerable to re-victimisation (being abused again). They may feel like they’re not worthy and gravitate towards men who abuse them.</p>
<p>Women who disclosed domestic violence in our study were more likely to have a history of anxiety or depression (34%) and have thoughts of harming themselves. </p>
<p>This is concerning, as <a href="https://theconversation.com/we-need-to-protect-new-mothers-from-trauma-and-suicide-17254">maternal suicide</a> during pregnancy or following the birth appears to be rising and has now become one of the <a href="https://theconversation.com/factcheck-is-suicide-one-of-the-leading-causes-of-maternal-death-in-australia-65336">main causes</a> of maternal death in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-to-protect-new-mothers-from-trauma-and-suicide-17254">We need to protect new mothers from trauma and suicide</a>
</strong>
</em>
</p>
<hr>
<p>We also found rising rates of pregnant women disclosing domestic violence and being admitted to hospital for bleeding and signs that labour may be starting early (before 37 weeks). When this happens, women are admitted to hospital to try to stop the labour, or to find the source of the bleeding. Sometimes stress can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179976/">contribute</a> to preterm birth and bleeding in pregnancy.</p>
<h2>Ethnic backgrounds</h2>
<p>We found that domestic violence occurred across all cultural groups, but reported rates were highest among women from New Zealand and Sudan. </p>
<p>Previous research has shown high rates of domestic violence among Maori women in some parts of <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.838.4995&rep=rep1&type=pdf">New Zealand</a>. </p>
<p>There is also evidence of high rates of domestic violence among <a href="https://www.reuters.com/article/us-southsudan-women-violence/south-sudan-war-seeps-into-homes-spurring-domestic-violence-idUSKBN1DT196">Sudanese</a> women prior to migration.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/family-violence-victims-need-support-not-mandatory-reporting-44133">Family violence victims need support, not mandatory reporting</a>
</strong>
</em>
</p>
<hr>
<p>We found that women born in India and China reported very low rates of domestic violence. This may reflect a cultural tendency not to discuss what is considered private family business with outsiders.</p>
<p>It’s important that health professionals know how to ask about domestic violence in a culturally appropriate way so women feel comfortable disclosing abuse and can access appropriate support. </p>
<h2>What needs to be done?</h2>
<p>Midwives need to consider cultural norms and acceptability when asking migrant women questions about domestic violence, and this must always be done in a way that keeps the woman safe. Partners should not be present when the questions are asked – and this may be done at another time in the pregnancy if necessary.</p>
<p>Where English is not the first language, interpreters should be used. But this can also present challenges if the interpreter comes from the same community and is known to the woman.</p>
<p>When women have <a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">continuity of midwifery care</a> and get to know a midwife well throughout the pregnancy, it is easier for midwives to gain women’s trust and to notice when things change. This style of care should be rolled out more widely in Australian public hospitals. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/acting-on-family-violence-how-the-health-system-can-step-up-45592">Acting on family violence: how the health system can step up</a>
</strong>
</em>
</p>
<hr>
<p><em>The National Sexual Assault, Family & Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.</em></p><img src="https://counter.theconversation.com/content/95048/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC and ARC. She is affiliated with the Australian College of Midwives</span></em></p><p class="fine-print"><em><span>Virginia Schmied receives funding from NHMRC ARC</span></em></p>Domestic violence in pregnancy not only causes distress and trauma for the mother, it also poses serious risks for the baby’s health and development.Hannah Dahlen, Professor of Midwifery and Higher Degree Director, Western Sydney UniversityVirginia Schmied, Professor, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/825602017-09-07T01:00:36Z2017-09-07T01:00:36ZWhy can’t more American women access medications for preterm birth?<figure><img src="https://images.theconversation.com/files/182131/original/file-20170815-28398-o94r74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A premature baby's hand is held through an incubator.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Mideast-Israel-Mozart-Effect/53a94195319d4a95afc908d4031d2cc6/4/0">Ariel Schalit/AP Photo</a></span></figcaption></figure><p>There are two medications that prevent preterm birth, the most common cause of <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_08.pdf">perinatal death</a> in the U.S. One costs 16 cents a week, one US$285. Poor black women aren’t getting either. Why?</p>
<p>In 2015, for the first time in eight years, the <a href="http://www.marchofdimes.org/materials/premature-birth-report-card-united-states.pdf">rate of preterm birth in the U.S. rose</a>, despite increased understanding of preventative measures. By one estimate, preterm births cost us an estimated <a href="https://www.ncbi.nlm.nih.gov/books/NBK11358/">$26 billion</a> per year.</p>
<p>Additionally, <a href="http://www.indexmundi.com/facts/indicators/SH.STA.MMRT/compare?country=oe#country=ca:eg:jp:oe:es:se:gb:us:ve">U.S. maternal death rates</a> are the among <a href="http://journals.lww.com/greenjournal/Abstract/2016/09000/Recent_Increases_in_the_U_S__Maternal_Mortality.6.aspx">the worst</a> for economically similar countries, currently double that of Canada and Spain, and almost three times than for women in Japan. In <a href="https://www.texasobserver.org/texas-worst-maternal-mortality-rate-developed-world-lawmakers-priorities/">Texas</a>, they doubled in just over two years.</p>
<p>When the rates are examined more closely, they reveal an alarming narrative about differences in health outcomes that are <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/74737/E89383.pdf">systematic, avoidable and unjust</a>.
The increased burden of preterm birth on low-income, urban and black women in America is <a href="http://www.marchofdimes.org/materials/premature-birth-report-card-united-states.pdf">48 percent higher that of white women in every state</a>.</p>
<p>As an obstetric provider for women with high-risk pregnancies at Boston Medical Center, the largest safety-net hospital in New England, I witness the tragic outcomes of these health inequities every day. As an investigator tasked with reducing them, I lead teams who have identified several important barriers to access.</p>
<h1>Preventing spontaneous preterm birth</h1>
<p>One potentially preventable cause of preterm birth is recurrent spontaneous preterm birth. That’s when babies deliver early despite attempts to prevent it, to mothers who have a history of early deliveries from the same cause. </p>
<p>Both the <a href="https://www.smfm.org/publications/87-progesterone-and-preterm-birth-prevention-translating-clinical-trials-data-into-clinical-practice">Society of Maternal Fetal Medicine and the American College of Ob/Gyn</a> recommend a specific progesterone preparation called 17P. This medication can reduce recurrent preterm birth in women with a history of spontaneous preterm birth. </p>
<p>Currently, it’s available only at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411212/">high cost, between $225 and $385 per week</a>. The cost has <a href="https://www.scienceandsensibility.org/blog/outrageous-price-charged-for-17-alpha-hydroxyprogesterone-caproate-(17ohp)-a-blessing-in-disguise">profoundly impacted</a> obstetric providers’ ability to obtain 17P for all eligible women – and <a href="http://www.medicaidinnovation.org/_images/content/Preventing_Preterm_Birth.pdf">contributes to the increased incidence</a> of spontaneous preterm birth in black women. </p>
<p><a href="http://www.medicaidinnovation.org/_images/content/Preventing_Preterm_Birth.pdf">Most health insurers</a> who enroll low-income and urban women – those seeking low-cost insurance through connectors – require prior authorization or numerous additional communications. These hurdles can be daunting, especially for anyone with competing financial needs and language or literacy challenges. </p>
<p>In Louisiana, a state with one of the highest rates of preterm birth in the U.S., <a href="https://igniteforchange.org/2016/11/01/louisiana-gets-another-f-for-premature-births/">only 5 percent of women</a> who should be getting this medication are able to obtain it. </p>
<p>When we started <a href="http://www.ajog.org/article/S0002-9378(15)01418-0/abstract">a study at Boston Medical Center</a>, we found that only 37 percent of our eligible patients received 17P. Our patients were not routinely informed that they had delivered preterm and were at risk of recurrence. </p>
<p>In fact, we found that none of our patients delivering preterm had documented counseling about their diagnosis or recommendations for future pregnancy during their hospitalization for that first preterm baby. Without this information, they were unaware of the risk to their next pregnancy or that they could reduce risk by asking in prenatal care for 17P.</p>
<h1>A cheaper treatment</h1>
<p>17P is expensive, so perhaps it seems reasonable for insurers to restrict it – even from those who qualify for its benefit. </p>
<p>But what about other preventable causes of preterm birth? Maternal complications of high blood pressure, <a href="http://www.mayoclinic.org/diseases-conditions/preeclampsia/home/ovc-20316140">also known as preeclampsia</a>, can also induce preterm birth.</p>
<p>Preeclampsia, a disease of constriction of small blood vessels, costs an estimated <a href="http://www.ajog.org/article/S0002-9378(17)30561-6/fulltext">$2.1 billion per year in the U.S.</a> This is at a time when the poorest women in America are at <a href="https://www.texasobserver.org/texas-worst-maternal-mortality-rate-developed-world-lawmakers-priorities/">rising risk of maternal death</a>, of which <a href="http://journals.lww.com/greenjournal/Abstract/2015/01000/Pregnancy_Related_Mortality_in_the_United_States,.3.aspx">preeclampsia is a leading contributor</a>.</p>
<p>The population at highest risk for preterm birth due to hypertensive disorders or placental insufficiency? Black women, especially those with a personal or family history of high blood pressure; first-time mothers; and obese women with low socioeconomic status. </p>
<p>A medication that costs 16 cents a week is also unavailable to many of the women most likely to benefit. This magical treatment is low-dose or “baby” aspirin. </p>
<p>In 2014, the U.S. Preventive Services Task Force, a congressionally authorized independent group of national experts, <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication">officially recommended</a> low-dose aspirin for pregnant women at high risk of preeclampsia. </p>
<p>Aspirin in highest-risk women may <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1704559#t=article">reduce preterm birth by 62 percent</a>. It can also cut the <a href="http://journals.lww.com/greenjournal/abstract/2010/08000/Prevention_of_Preeclampsia_and_Intrauterine_Growth.23.aspx">overall incidence of hypertensive pregnancy complications</a> in half. </p>
<p><a href="http://dx.doi.org/10.1016/S0140-6736(76)93025-7">Low-dose aspirin</a> has been used safely for both mothers and babies for more than 80,000 pregnancies <a href="http://dx.doi.org/10.1016/S0140-6736(07)60712-0">over 30 years</a>. But our study showed that only 11 percent of high risk pregnant woman at Boston Medical Center received low-dose aspirin, when our goal is for 90 percent of qualified women to get this benefit. Why aren’t women, especially high-risk women, getting this medication? </p>
<p>At Boston Medical Center, we are working to address our three specific identified barriers to access. Providers are reluctant to prescribe low-dose aspirin, pharmacists are reluctant to fill it, and, when prescribed, women are afraid to take it. </p>
<p>Though it hasn’t been fully studied, reluctance on the part of providers and pharmacists likely stems from a lack of knowledge or acceptance about risk factors. Meanwhile, women, eager to have a safe pregnancy, are bombarded by mixed messaging when searching online for information about aspirin in pregnancy. </p>
<h1>Changing the narrative</h1>
<p>The medical community can do better to reduce this racial disparity, but doing so requires focused interventions directed toward those women most likely to benefit. </p>
<p>At our hospital, we were able to increase our patients’ access rate to 17P to almost 90 percent. We focused on four specific barriers: lack of patient knowledge, lack of provider awareness, suboptimal communication in the electronic health record and insurance challenges in obtaining the medication. This subsequently reduced our preterm birth rate by 62 percent. </p>
<p>At a time when reproductive health care sites <a href="http://www.pbs.org/newshour/rundown/states-fighting-womens-access-health-care/">are being closed</a> and preventative care restrictions on poor women are implemented daily, we need to prioritize every woman’s access to interventions that reach high-risk women in order to prevent infant mortality and preterm birth.</p><img src="https://counter.theconversation.com/content/82560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jodi Frances Abbott receives funding from the March of Dimes. </span></em></p>There are two common medications that prevent preterm birth – and poor black women often can’t access either one.Jodi Frances Abbott, Associate Professor of Obstetrics & Gynecology, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/634042016-08-05T01:21:34Z2016-08-05T01:21:34ZCommon method of preventing early births may be causing more<figure><img src="https://images.theconversation.com/files/133034/original/image-20160804-12192-tj896x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Preterm babies are at significant risk of health and development problems, highlighting the need to get prevention strategies right.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>New research has found a commonly used method of preventing early or preterm birth (delivery of a baby before 37 weeks) may in fact be causing more to occur, and leading to further problems.</p>
<p>The “cervical cerclage” is a surgical procedure involving stitching the neck of the womb (the cervix) closed in pregnancy. The cerclage stitch prevents preterm birth as it provides support to a weakened cervix. </p>
<p>This <a href="http://www.sutureonline.com/wound-closure-manual">prevents the cervix from opening</a> too early in pregnancy, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12114901">also acts a barrier</a>, protecting the baby from vaginal infection.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=756&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=756&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=756&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=950&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=950&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133186/original/image-20160805-484-4s3ba6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=950&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The cerclage stitch prevents preterm birth as it provides support to a weakened cervix.</span>
<span class="attribution"><span class="source">Screenshot</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Some two million cervical cerclages are performed annually to prevent preterm birth. Worldwide, 80% of doctors use a tape-like braided suture material for the <a href="http://www.tandfonline.com/doi/abs/10.3109/14767058.2013.870551?journalCode=ijmf20">cerclage stitch</a>. A minority of doctors use a thinner “monofilament” material (like fishing line), although until now there has been no evidence to support this alternate practice.</p>
<p>Our study looked back at pregnancies across ten years at five United Kingdom university hospitals. Comparing the two suture materials, we found rates of stillbirth were three times higher in women who had a braided rather than monofilament cerclage, as were rates of preterm birth – 28% in women with braided suture compared to 17% with monofilament.</p>
<p>While larger studies will be required to replicate our findings, we estimate switching to the thinner monofilament thread for all cerclage procedures in the meantime could prevent 170,000 premature births globally every year, and 172,000 stillbirths across the world.</p>
<h2>What we did</h2>
<p>To investigate why preterm and stillbirth rates were higher in women who had a braided cerclage, vaginal fluid was sampled from high-risk women receiving either a braided or monofilament cerclage in pregnancy. At the same time, ultrasound scans were performed to see how the cervix was affected by the different suture material types. </p>
<p>Using lab-based techniques to assess the bacteria in the birth canal – called the microbiome – we revealed the traditional braided suture material caused a five-fold increase in abnormal and potentially harmful bacteria during pregnancy. </p>
<p>In contrast, the monofilament suture maintained high amounts of good lactobacillus bacteria in the vagina, throughout pregnancy. We also noticed this overgrowth in bad bacteria observed in the braided suture material was associated with an increase in potentially harmful levels of inflammation as well as abnormally early changes to the cervix, detected by ultrasound scan. </p>
<p>There is now strong evidence that infection is an important cause of the cervix opening too early in pregnancy, which results in preterm birth. The cerclage, the thicker woven structure of the braided thread, shown to encourage the growth of dangerous bacteria in our study, may increase the risk of adverse pregnancy outcomes in certain women. </p>
<p>Importantly this study finds this overgrowth of harmful bacteria was not observed in the thinner and simpler structure of the monofilament.</p>
<h2>Why this matters</h2>
<p>Preterm birth affects about <a href="http://www.who.int/bulletin/volumes/88/1/08-062554/en/">7-15% of pregnancies worldwide</a> and affects babies’ breathing, feeding and ability to fight infection. </p>
<p>Preterm babies are therefore at <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2006.01118.x/abstract">significant risk</a> of longer-term brain damage as well as learning difficulties, blindness and deafness. </p>
<p>Some babies are so unwell <a href="http://digital.nhs.uk/hes">they may not survive</a> the stress of prematurity, with preterm birth being the <a href="http://www.who.int/gho/child_health/mortality/causes/en/">largest single cause of death</a> in children under the age of five. </p>
<p>Preterm birth <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa041367">places major strain</a> on families coping with the substantial emotional and financial health care costs of medical problems resulting from being born too early. </p>
<p>Caring for a premature baby in a neonatal intensive care unit <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2005.00577.x/full">costs an estimated</a> GB£317,166 (A$555,000) per night in the UK, and many preterm babies are admitted for weeks and even months. In the United States <a href="http://www.ncbi.nlm.nih.gov/pubmed/21219170">preterm birth is thought to cost</a> more than US$26 billion every year.</p>
<p>Despite a significant increase in research focused on preterm birth over the last 20 years, rates remain largely unchanged. The major priority in tackling this important condition is in understanding how to prevent preterm birth in women at risk.</p><img src="https://counter.theconversation.com/content/63404/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsay Kindinger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research has found a commonly used method of preventing early or pre-term birth (delivery of a baby before 37 weeks) may in fact be causing more to occur, and leading to further problems.Lindsay Kindinger, Prematurity Clinical research fellow, Imperial College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/625452016-07-18T20:06:30Z2016-07-18T20:06:30ZMums and dads of very preterm babies more likely to be depressed<p>The classic image of a newborn baby happily nestled in the proud parents’ arms is one we are all familiar with. Many of us are lucky enough to have one on the mantelpiece, but some families miss out on taking this photo. </p>
<p>Babies who come too early, often weighing under a kilogram, are rushed away from their parents to the neonatal intensive care nursery in a fight for survival. Babies are classified as preterm when they are born <a href="http://www.who.int/mediacentre/factsheets/fs363/en/">prior to 37 weeks’ gestation</a>. </p>
<p>Within this group, those born prior to 32 weeks are classified as very preterm. In Australia, more than <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545698">5,000 babies</a> are born very preterm every year, and it is these babies who are at greatest risk for a <a href="http://www.ncbi.nlm.nih.gov/pubmed/12824207">wide range of adverse outcomes</a>. </p>
<p>A new baby is life-changing for all parents, but for those whose babies are born too early, the challenges can be immense. </p>
<p>Our research <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=2532578">published today in JAMA Pediatrics</a> reports concerning levels of psychological distress in both mothers and fathers of very preterm babies. We closely followed these families, assessing parental mental health every two weeks for the first 12 weeks after birth, then again six months later. </p>
<p>In the weeks immediately following the birth of their babies, 40% of mothers and 36% of fathers experienced clinically significant symptoms of depression. This was compared to just 6% of mothers and 5% of fathers of healthy full-term babies.</p>
<p>Rates of anxiety were even higher, at close to half of both mothers and fathers. Thankfully, symptoms improved over the course of the first 12 weeks. When we checked in again with parents six months later, though, 14% of mothers and 19% of fathers were still distressed, compared to 5% of mothers and 6% of fathers of full-term babies. </p>
<p>There was little evidence changes in parental psychological distress were related to medical severity, time of transfer or discharge from hospital, or other family factors. </p>
<p>In many ways, it’s not surprising parents of very preterm infants are at far higher risk of depression and anxiety than parents of healthy, full-term babies. Their experiences are vastly different. </p>
<p>Parents of very preterm babies often describe great fear, shock, feelings of helplessness and unmet expectations, as well as inherent separation from their babies. </p>
<p>On average, the very preterm babies in our study stayed in hospital for about three months – a far cry from the few days following a straightforward birth. A baby’s path through the neonatal intensive care unit is often not smooth, which puts enormous strain on families in a multitude of ways. </p>
<p>There is also the impact of grief – many parents speak of the sense of loss they feel for the pregnancy, the birth and the baby they had imagined. </p>
<h2>Father’s depression often neglected</h2>
<p>Fathers of very preterm babies have been largely neglected in the research to date. This study is the first to our knowledge to look at the mental health of fathers in this way. </p>
<p>We found they were no less susceptible to depression and anxiety than mothers. This differs from rates reported in the general population, which show that <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0">men have lower rates of depression and anxiety than women</a>, regardless of whether they are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20483973">fathers</a> or not.</p>
<p>There are a few potential reasons for this new finding. First, there is no doubt the neonatal intensive care unit experience can be highly stressful for both mothers and fathers. </p>
<p>However, it is important to appreciate that fathers also often have unique pressures. Many men described feeling torn between their partner and their baby, both in need of extra support. They were often going back to work and juggling multiple responsibilities, especially when there are other children at home. </p>
<p>Many also spoke of the challenges of trying to meaningfully engage in an environment where traditionally the focus is on mothers. </p>
<h2>What can be done?</h2>
<p>It’s important for parents to know that, for many people, the distress they feel after having a preterm baby does improve over the first few months. This may represent a period of adjustment. </p>
<p>However, as parents in our study were still showing higher rates than their full-term counterparts six months later, it is also important to be aware the challenges for these families do not end when they leave hospital. </p>
<p>We know from previous research mothers still have higher rates of psychological distress <a href="http://www.ncbi.nlm.nih.gov/pubmed/19955253">two</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24359937">seven</a> years after having a very preterm baby. </p>
<p>It’s important health professionals working with these families closely monitor parents for signs of depression and anxiety at regular intervals during the hospital stay and beyond, and ensure they are receiving appropriate support. This support needs to continue far beyond the traditional postnatal period. </p>
<p>It’s clear we need to be more aware of the well-being of fathers. Many of our fathers said they were surprised we were interested in how they were going, and were grateful for it. </p>
<p>This article talks about the typical nuclear family consisting of a mother and father, but of course there is also much diversity in families. This extra awareness and support must apply to all caregivers and support people involved in the birth of a child. </p>
<p>All parents sometimes need reminding to look after themselves. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/21052833">large body of research</a> shows parental mental health is important for child outcomes. Parents of very preterm babies getting the support they need will not only improve their own well-being, but will go a long way to help protect these vulnerable babies too.</p>
<hr>
<p><em>Further information and support for parents of preterm babies can be found at <a href="https://www.lifeslittletreasures.org.au">Life’s Little Treasures</a> or <a href="http://raisingchildren.net.au/premature_babies/premature_babies.html">Raising Children Network</a>.</em></p>
<p><em>For general support you can contact <a href="https://www.lifeline.org.au">Lifeline</a>: 131 114 or <a href="https://www.beyondblue.org.au">Beyond Blue</a>: 1300 22 4636</em></p><img src="https://counter.theconversation.com/content/62545/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carmen Pace does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new baby is life-changing for all parents, but for those whose babies are born too early, the challenges can be immense.Carmen Pace, Clinical Psychologist and Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.