tag:theconversation.com,2011:/id/topics/preterm-babies-29380/articlesPreterm babies – 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>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/every-2-seconds-in-the-world-a-baby-is-born-prematurely-report-identifies-biggest-challenges-for-their-survival-207034">Every 2 seconds in the world a baby is born prematurely – report identifies biggest challenges for their survival</a>
</strong>
</em>
</p>
<hr>
<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>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/eyvrWh_GWic?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Five simple ways to prevent preterm deaths.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-number-of-premature-baby-deaths-is-still-too-high-what-can-be-done-about-it-67534">The number of premature baby deaths is still too high. What can be done about it</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/222302/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>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/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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<figure class="align-center ">
<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">
<figcaption>
<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>
</figcaption>
</figure>
<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>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/who-are-my-parents-why-new-zealands-creaky-surrogacy-laws-are-overdue-for-major-reform-166745">Who are my parents? Why New Zealand’s 'creaky' surrogacy laws are overdue for major reform</a>
</strong>
</em>
</p>
<hr>
<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>
<figure class="align-center ">
<img alt="Pregnant women holds her hands under her belly" src="https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.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">
<figcaption>
<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>
</figcaption>
</figure>
<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>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/surrogacy-shake-up-in-uk-would-create-uneven-treatment-for-birth-mothers-202872">Surrogacy shake up in UK would create uneven treatment for birth mothers</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/206182/count.gif" alt="The Conversation" width="1" height="1" />
<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>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3fQaH6fLVxs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<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>
</figure>
<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>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/hCfyEM_aE2g?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Be aware of the risk factors for preterm birth.</span></figcaption>
</figure>
<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/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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1285238398031028224"}"></div></p>
<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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1243193758268751874"}"></div></p>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<figure class="align-center zoomable">
<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>
<figcaption>
<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>
</figcaption>
</figure>
<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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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/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>
</strong>
</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>
</strong>
</em>
</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/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/765392017-04-26T01:05:48Z2017-04-26T01:05:48ZCutting EPA budget puts babies at risk – and makes little economic sense<p>President Donald Trump recently ordered an air strike on Syria, fueled in part by <a href="http://www.telegraph.co.uk/news/2017/04/10/ivanka-trump-influenced-father-launch-air-strikes-against-assad/">moral outrage</a> at images of babies being injured and killed by airborne toxins.</p>
<p>American babies are under threat as well. In this case, the culprit is the Trump administration’s <a href="https://www.nytimes.com/2017/04/10/climate/trump-epa-budget-cuts.html">proposal to slash the Environmental Protection Agency’s budget</a> by 31 percent, including cuts to the enforcement division, Targeted Air Shed Grants and the Clean Power Plan. </p>
<p>These reductions degrade the protections needed to reduce airborne toxins and maintain the nation’s air quality. Expectant mothers will face greater exposure to air pollution, which causes more preterm births, infant illnesses and deaths. </p>
<p>As an economist who studies the link between health and socioeconomic status, I’ve explored the extensive research demonstrating the importance of a clean environment to the well-being of children. By improving health outcomes, the EPA’s efforts to reduce pollution reduces health care costs and can benefit the economy. </p>
<h2>Dirty air and baby health</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/21112090">link</a> between fetal and infant health and exposure to air pollution <a href="https://www.ncbi.nlm.nih.gov/pubmed/22726801">has been well-established</a> by <a href="https://www.ncbi.nlm.nih.gov/pubmed/15811825">many experts</a> using a variety of methods and data sets over decades. </p>
<p>This large body of work clearly shows that prenatal exposure to airborne pollutants significantly raises the risk of preterm birth, low birth weight, and infant respiratory and cardiovascular illness as well as developmental problems, like autism. </p>
<p><a href="https://e-zpassiag.com/about-us">Adoption of the E-Z Pass system</a> on the New Jersey and Pennsylvania turnpikes in the late 1980s provided a natural experiment and illustrates the connection between air pollution and fetal health. </p>
<p>Turnpike authorities adopted E-Z Pass in order to reduce the time drivers spent in toll plazas. And it worked; traffic congestion fell by 85 percent. Because vehicles spent less time at the toll plazas, EZ Pass also reduced vehicle emissions and improved local air quality. </p>
<p>Economists Janet Currie and Reed Walker <a href="https://www.aeaweb.org/articles?id=10.1257/app.3.1.65">found</a> that within three years of the introduction of E-Z Pass in these two states, the number of premature births and low birth weight babies born to mothers living within two kilometers of toll plazas dropped by roughly 8 percent and 10 percent, respectively. </p>
<p>Because babies born prematurely or with low birth weight suffer more health problems, reducing these adverse birth outcomes reduces infant illness and deaths. </p>
<h2>The economic case</h2>
<p>And from an economic perspective, healthy babies save money. </p>
<p>Currie and Walker estimate the drop in adverse birth outcomes in the neighborhoods near the toll plazas saved US$10 million to $13 million in health care costs. Generalizing their results suggests that reducing traffic congestion nationwide would reduce preterm births by 8,600 and save $444 million in health care costs annually. </p>
<p>Molecular epidemiologist Frederica Perera and her colleagues <a href="https://www.ncbi.nlm.nih.gov/pubmed/24804951">found</a> that a modest reduction in the amount of toxins known as polycyclic aromatic hydrocarbons in the air in New York City would raise low-income infants’ IQ, increasing their lifetime earnings by $43 million to $215 million. </p>
<p>And to add the national perspective, pediatrician Leonardo Transande and his research team <a href="http://dx.doi.org/10.1289/ehp.1510810">projected</a> that reducing air pollution nationwide would save billions of dollars in medical costs and lost economic productivity over the lifetimes of exposed infants. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.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">
<figcaption>
<span class="caption">Prenatal exposure to airborne pollutants significantly raises the risk of complications like preterm birth and infant respiratory and cardiovascular illness.</span>
<span class="attribution"><span class="source">Pregnant woman via www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>A great return</h2>
<p>Now let’s consider the <a href="https://www.epa.gov/clean-air-act-overview/1990-clean-air-act-amendment-summary">Clean Air Act Amendments of 1990</a>, which garnered bipartisan support and was signed into law by President George H.W. Bush. </p>
<p>EPA <a href="https://www.epa.gov/sites/production/files/2015-07/documents/fullrept.pdf">cost-benefit analysis</a> of this legislation indicates that it generated $4 of benefits per dollar of cost incurred, where benefits were defined as reduced health costs and greater labor productivity. That’s a good return. </p>
<p>The EPA’s nearly 25-year effort to remove lead from gasoline <a href="https://yosemite.epa.gov/ee/epa/eerm.nsf/vwan/ee-0034-1.pdf/$file/ee-0034-1.pdf">generated even more impressive results</a>. This policy lowered Americans’ average blood lead levels by 75 percent.</p>
<p>Lower lead levels in children reduced infant mortality and improved children’s physical health, raised IQs and reduced aggressive behaviors. When these children matured into adults they were more economically productive and less likely to commit crimes. This policy <a href="https://yosemite.epa.gov/ee/epa/eerm.nsf/vwan/ee-0034-1.pdf/$file/ee-0034-1.pdf">saved an estimated</a> $10 for every dollar spent on getting the lead out of gasoline. That’s a great return.</p>
<p>The health and economic benefits of the Clean Air Act Amendments and the transition to unleaded gasoline show that not all environmental policies waste taxpayer money. In fact, the <a href="https://www.gop.com/the-2016-republican-party-platform/">Republican Party 2016 platform</a> states that “human health and safety are the proper measures of a policy’s success.” By that standard, the EPA’s work with on the Clean Air Act Amendments and the elimination of leaded gasoline constitute great successes. </p>
<p>The EPA’s efforts to preserve air quality protects babies (and the rest of us) from damage caused by airborne toxins. It also saves a lot of money. Whether you care about economics or children’s health, cutting the EPA’s budget is not a good deal in the long run.</p><img src="https://counter.theconversation.com/content/76539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Smith 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>An extensive amount of research has shown a direct link between air quality and fetal and infant health. Cleaner air has saved lives – and money.Patricia Smith, Professor of Economics, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/716442017-01-31T08:26:29Z2017-01-31T08:26:29Z‘Kangaroo mother care’ helps preterm babies survive … but offers benefits for all<figure><img src="https://images.theconversation.com/files/153598/original/image-20170120-5211-li6rl9.jpg?ixlib=rb-1.1.0&rect=0%2C146%2C1920%2C1224&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kangaroo mother care: the marsupials have got it right.</span> <span class="attribution"><a class="source" href="http://www.publicdomainpictures.net/view-image.php?image=40311&picture=joey-in-mothers-pouch">Lilla Frerichs</a></span></figcaption></figure><p>It’s become increasingly clear over decades of studies that the early days, months and years of a child’s life are critical for their future physical and mental health. The remarkable findings of a recent study suggest that close skin-to-skin contact between mother and baby combined with breastfeeding in the early days creates demonstrable improvements to the child’s future health and well-being that are <a href="http://pediatrics.aappublications.org/content/139/1/e20162063">still evident even after 20 years</a>. </p>
<p>This technique, known as <a href="http://www.who.int/maternal_child_adolescent/documents/9241590351/en">“kangaroo mother care”</a> is generally associated with caring for low-birthweight premature babies. It features skin-to-skin contact between a mother (or father) and their newborn, frequent and exclusive or nearly-exclusive breastfeeding, and early discharge from hospital. </p>
<p>A previous study between 1993 and 1996 had examined a group of small, premature babies in order to determine the benefits of kangaroo mother care at one year of age. At the time, short-term benefits were found to <a href="http://pediatrics.aappublications.org/content/108/5/1072.long">include improvements in IQ and growth, and fewer severe infections</a>. For this new study, led by Nathalie Charpak of the <a href="http://www.fundacioncanguro.co/">Fundación Canguro</a> in Bogotá, Colombia, alongside a team of medics and academics drawn from universities in Colombia and Québec, Canada, around 500 of the nearly 700 original participants were contacted and studied again between 2012 and 2014. The benefits relating to IQ, social and behavioural development were long-lasting and still evident 20 years later.</p>
<p>The question is, why does kangaroo mother care have this affect? It is not an easy question to answer. Kangaroo mother care is a group of interventions, which makes it difficult to know where the effects of one start and those of another end. That said, what each element of kangaroo mother care has in common is the closeness between parent and baby, in comparison to a typical approach of nursing preterm babies within an enclosed incubator. It may be that the benefits of the technique are tied up with the physical and emotional closeness and avoidance of separation that it offers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/153601/original/image-20170120-5238-mmi6u7.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">
<figcaption>
<span class="caption">Edith’s twin boys, strapped to their grandmother’s chest in the Queen Elizabeth hospital in Blantyre, Malawi.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dfid/7497732174/">DFID</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Importance of the physical bond</h2>
<p>How can physical closeness at one time of life have physical and emotional benefits that last decades? The link between physical closeness and the psychological process of bonding and attachment is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468719">well documented</a>. In neonatal care, the effects of separation may have a profoundly negative effect on the bonding process, which in turn may affect the baby’s psycho-emotional development.</p>
<p>Skin-to-skin contact between the baby and the body or chest of the parent stimulates the release of the hormone oxytocin. This plays a crucial role in a mother’s bonding behaviour, in turn positively affecting her mood and interactions with the baby. Close physical contact can also decrease babies’ cortisol levels, a chemical associated with the stress response and a reduction in the signs of pain. </p>
<p>Premature babies are born at a period when the body is maturing fast. Any interruption to this process due to being deprived of an optimal environment inside the womb can significantly affect development. The <a href="http://www.brazelton.co.uk">Brazelton Centre</a>, an expert centre in infant behaviour, has asserted that a premature baby’s nervous system becomes more easily organised while in a calm environment without excessive stimuli. Kangaroo mother care provides this through the calming effect of close contact, <a href="http://bit.ly/2ksNWGT">mimicking to some extent that experienced in the womb</a>. Several other studies since have <a href="http://pediatrics.aappublications.org/content/129/5/e1322">corroborated this idea</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/153596/original/image-20170120-30764-1frn8jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Incubator care is common, but doesn’t have the same positive benefits as kangaroo mother care.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Neonatal_Jacoplane.jpg">Jacoplane</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Given their vulnerability, the brains of premature babies are at risk of abnormal development and subsequent problems later in life. However, the human brain’s plasticity affords it the potential to compensate for injury. In this case, it’s not only the link between physical closeness and psychological stability that is important but also the part played by a favourable environment to which a baby is exposed – something kangaroo mother care appears to provide. There is evidence in both humans and animals that suggests that brain development is influenced by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818078">quality of care given to babies in early postnatal life</a>.</p>
<p>Studies of brain volume in children born prematurely have shown that premature birth can reduce an area of the brain known as the <a href="http://www.healthline.com/human-body-maps/caudate-nucleus">caudate nucleus</a>. Charpak’s study proposes that the group of babies the team studied might have experienced an increase in the volume of the caudate nucleus through the interplay of the plasticity of their brains and the effects of kangaroo mother care.</p>
<h2>Enhancing connections</h2>
<p>Finally, the close and constant presence of a parent may provide the baby with learning experiences that they might not receive, such as interactivity and communication. Exposure to parent talk in the neonatal intensive care unit has been found to be a <a href="http://pediatrics.aappublications.org/content/128/5/910.long">significantly stronger predictor of preterm baby vocalisations</a> than talk from other adults, for example.</p>
<p>All this poses another question: whether the effects of kangaroo mother care apply to babies beyond only those born prematurely? The principles of closeness and the avoidance of separation are <a href="http://www.bjdd.org/new/105/81to95.pdf">supported by research</a> that indicates that a positive nurturing environment is linked to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621015">better psychological outcomes for the child</a>. It seems that this combination of biology and the environment in the early days and weeks after birth is vital for any child, as they form the early foundations for both the physical development of the brain and the child’s psycho-emotional development.</p>
<p>Although the exact nature of how parental closeness leads to improved child outcomes is not clear, studies reveal a close relationship between early emotional connection and the child’s later health and well-being. Cost free and straightforward, kangaroo mother care should be promoted to all parents and their babies in any setting as early as possible in order to promote the closeness that can have a demonstrable and long-lasting effect on the child.</p><img src="https://counter.theconversation.com/content/71644/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Petty receives funding from University of Hertfordshire for a small research grant in collaboration with University of Technology Sydney. Research currently in progress. She is affiliated with the UK Neonatal Nurses Association as an executive member. </span></em></p>Kangaroo mother care: the long-term benefits of closeness in the early days of life.Julia Petty, Senior Lecturer in Children's Nursing, University of HertfordshireLicensed 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.