Preventing Prematurity: What the Research Shows
One of the best things parents can do to give their child a healthy start in life is to help prevent premature birth — defined as anything before 37 weeks of pregnancy. Prematurity is not only the leading cause of infant death, but it is also linked to severe long-term health problems including autism, intellectual disabilities, lung and respiratory disorders, cerebral palsy, and vision and hearing problems.
So what can a parent do? Surprisingly, quite a lot. Dr. Paul Ogburn Jr., Director of Maternal-Fetal Medicine (the medical specialty that cares for high-risk mothers and babies during pregnancy and beyond) at Stony Brook Medicine, talks about proven practices — some of them quite simple — that lead to healthy, full-term pregnancies.
What is the first thing that parents need to know about preventing prematurity?
The first step is awareness. Women need to know that there are many things they can do to prevent early delivery and that there are abundant resources here in Suffolk County to support them, Stony Brook Medicine being one. Stony Brook Medicine is a Level 4 New York State designated Perinatal Referral Center, which means not only does it have the expertise to take care of difficult pregnancies and high-risk moms and babies, but it also serves the entire region through education, leadership, and collaboration with community hospitals, government programs and county clinics to improve the outcomes of pregnancies. It’s a responsibility we assumed willingly and with great enthusiasm because it perfectly reflects our mission to improve the health of all of Suffolk County. The county’s rates of premature birth are one of the highest in the state, and we are working diligently to reverse this.
You said many of the steps to ensuring a healthy, full-term pregnancy are fairly simple. What are they?
Overall, getting early and ongoing prenatal care is one of the most important things a pregnant woman can do. Studies show that women who receive prenatal care early as compared with women who only receive it in the later months have better outcomes. Ideally, a woman should be working with her physician even before she gets pregnant so we can take proactive steps, such as starting prenatal vitamins, or identify possible risks that may lead to premature birth. These risk factors could be anything from the mother’s age to autoimmune diseases to a family history of Down syndrome to chronic conditions such as diabetes or heart disease.
We are also working very hard to remove barriers to prenatal care so that access, cost, language, transportation and other factors do not keep women from getting the care they need. Again, with Stony Brook’s role as a perinatal center, we are connected to resources and initiatives that link women with appropriate resources and support.
Besides early prenatal care, what else can a woman do to prevent prematurity?
Research shows that there are several key factors that a woman can control: obesity, smoking, dental care and prenatal vitamins. Here’s why.
What does good prenatal care encompass?
It really comes down to monitoring the mother and the fetus. We now have the capabilities to perform ultrasounds very early in the pregnancy, which will give us a clearer idea of the due date. At 12 weeks, we can measure the size of the baby and draw blood that will tell us about risks for Down syndrome and other abnormalities, and as the pregnancy progresses we can use other routine tests to look for chromosome abnormalities. At 18 to 20 weeks we can use ultrasound to take a detailed look at the fetus to ensure that everything is normal and is in the right place anatomically. At 22 weeks, echocardiography can detect 90 percent to 95 percent of all major heart defects in the baby before birth. In some cases when we’ve identified an abnormality, we can take care of it before the baby is born through surgery or other interventions, which improves outcomes. As the pregnancy progresses, we can look for conditions that might trigger early labor, for example cervical incompetence, and address them through monitored bedrest, cerclage and other interventions. We do everything we can to safely prevent premature delivery.
What if despite these efforts, the baby does deliver prematurely?
Sometimes it is safer for mother and/or baby to let the delivery proceed. In these cases, you want to be at a medical institution like Stony Brook that has capabilities to deal with obstetrical emergencies and premature babies. The Labor & Delivery Suite at Stony Brook is equipped to handle these emergencies 24/7, which is important because at times like these, every second counts. It also has a Level III neonatal intensive care unit (NICU) equipped with the technology and specialty physician expertise to treat the smallest and sickest babies.
One more thing to mention: If a mother or baby is at high risk for complications, it is better if the birth occurs at a regional perinatal center. If that is not possible, Stony Brook has a maternal/fetal transport services that can safely bring them to us immediately after birth. However, studies show that the chances of the baby’s survival are twice as good if born at a regional center than if transferred after birth.
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