In an average week in Connecticut, 81 babies are born prematurely. Though to some the number may seem insignificant, the reality is not.

It’s a heartbreaking story. The anticipation and excitement of pregnancy turn suddenly into panic and dismay as a mother rushes to the hospital in preterm labor. Rather than making celebratory phone calls and welcoming the infant to his or her new home, parents instead may spend hours waiting helplessly in intensive care units with the fear that their newborn might not survive.

Watching a tiny infant perhaps struggling to feed or even breathe can prove heart-rending for any parent. And the initial worry and stress parents face when a baby is born prematurely may only be compounded later on in the child’s life in the form of complications.

Unfortunately, the problem of premature birth is only growing. The March of Dimes, a national health agency whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality, recently reported that the preterm birth rate (the percentage of babies born at less than 37 completed weeks gestation) in the United States is currently 12.5 percent — more than a 30 percent increase since 1981.

On a more local level, the rate of infants born preterm in Connecticut increased nearly 10 percent between 1994 and 2004.

Of the more than half a million babies born early in 2004 in the United States, over four thousand of these were born in Connecticut, affecting 10.1 percent of all live births.

These numbers reflect a grave issue. Government data has shown preterm birth to be the leading cause of death among newborns, accounting for more than two-thirds of infant deaths.

Though advances in modern medicine have helped many premature babies survive and go on to lead healthy lives, countless others are not as fortunate.

The earlier the birth, the greater the risk. Babies who are born very preterm — 16 babies in an average week in Connecticut — are at a high risk for brain problems, breathing problems, digestive problems and death in the first few days of life. They are also at risk for problems later in their lives, such as delayed development and learning difficulties in school.

Aside from the devastating effects preterm birth can have on families, society is also paying for the growing crisis. A recent report from the Institute of Medicine found that preterm birth cost the United States more than $26.2 billion in 2005 in medical care, lost household and labor market productivity and early intervention services.

Risk Factors for Preterm Labor

A normal pregnancy lasts approximately 40 weeks. Preterm birth is any birth that occurs before the 37th week of pregnancy.

Every pregnant woman has the potential to go into preterm labor. While the specific causes of spontaneous preterm labor are generally unknown, research has shown that it is most likely due to a complex interplay of multiple risk factors.

Behavioral and environmental factors, genetics and certain medical conditions can contribute to the likelihood that a woman will go into preterm labor.

Women who have had a previous preterm birth, who have certain uterine or cervical abnormalities or who are pregnant with twins, triplets or more are considered to be at greatest risk for preterm labor and birth.

In 2004, multiple births in Connecticut were seven times as likely as single births to be preterm. The number of multiple births in the nation has been increasing, due in part to more and more women in their late 30s or early 40s having babies. Women over the age of 35 are more likely than younger women to conceive multiples. They are also more likely to use fertility treatments to conceive, which can lead to a multiple pregnancy.

Certain environmental and lifestyle factors have also been associated with an increased risk for preterm birth. These include late or no prenatal care; smoking, drinking alcohol and using illegal drugs; exposure to the medication DES; domestic violence, including physical, sexual or emotional abuse; lack of social support; stress; and long working hours with long periods of standing.

Some medical conditions can increase the likelihood for preterm labor as well. These include urinary tract, vaginal, sexually transmitted and other infections; diabetes; high blood pressure; clotting disorders (thrombophilia); bleeding from the vagina; certain birth defects in the baby; being pregnant with a single fetus after in vitro fertilization; being underweight before pregnancy; and obesity.

While obesity does not directly cause preterm birth, it does increase the rate of medical complications, such as hypertension and diabetes, that do contribute to preterm birth. Some research studies have suggested that increasing rates of obesity in the nation may be related to the rise of premature births. In 2003 in Connecticut, 16.2 percent of women of childbearing age were obese.

Studies have shown that both high and low weight gain during pregnancy may increase the risk of preterm birth. Researchers from San Francisco General Hospital recently found that low weight gain during pregnancy increased the odds of spontaneous preterm birth by 2.5-fold.

Another medical risk is a short time period between pregnancies — less than six to nine months between birth and the beginning of the next pregnancy.

Researchers have also found that African American women, women younger than 17 or older than 35 and poor women are at greater risk for preterm labor, though they have not been able to discern the cause of these trends. Some research has shown that poor and minority women are less likely than affluent white women to receive prenatal care, which may contribute to the risk.

Medical intervention to deliver the baby early due to maternal or fetal conditions, such as early C-sections and medically induced labor, may be contributing to the growing number of late preterm babies, or those who are born between 34-36 weeks gestation. These account for 70 percent of all premature births.

Medically induced labor is a necessary tool to protect the health of a mother and her baby, especially when there are complications. However, health care professionals and pregnant women must be aware that when delivering a baby, being off by even a week or two can result in a premature birth, possibly making a difference in the baby’s health. Women and doctors should aim for continuing a pregnancy to term — if medically advisable — to give the baby a healthy start.

"While babies born late preterm often are considered healthy, they have higher risks of complications at birth than babies born just a few weeks later at full term," said Nancy Green, M.D., medical director of the March of Dimes. "Keep in mind that a baby’s lungs and brain are last to mature during pregnancy. Late preterm babies are more likely to have problems with breathing, feeding or maintaining their temperature and to develop jaundice than full-term babies."

What Can Be Done?

Organizations such as the March of Dimes and government agencies have been working to address the growing epidemic of premature births. In 2003, the March of Dimes launched a multi-year national campaign to stop the rise in premature births and promote public awareness, consumer education and research on the issue.

The organization’s efforts may have paid off. Recently, the United States Congress approved a bill that will increase federal support for research and education on prematurity.

Sponsored in part by Connecticut Senator Christopher Dodd, the Prematurity Research Expansion and Education for Mothers Who Deliver Infants Early Act, also known as the PREEMIE Act, will authorize expanded federal research and a Surgeon General’s conference to establish a public-private agenda on premature birth.

Dr. Jennifer L. Howse, president of the March of Dimes, said that at this conference, "scientific and clinical experts from the public and private sectors will sit down together to formulate a national action agenda designed to speed development of prevention strategies for preterm labor and delivery."

Researchers also continue to work to predict and prevent premature birth. In early 2006, the March of Dimes awarded more than $2.4 million in grants to researchers worldwide. Recipients included two scientists from the Yale University School of Medicine, who are exploring the role and use of hormones in predicting and preventing preterm labor and delivery.

"Supporting research is critical if we are to end this epidemic," said Howse.

Hospitals and facilities around the state also work to increase awareness and support for preterm birth.

For example, in June 2006, the March of Dimes Connecticut Chapter initiated the March of Dimes NICU Family Support project at the University of Connecticut Health Center. The project helps staff members provide information and comfort to families with premature and other critically ill infants being cared for in the Neonatal Intensive Care Nursery. It is one of only 39 sites in the country, and is the only one in the state.

On a more personal level, pregnant women can help reduce their chances for a premature birth by increasing their knowledge about the issue. Although there is no way to ensure that a baby will not be born prematurely, there are steps a mother can take to help prevent a preterm birth.

Mothers should get prenatal medical care both before and during pregnancy. If a mother does go into preterm labor, she must seek medical help quickly. This improves the chances that both mother and baby will do well. There are medications that can slow or stop labor if administered early enough, as well as medications that can help the baby’s brain and lungs mature if given 24 hours before birth.

Treatment with the hormone progesterone may help prevent premature birth in some women who have already delivered a premature baby.

Pregnant women must also be sure to take care of themselves to give their babies a better chance of being born healthy. Smoking cigarettes, for example, is a major preventable cause of preterm birth. Maintaining a healthy body weight and taking supplements such as folic acid are other lifestyle changes that can help contribute to a normal pregnancy.

Knowing the symptoms of preterm labor is essential to seeking appropriate medical attention in the event that it does occur. Symptoms include contractions every 10 minutes or more often; a change in vaginal discharge; pelvic pressure, or the feeling that the baby is pushing down; a low, dull backache; cramps similar to menstrual cramps; and abdominal cramps with or without diarrhea.

Any of these symptoms warrant a call to a health care provider or a hospital visit. Concerned women should be sure to tell the health care provider that they are worried about the possibility of preterm labor.

While there is still no guaranteed way to predict or prevent preterm labor and delivery, there are a number of organizations and researchers working every day to reduce the incidence of this troubling occurrence. In time, it is hoped that preterm birth will become more of a rarity than an everyday occurrence.

This article was originally printed in the January 2007 issue of Connecticut Parent Magazine