Preventing preterm births for Black women: what you can do to reduce risk factors for this serious pregnancy complication

Ebony, Oct, 2008 by Joy T. Bennett

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Though Jocelyn Hayes-Fields did everything right during her two pregnancies, she's the mother of two children born prematurely who spent a total of 194 days in neonatal units fighting for their lives. She is now a spokesperson about preterm births, and she doesn't need a forum, a news conference or a script to explain it. For her it is a very personal experience.

Hayes-Fields of Los Angeles had no history of preterm births, and after a careful regimen of prenatal care and taking her prenatal vitamins, she and her husband, Timothy, were still surprised to welcome their first son into the world at only 26 weeks gestation. "It was a total surprise. Actually, when Timothy was born, I had heard of preemies, but not that extreme of a preemie," she now says. "I could fit the kids in the palm of my hand. I had never even heard of the NICU [neonatal intensive care] unit."

But after the births of Timothy (now 5 years old and robustly healthy) and sister Tamia [now a healthy 3-year-old], who was born at 24 weeks, Hayes-Fields became more informed through the March of Dimes, a national health advocacy group. "I found out that African-Americans are at higher risk because of high blood pressure, diabetes, multiple births and if you've had a preemie before," she says. "But at first, after I delivered Timothy, I had no clue."

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Nearly 500,000 babies born in the United States (1 in every 8 births) are born preterm, and medical experts don't know why this number is increasing. A woman may do all the right things, have no known risk factors and, like Hayes-Fields, still give birth prematurely, according to medical experts. This means that any pregnant woman is at risk for preterm delivery.

A normal pregnancy should last about 40 weeks. A pregnancy that ends between 20 weeks and 37 weeks is considered preterm, and all preterm babies are at significant risk for health problems. Preterm birth is a major cause of infant death and places babies at increased risk for serious lifelong disability.

Premature birth rates have reached epidemic proportions in the United States, endangering the lives of more than half a million babies. African-American women have the highest premature birth and infant mortality rates of all racial groups, according to the March of Dimes. In 2005, the preterm rate for African-American women averaged 18.4 percent, compared to the national average of 12.7. Infant mortality rates for African-Americans averaged 13.5 for every 1,000 live births between 2002 and 2004, compared to the national average of 6.9.

The repercussions of a baby's early entrance into the world can last a lifetime. Premature babies can start life with a range of health problems that may affect their organs, from lungs and heart to brain and eyes, problems that may never get better. In fact, half of all neurological disabilities in children are related to premature birth.

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"The federal government and the numerous health advocacy groups have worked diligently for decades to overcome the problem of preterm birth," says Acting Surgeon General Steven K. Galson, M.D., M.P.H., a rear admiral in the U.S. Public Health Service. Galson explains that recent advances make it possible to identify numerous risk factors that predispose women to give birth prematurely. This has led to treatment that may reduce premature births among some at-risk mothers. During a conference earlier this year, the surgeon general outlined an agenda that calls for improved methods for estimating the age of the fetus and for studies to identify biomarkers signaling the beginning of preterm labor. A major sign of a possible preterm birth is contractions (the abdomen tightens like a fist) every 10 minutes or more frequently.

Experts say if the symptoms get worse or do not go away after one hour, call your health care provider or go to the hospital. It's not necessary to have all the symptoms; you should take action if you have only one. "Specifically African-American women of all incomes are at increased risk," says Dr. Janice E. Whitty, a National Medical Association spokesperson and director of maternal fetal medicine, chief of obstetrics and gynecology, Me-harry Medical College. "If a woman comes here from Africa, her risk is not great."

How do we lower the risk? If a woman already has one premature baby, she should ask her health care provider if progesterone treatment might help prevent another early birth. Progesterone injections can reduce her risk of preterm birth by 30 percent, Whitty says. Prenatal care is a must. "If a woman is planning to get pregnant, she should see a doctor first," she adds. Whitty also advises women to see a doctor right away once they think they are pregnant; maintain a healthy diet with lots of fresh fruits and proteins, take a multivitamin with folate, get plenty of rest and keep stress levels down because stress can lead to preterm birth. That includes the stress of racial discrimination.

Physically uncomfortable pregnant mothers should also resist the urge to press their physicians to deliver their babies early, even a few weeks early. A recent study from the U.S. Centers for Disease Control and Prevention and the March of Dimes documented a spike in the delivery of near-term babies, usually delivered by Caesarean section. Although clear medical guidelines stipulate when an early C-section is necessary for medical reasons, sometimes morns request earlier deliveries for non-medical reasons, and physicians, worried about litigation, often comply. Sometimes the exact age of the fetus is also not known, experts add.