The nation gets a C, but some states get A’s for preventing preterm births.
The percentage of babies born prematurely in the United States fell for the sixth straight year, but the problem remains more common than in most other industrialized nations, says an annual report card out Friday.
The nation’s preterm birth rate in 2012 was 11.5%, which is a 15-year low, according to the report from the March of Dimes. But the non-profit organization says it could be as low as 9.6% if known prevention efforts were fully embraced.
The group gave “A” grades to six states that achieved that — including the state with the most births, California – but it gave a “C” to the nation overall. An earlier global report on preterm births found the United States ranked 131st out of 184 countries, on par with Somalia, Turkey and Thailand and far behind nations ranging from Finland to China.
"We need to do better," says Edward McCabe, medical director of the March of Dimes, based in White Plains, N.Y.
That’s particularly true, he says, when it comes to reducing preterm births among black and Native American women, who had rates of 16.8% and 13.6% of births. For white women, it was 10.5% of births.
The reasons for those racial gaps are poorly understood and not explained by socioeconomic and educational differences, says Craig Rubens, executive director of the Global Alliance to Prevent Prematurity and Stillbirth, based at Seattle Children’s Hospital. One theory, he says, is that stress — including stress associated with racism — can play a role.
What is known is that premature birth — before the 37th week of pregnancy — is the leading cause of newborn deaths in the United States and can contribute to life-long problems in health and development among survivors. Prevention strategies include reducing smoking and increasing health insurance coverage among pregnant women, McCabe says. If the new health care law results in more women getting insurance and prenatal care, that could help, he says.
Meanwhile, efforts to eliminate elective early births, by cesarean section and induction before 39 weeks of pregnancy, already are helping, he says. That’s because doctors and women sometimes get due dates wrong when they schedule deliveries for 37 or 38 weeks and end up with premature babies. That practice is now strongly discouraged by the American College of Obstetricians and Gynecologists and many hospital systems. Efforts to reduce multiple births, by more prudent use of fertility treatments, also are helping, McCabe says.
But making more progress, in the USA and around the world, will mean learning more about why so many babies are born too soon, Rubens says.
"It’s really embarrassing to say that we don’t even know why women go into labor at full term, much less why some go into labor early," he says.
Rubens says it’s important to note that one reason the USA fares so poorly on international rankings is that many babies born very early — between 23 and 28 weeks — survive long enough to be counted in the United States but are listed as stillbirths in countries with less medical technology or less stringent record-keeping. Even so, he says, that does not explain why the USA has so many more preterm births than countries with similar resources.
In addition to California, states that got an “A” on the report card were Alaska, Maine, New Hampshire, Oregon and Vermont.
Puerto Rico and three states, Alabama, Louisiana and Mississippi, each scored an “F,” for preterm birth rates at or above 14.6%.
(From USA Today)
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