On May 13, the Senate Health, Education, Labor, and Pensions Subcommittee on Children and Families held a hearing on the rising rates of prematurity. Chair Lamar Alexander (R-TN) opened the hearing by detailing the statistics: “The percentage of babies born prematurely (three weeks or earlier) has risen to a national average of 12 percent. One in every eight babies is born prematurely. This mean the 1,305 babies are born prematurely a day in this country.”
Stating that Tennessee has the fourth highest rate of preterm births in the nation, Sen. Alexander described legislation (S. 1726) he sponsors with Sen. Christopher Dodd (D-CT) that would expand research into the causes of prematurity. The Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Act would expand and coordinate research on preterm labor and delivery and infant mortality at the National Institutes of Health (NIH). The PREEMIE Act also would authorize a demonstration project to educate health care providers and the public about the signs of preterm labor; screening for, and treatment of, infections; optimal weight and good nutrition counseling; smoking cessation counseling; and stress management. S. 1726 would authorize programs to improve the treatment and outcomes of premature babies using evidence-based standards and would authorize family support programs to deal with the emotional and informational needs of families during the stay of an infant in a neonatal intensive care unit, during the transition of the infant to the home, and in the event of a newborn death. A companion bill (H.R. 3350) is sponsored by Reps. Fred Upton (R-MI) and Anna Eshoo (D-CA).
Dr. Duane Alexander of the National Institutes of Child Health and Human Development (NICHD) at the NIH detailed the state of current research on prematurity. He noted that infant mortality rates have dropped more than 70 percent since the NICHD was established 40 years ago, saying that the decline was largely due to NICHD-sponsored research on care of low birthweight babies and Sudden Infant Death Syndrome. Despite the progress, “we are still far from solving the problem of prematurity,” he said, noting that over the last 20 years, preterm births in the U.S. have increased by 21 percent.
More recently, he noted research published in the New England Journal of Medicine in 2003 showing daily progesterone injections to be effective in reducing premature labor, particularly in women who have had a previous premature birth. “Not only were the women treated with progesterone 30 percent more likely to carry their babies to term, their infants also had a much lower rate of life-threatening complications…The reduction in preterm birth—for African American women as well as non-African American women—was so dramatic that the scientists halted the study early to make the results available to practitioners.”
Dr. Alexander also stated that the “studies have shown that bed rest, which until very recently was the most common preventive approach, was not effective in preventing preterm labor or in delaying preterm birth. In some cases, bed rest may have actually made the situation worse.” Additionally, other studies are examining the effectiveness of different drugs in halting preterm labor, as well as whether exposure to certain environmental contaminants during pregnancy relates to preterm birth.
Testifying on behalf of the Health Resources and Services Administration (HRSA), Dr. Peter van Dyck of the Maternal and Child Health Bureau said that HRSA has a number of programs and initiatives aimed at addressing prematurity. Under the Maternal and Child Health Block Grant, grantees are required to submit annual performance measures. Two such measures pertain to prematurity: percent of very low birthweight infants among all live births and percent of very low birthweight infants delivered at facilities for high-risk deliveries and neonates. “Each State tracks annually performance goals that include preterm infants as well as related performance measures such as increasing early access to prenatal care and decreasing the disparate ratio of black-white infant mortality rates,” stated Dr. van Dyck. “Based upon the specific needs of their State, these programs also develop and report on individual state performance measures targeting low birthweight, preterm birth, and infant mortality.”
Dr. van Dyck also cited the program Healthy Start, which supports 114 projects in 96 communities that have excessive rates of prematurity, low birthweight, and infant mortality. “The program emphasizes outreach, case management, screening and referral for perinatal depression and health education interventions to reduce risk factors such as smoking, alcohol, and substance abuse,” he said.
Other HRSA programs include the African American-Focused Risk Reduction component of the Closing the Health Gap Initiative on Infant Mortality, research on community-level and neighborhood-level factors associated with preterm birth, research on the relationship between stress and preterm birth/low birthweight, a forum this fall that will summarize evidence around periodontal disease and preterm birth, the Departmental Advisory Committee on Infant Mortality, community health centers, and the Interagency Coordinating Council on Low Birth Weight and Preterm Births.
The Centers for Disease Control and Prevention (CDC) also funds numerous programs aimed at addressing prematurity. Dr. Eve Lackritz of the National Center for Chronic Disease Prevention and Health Promotion at the CDC detailed her agency’s efforts, stating that surveillance is the core of CDC’s work. “For preterm birth, this is the backbone of health surveillance, where risk factors are evaluated such as the mother’s education, tobacco use, race, and the infant’s birthweight. Vital records allow epidemiologists to follow trends, risk factors, and identify areas with high rates of preterm births,” she said.
In particular, she pointed to the Pregnancy Risk Assessment Monitoring System (PRAMS) as one of their key maternal and infant health surveillance systems. “PRAMS is an ongoing, state-specific, population-based surveillance system designed to identify and monitor selected maternal behaviors and experiences before, during, and after pregnancy,” stated Dr. Lackritz. Additionally, the “CDC provides assistance to states and communities to collect and analyze data for development of maternal-infant policy and programs responsive to local, tribal, and state-specific needs.”
Outlining an agenda for prevention and research, Dr. Lackritz said that the CDC is taking steps to research the causes and risk factors for preterm delivery, identify women at risk early in their pregnancy, move new research discoveries to public health prevention, and expand community-based programs on prematurity. “We have very few public health threats of this magnitude, and this health threat goes well beyond the burden of prematurity,” she said, adding, “The toll of preterm delivery is not just financial. It tears at the fabric of our families and our communities, and takes an enormous emotional toll on mothers and fathers.”
Dr. Jennifer Howse of the March of Dimes told the subcommittee about a new campaign the March of Dimes has launched regarding prematurity. In its second year, the five-year, $75 million campaign “works to educate women on the signs and symptoms of premature birth, and to support more research into the causes. One of the goals of the campaign is to reduce the rate of premature birth by 15 percent by 2007,” she said, calling it a “formidable goal.” Dr. Howse continued, “Premature birth accounts for about half of all infant hospitalization charges. In 2001, the total national hospital bill for premature babies was $13.6 billion.”
Kelly Jordan said she “did everything by the book” as she told the subcommittee her experience of delivering a one pound ten ounce girl at 26 weeks gestation. Three years later, her daughter “has absolutely no repercussions from her early birth, and I mean no repercussions,” Ms. Jordan said. “While we had a good outcome, there were two other babies who weren’t so lucky,” she said, pointing to her daughter as proof that research works and can make a difference.
During the question and answer session, Sen. Alexander asked the panel to list two or three things that a women would need to know to prevent prematurity. Dr. Alexander responded that a woman should plan the pregnancy; achieve good health status before getting pregnant, including taking folic acid; undergo a preconception examination by a physician; quit smoking; and get regular prenatal care. “Of all the things we know that contribute to prematurity, smoking is number one,” he said.
Dr. van Dyck added that there are many women who do not get prenatal care or do not have access to prenatal care due to poverty. “We know that up to 10 percent don’t get prenatal care and a larger percentage don’t get adequate prenatal care.”
