Prematurity: Risks associated with delivering babies before 39 weeks

Prematurity: Risks associated with delivering babies before 39 weeks

Mayrene Hernandez, MD

[dropcap]N[/dropcap]ovember was National Prematurity Awareness Month, but December still is a good time for families in Florida and nationwide to think about the health of expectant mothers and babies, and to raise awareness of and increase safe and healthy pregnancies and deliveries.

One out of eight babies nationwide each year is born premature, according to the Centers for Disease Control & Prevention. Premature births represent a small percentage of all births; however, these infants comprise a large proportion of all infant deaths. In Florida, the infant mortality rate is about 6.7 per 1,000 live births, ranking the state No. 29 nationwide, according United Health Foundation’s 2013 America’s Heath Rankings.

Appropriate prenatal and postnatal care is critically important for mother and baby’s health. It also is important for mothers and families to understand the risks associated with elective deliveries before 39 weeks of gestation and their potential impact on infant health. The American College of Obstetricians and Gynecologists (ACOG) defines full-term as 39 weeks and advises against elective deliveries before that.

The potential complications involved with elective childbirth before 39 weeks are very real, yet some first-time mothers may be unaware of the risks. Babies born before 39 weeks are more likely to have respiratory problems and developmental delays, according to numerous published studies.

A review of claims data by UnitedHealthcare showed that 48 percent of newborns admitted to the neonatal intensive care unit (NICU) at select hospitals were from scheduled admissions for delivery — many before 39 weeks of gestation. By being scheduled, or electively induced, these deliveries were prevented from progressing to full term. After sharing these findings, physicians and hospitals altered practice patterns and realized a 46-percent decrease in NICU admissions in the first three months.

The U.S. has the highest rate of preterm birth of any industrialized country. In 2012 more than 11 percent of births occurred before 37 week of gestation, according to the March of Dimes. Preterm birth and infant mortality rates have been improving in recent years, in part because of an effort to eliminate unnecessary deliveries before 39 weeks.

However, we need to do more. More than 1.3 million babies were delivered by cesarean section in 2011, with wide variation in C-section rates at hospitals nationwide, according to a new study from the University of Minnesota. The overall Csection rate was 33 percent, but the rate ranged between 19 and 48 percent at hospitals across the nation; the researchers could not identify evidence-based factors to explain the variation. C-section deliveries can carry a variety of risks, including infection, blood clots and problems in future pregnancies.

New tools, including myriad mobile apps, are helping pregnant women and new parents with prenatal and postnatal care.

For instance, UnitedHealthcare’s Baby Blocks is a mobile incentive program now available to Medicaid beneficiaries in 14 states, including Florida, and people enrolled in employer-sponsored health plans. Users access interactive “baby blocks” via the app on their iPhones and Android smartphones that show their prenatal visit. Users can then earn rewards for following a prenatal- and postnatal-visit schedule, including gift cards, toys and diapers.

Encouraging a healthy and full-term pregnancy is the responsibility of parents and health professionals, and technology is helping make that possible. The last few weeks of pregnancy for many mothers can seem endless and often uncomfortable. But expectant parents should take the opportunity to learn just how important the last few remaining weeks are for their baby’s development and health.
Mayrene Hernandez, MD, is medical director, UnitedHealthcare of Florida.

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