The Cause and Effects of Premature Birth

Nearly 22,000 neonatal mortalities are reported each year, with preterm birth being the leading cause (Kochanek 14). A national statistic reported by the Centers for Disease Control and Prevention found that one in ten babies during the year 2018, were born before reaching full term. Each year, the percentage of premature babies being born has a lingering increase, and while the increase may seem insignificant, it provides supporting evidence that women who are pregnant are having a harder time carrying their babies to full term. What are the causes of preterm birth, and what are some preventative methods to help reduce the climbing rate of premature babies being born? Substance abuse, chronic conditions, as well as being categorized in a lower social class increase the likelihood of complications during pregnancy, and more specifically, leads to the mother’s becoming more susceptible to preterm labor and delivering a premature baby.

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A premature baby is a baby who is delivered before completing thirty-seven-weeks of the average forty-week gestation period.  Infants born before thirty-two-weeks’ gestation are classified as “very” preterm, and those born before twenty-eight-weeks’ gestation are classified as “extremely” preterm (Tucker and McGuire 675). A baby who is preterm is classified entirely on the gestation age; while an infant’s weight is important, the birth weight does not affect whether a baby is categorized as preterm. The most common type of preterm labor is known as spontaneous preterm delivery. This often occurs in women who experience an amniotic membrane rupture, or for unknown reasons. An amniotic membrane rupture is the breaking or rupturing of the amniotic sac, “breaking the water.” Nearly one to two percent of the total preterm babies who are delivered before reaching the thirty-two-week gestation age, and 0.4% of babies delivered before the twenty-eight-week gestation age experience the most serious types of complications (Tucker and McGuire 677).  This statement leads one to question the causes of preterm births and which causes have a greater effect on the fetus. 

Numerous factors contribute to the increasing rate of preterm births in the United States, with one of the leading factors being substance abuse. Between 55 to 94% of newborns experience neonatal abstinence syndrome due to their mother’s being treated with or becoming addicted to opioids during their pregnancy (McQueen and Murphy-Oikonen, par. 4). Neonatal Abstinence Syndrome is a syndrome where the newborns begin to experience withdrawing symptoms due to the exposure of narcotics in the womb. The United States has multiplied the average of babies born with this disease by five between the years 2000 and 2012. In 2012, there were 21,732 infants diagnosed with Neonatal Abstinence Syndrome (McQueen and Murphy-Oikonen, par. 2). While this is a significant increase over the past decade, the reported number of infants diagnosed with NAS is not particularly surprising. There is a correlation between the rise in numbers of infants being born with this syndrome and the rise in women being prescribed opioids for painkillers during pregnancy.  Aside from the use of opioids leading to preterm births, marijuana and cocaine have also been found to increase the risk of preterm birth. According to the authors of “Preterm Birth: Causes, Consequences, and Prevention,” Richard Behrman and Adrienne Stith Butler, women who use cocaine are twice as likely to have a preterm birth than women who do not use cocaine. While no woman should consume such harmful substances through the entirety of the pregnancy, the use of illicit drugs has a stronger effect on the fetus when they are being consumed during the second and third trimester.

Alcohol and smoking are two factors in premature births that are frequently grouped together to be researched: “Cigarette smoking is among the most prevalent, preventable causes of adverse pregnancy outcomes” (Behrman and Butler 91).A sample was taken from 801 participants to examine the effects and correlation of the consumption of alcohol and smoking during pregnancy. The results concluded that women who consume an ounce of pure alcohol every day before becoming pregnant, lower the birth weight by 91 grams. A decrease of 160 grams is found when women consume an ounce of pure alcohol daily during their late pregnancy (Little 1155). The consumption of alcohol and nicotine during the late stages of pregnancy can have a significant effect on the development of the fetus compared to the substances’ being consumed in the first trimester. This is due to the development of the placenta; since the placenta is the direct connection between mother and fetus, once the placenta is fully matured all of the nutrients and enzymes are shared. The consequence to sharing nutrients and enzymes is that the mother’s health is one of the deciding factors on the baby’s health.

During pregnancy, the mother’s health is vital in order for the fetus to properly develop and lower the risk of preterm labor. Medical conditions that a woman has previously faced prior to becoming pregnant can have a significant effect on the baby’s health as he or she grows, unless closely monitored. Aside from previous health complications, women have to be proactive and monitor their diet to ensure no further health complications arise. One of the most commonly seen and relatively treatable problems comes from the mother’s poor nutrition, which in turn affects the fetus. The reason for the fetus’s obtaining the same malnutrition and congenital health problems as the mother is defined by the term placenta. A placenta is an organ within the uterus that transports oxygen and nutrients, as well as removes wastes from the fetus’s blood; the placenta provides a direct connection between the mother and fetus (Monk 124).

An adequate amount of proteins, iron, and glucose should be consumed daily, especially if pregnant. Glucose levels have a significant effect on both the health of the mother and the fetus if it is not regularly monitored. By exposing the fetus to high concentrations of glucose, the risk of congenital abnormalities is greatly increased.  The urogenital system is composed of the urinary system and reproductive organs and is primarily responsible for the kidneys. According to Germaine Miese-Looy, Jessica Rollings-Scattergood, and Anna Yueng: “A low protein diet predisposes offspring to problems with renal structure and function, and increased risks of hypertension and renal dysfunction” (76). Hypertension is known as high blood pressure. The combination of high blood pressure and renal dysfunction often leads to kidney failure. Another system that is greatly affected is the cardiovascular system. Both a low protein intake and a high consumption of fats and lipids has been found to have severe effects on the cardiovascular system (Miese-Looy, Rollings-Scattergood, and Yueng 77). Each of these systems is a vital component of the body’s functions, and malnutrition during pregnancy will result in the loss of proper functioning systems. In the book, “Preterm Birth: Causes, Consequences, and Prevention, the authors stated: “A low pregnancy weight is associated with an increased risk of preterm birth” (Behrman and Butler 93). This statement is an example of the relationship between mother and baby. What the mother does to her body directly affects the fetus and thus puts both individuals in harm for potentially life-threatening medical conditions.

Chronic health conditions that the mother currently has or once had at the time of her pregnancy can play just as significant of a role in the baby’s health, as malnutrition: “Poor glycaemic control in diabetic mothers is associated with numerous serious effects, including a three-fold increase in congenital malformations as well as increases in miscarriage rates and perinatal mortality” (Miese-Looy, Rollings-Scattergood, and Yueng 75). In addition to poor glycaemic control, the development of preeclampsia is a life-threating medical condition for both the fetus and the mother.

Preeclampsia is a health complication during pregnancy that can be a fatal health condition for both the mother and the fetus if left untreated. Common symptoms that occur are high blood pressure and signs of other organ systems failing, such as the liver or the kidney; preeclampsia usually begins to show symptoms after about twenty-weeks into the gestation period. There are many theories discussing the causes of preeclampsia, but the most common explains that during pregnancy, there are blood vessels that function to send blood into the placenta. Women who develop preeclampsia, either do not develop these blood vessels, or the blood vessels become so narrow that there is a deficiency in the amount of blood reaching the placenta. Intrauterine growth restriction is known as a fetal growth restriction and can be caused for many reasons, but more specifically for women who have preeclampsia or other high blood pressure disorders that occur during pregnancy.

An Epipap study was conducted to study the correlation between maternal periodontitis and preterm birth. The participants within this study come from six maternity units in three different French regions from 2003 to 2006. Over the course of three years, any woman who gave birth between the twenty-two to thirty-six-week gestation period was eligible to participate in the study. In total, 1,108 women had a preterm delivery and 1,094 women delivered at full term. (Nabet 2). Periodontal disease is an oral inflammatory disease, commonly known as gingivitis and periodontitis. Periodontitis is a disease that destroys the connective tissue and alveolar bone, which supports the teeth (Nabet 2). For this study periodontitis is the disease being studied to determine whether or not preterm birth is the result of a mother who is infected with this disease during their pregnancy. The study concluded that the relationship between periodontitis and preterm birth was strongly correlated, more specifically, periodontitis was correlated to an increased risk of the mother acquiring preeclampsia during their pregnancy. Along with that, women who confessed to smoking either prior to or during their pregnancy significantly increased the risk of acquiring periodontitis (Nabet 5). During a women’s pregnancy, there are numerous diseases and complications that can affect both the mother and the baby, which expresses the significance as to why women need to practice the safest and healthiest habits to help reduce the risk of complications for themselves and their baby.

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Preterm delivery is a worldwide issue for many reasons that have previously been explained, but one issue can simply be a person’s geographical location. The limited access to healthcare facilities and the proper information on how to take care of one’s body and preventative measures to take to ensure the safest and healthiest pregnancy possible, is partially the reason why preterm delivery is a growing issue. Two of the most commonly found reasons for spontaneous preterm delivery are a history of preterm delivery and having a poor socioeconomic background (Tucker and McGuire 676). Those who live in a lower socioeconomic class have less resources available to them due to the lack of money and ability to receive care in certain healthcare facilities and pharmacies. Over the years, technological advancements have been made to improve the preterm delivery outcomes in countries with already developed research and prenatal facilities. However, for the countries that have yet to develop a basic midwifery and or obstetric care, the outcomes of preterm deliveries have not improved (Tucker and McGuire 676). The reason some countries do not have the proper obstetric care is due to the lack of funding and education. According to Catherine Monk, Michael Georgieff, and Erin Osterholm, “Sixty percent of these low-income women experienced at least one major stressor while pregnant” (116). Another cause of preterm birth is due to the poor nutrition women have during pregnancy. Malnutrition is also caused by limited access to resources. While these reasons may seem insignificant in the causes of preterm deliveries, they are serious issues in underdeveloped countries.

For some women conception is harder to achieve for various reasons, which increases the likelihood of preterm birth upon successful conception. In Vitro Fertilization, IVF, is a common fertilization procedure that involves the transportation of previously harvested embryos into one’s uterus with the hopes of at least one of them will become fertilized (Fechner 221). There are many positive reasons and statistics on the successes had because of the In Vitro Fertilization procedure, but one of the most common of the negative outcomes is preterm birth. Success rates of IVF have increased throughout the years; however, these successes have come at the expense significantly higher chances of conceiving twins and higher multiples of babies. These high-risk conditions put the mother and fetus at risk for complications (Fechner 221). None of the available options for fertility treatments are seemingly risk-free, but research supports the idea that IVF has the greater potential to become a high-risk pregnancy.  The journal article, “Effect of Single Embryo Transfer on the Risk of Preterm Birth Associated with in Vitro Fertilization,” made the statement: “The increased prematurity rate in the ovulation induction and IVF groups compared to their controls were more highly significant compared to the infertile group that did not undergo ovarian stimulation” (Fechner 223). The reason why ovarian induction and IVF is known to have a significantly higher prematurity rate is because they are much more invasive procedures. Ovulation induction is a stimulant that is usually given in the form of a medication and is used to stimulate the development of ovarian follicles (Fechner 223). Another method that would reduce the risk of preterm birth would be to transfer frozen thawed fresh embryos into the uterus. There are many methods to be explored that would pose a potentially significant risk for both the mother and the embryo; however, the high-risk pregnancy that comes with the fertility treatments are successful and are used as another option for women to experience motherhood.

Singleton and multiple births can occur either naturally or as a result of fertility treatments. However, there is a significant difference between the two when looking at the risk factors and common complications. Janet Tucker and William McGuire stated: “About one quarter of preterm births occur in multiple pregnancies” (677). The capacity women have within their abdominal and pelvic cavities is rather limited, and therefore, when women are carrying multiple babies, often times their labor is induced, they deliver by caesarean, and or they deliver preterm. Women who receive fertility treatments are at an increased likelihood of conceiving multiple babies, which undoubtedly increases the risk factors. Whether a woman is delivering a singleton or multiple births, there is a risk factor in either. However, in a research study conducted by Joyce Martin and Michelle Osterman, there was a preterm rate, in multiple births, in the year 2014 that increased from 59.99% to 61.04% in 2016 (Martin and Osterman 3). While this is a factor in preterm births, it is also an uncontrollable factor, unlike the other reasons that cause preterm births.

The complications in pregnancy that have a strong influence on the causes and effects of preterm birth are factors such as substance abuse, chronic conditions, and being in a lower socioeconomic class. As women, there are many preventative methods that can be taken in order to ensure a safe and healthy pregnancy for both the mother and the fetus, but some of the causes of premature birth are uncontrollable. The importance in decreasing the number of babies born prematurely each year is due to the desire to give the infants a fighting chance at life. The death rates in infants should not be as high of a percentage as it is, especially when compared to the mortality rates in older individuals. By creating awareness and expressing the importance of healthy practices during pregnancy, the number of premature babies born each year would decrease.

Works Cited

• Behrman, Richard E., and Adrienne Stith Butler, editors. Preterm Birth: Causes, Consequences, and Prevention. National Academies Press, 2007, doi:org/10.17226/11622. Accessed 10 Nov. 2019.
• Fechner, Adam, et al. "Effect of Single Embryo Transfer on the Risk of Preterm Birth Associated with in Vitro Fertilization." Journal of assisted reproduction and genetics , vol. 32, Feb. 2015, pp. 221-24, doi:10.1007/s10815-014-0381-2. Accessed 5 Dec. 2019.
• Goler, N., et al. "Substance Abuse Treatment Linked with Prenatal Visits Improves Perinatal Outcomes: A New Standard." Journal of Perinatology, vol. 28, 26 June 2008, pp. 597-603, doi:0.1038/jp.2008.70. Accessed 10 Nov. 2019.
• Martin, Joyce, and Michelle Osterman. "Describing the Increase in Preterm Births in the United States,2014-2016." CDC, edited by Charles Rothwell and Jennifer Madans, National Center for Health Statistics, June 2018, www.cdc.gov/nchs/products/databriefs/db312.htm. Accessed 10 Nov. 2019.
• McQueen, Karen, and Jodie Murphy-Oikonen. "Neonatal Abstinence Syndrome." The New England Journal of Medicine, 22 Dec. 2016, DOI:10.1056/NEJMra1600879. Accessed 10 Nov. 2019.
• Miese-Looy, Germaine, et al. Long-term Health Consequences of Poor Nutrition during Pregnancy . 2008, file:///Users/meaganm/Downloads/421-Article%20Text-2278-3-10-20080229.pdf. Accessed 17 Nov. 2019.
• Monk, Catherine, et al. "Research Review: Maternal Prenatal Distress and Poor Nutrition – Mutually Influencing Risk Factors Affecting Infant Neurocognitive Development." Journal of Child Psychology and Psychiatry, vol. 54, no. 2, 2013, pp. 115-30, doi:10.1111/jcpp.12000. Accessed 17 Nov. 2019.
• Nabet, Cathy, et al. "Maternal Periodontitis and the Causes of Preterm Birth: The Case-control Epipap Study." Journal of Clinical Periodontology, vol. 37, 1 June 2010, pp. 37-45, doi:10.1111/j.1600-051X.2009.01503.x. Accessed Jan. 2010.
• "Preeclampsia ." Mayo Clinic , 16 Nov. 2018, www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745. Accessed 5 Dec. 2019.
• Romero, Roberto, et al. "Preterm Labor: One Syndrome, Many Causes." American Association for the Advancement of Science, 15 Aug. 2014, pp. 760-65, doi:10.1126/science.1251816. Accessed 4 Dec. 2019.
• Tucker, Janet, and William McGuire. "Epidemiology of Preterm Birth." British Medical Journal, vol. 329, 18 Sept. 2004, pp. 675-78, doi:10.1136/bmj.329.7467.675. Accessed 11 Nov. 2019.