Worldwide, a million babies die every year from premature birth. Twelve million others survive their early birth but may face serious medical problems and permanent disabilities from cerebral palsy to blindness to mental retardation.
A 2006 Institute of Medicine report estimated that the annual cost of caring for preemies in the United States alone tops $26 billion. And the problem is right here in Colorado’s own backyard. The state gets a “D,” according to the March of Dimes Premature Birth Report Card. More than 12 percent of Colorado’s babies are born too soon.
Health care experts have known for years that premature births are a major contributor to rising health care costs in the U.S. A healthy pregnancy for a woman with health care coverage through the workplace costs an employer about $4,500, compared to around $49,000 for a premature delivery. Newborn intensive care for the smallest pre-term babies may exceed one million dollars per case.
For too long, conventional wisdom held that not much could be done to reduce rates of pre-term birth beyond encouraging women to see their doctors and adopt healthy lifestyles. But there are other steps that can and must be taken on behalf of the 540,000 babies born prematurely in this country:
Give caesarean sections more careful thought. Nearly 234,000 pre-term babies were delivered by c-sections in the U.S. in 2006. Too many mothers and physicians are opting for elective c-sections before 39 weeks gestation, unaware that the last few weeks of pregnancy are critical to a baby’s brain and lung development. Several health systems have reduced their c-section rates through quality improvement programs that require physicians and women to meet specific criteria before c-sections are authorized.
Give health professionals a new tool – 17 hydroxyprogesterone. Ten thousand pre-term births could be averted annually through full implementation of this promising hormone treatment. The American College of Obstetricians and Gynecologists has issued clear guidelines for appropriate use. Many insurers cover the use of the drug for this purpose, but it needs expedited consideration by the Food & Drug Administration in order to help provide better access to the drug.
Hold doctors accountable to best practices in fertility treatment. Approximately 88,000 babies are born pre-term annually as a result of the explosion of twins, triplets, and other multiple births. Adherence to professional guidelines on use of fertility drugs and assisted reproductive technologies would help prevent many premature births.
Promote smoking cessation during pregnancy. Smoking during pregnancy contributes to pre-term birth and low birth weight, yet more than 20 percent of pregnant women continue to smoke.
Look beyond medicine to communities themselves to fully understand how poverty, social isolation, unsafe neighborhoods, lack of access to healthy food stores and other factors determine the health of women and infants.
After a 30-year rise in premature births, it’s time to address this crisis. We urge health professionals, policy makers, women of childbearing age and their families, parent/patient organizations and communities to join forces so that every baby born has the same chance to live a healthy, full life.
Jennifer L. Howse, Ph.D, is president of the March of Dimes. Christopher P. Howson, Ph.D, is vice president for global programs of the March of Dimes. Dr. Edward Fenstermacher is a CIGNA medical director based in Denver. CIGNA is a 16-year sponsor of the March of Dimes. EDITOR’S NOTE: This is an online-only column and has not been edited.
