How a Premature Birth Impacts Future Pregnancies

Dear Doctor:

My husband and I are thinking of having another baby. This should be a moment of joy, but I am actually scared. We have an incredible seven-year-old son who was born six weeks early. We were extremely fortunate that while he was small and premature, he was healthy.  He spent several weeks in a special care nursery before being strong enough to come home. He has had some minor developmental delays but with interventions he is meeting all his milestones. The doctors at that time told me that I was at high risk for having another premature delivery and I know not all premie babies are as fortunate as my son.  Is there anything I can do to reduce my risk of having another preterm delivery?

Answer:

Dear Reader:

It is wonderful to hear that your son is doing so well and that you are now planning to expand your family. As you mentioned many premature infants are not as fortunate as your son.  Prematurity is the leading cause of death in infants and young children. Worldwide, there are an astounding 15 million babies are born prematurely each year with one million dying as a result of premature birth. Here in the US, one out of ten babies is born prematurely. Due to advances in neonatal care more infants are surviving but many will still deal with long term intellectual and developmental disabilities. The societal cost of prematurity in the US is an astronomical $26.2 billion annually.

Any infant born before a gestational age of 37 weeks is considered premature. While some infants are born prematurely because the baby’s or the mother’s health is at risk, most premature infants are born due to the spontaneous onset of labor. Preterm labor is a complex problem that has many causes.  

While it is not yet possible to eliminate all premature deliveries there are many things that we can do to reduce the risk that a baby is born too soon.

Preparing for Pregnancy 

1. See you obstetrician and discuss your personal health before your pregnancy. Make sure any pre-existing health issues such as diabetes or hypertension are well controlled. Review any medications you are taking with your provider to ensure that they are safe for a pregnancy.
2. If you are a smoker, you need to quit. Your health care provider or local health department can offer assistance. Do not use street drugs or drink alcohol.
3. Make sure you are up-to-date with your vaccines.
4. Start a prenatal vitamin before you try to conceive.
5. Reduce stress. It is important to minimize and avoid stress during pregnancy. Consider adopting relaxation techniques such as meditation or yoga.
6. Get regular exercise. This can help you stay physically healthy and reduce stress.
7. Consider spacing pregnancies at least 18 months apart.
8. See your dentist for regular checkups.
9. Avoid cat litter, rodents and raw meat that can be a source of infections harmful to your baby.

During your Pregnancy

1. Keep regular prenatal care appointments and follow the advice of your medical provider.
2. Discuss the use of progesterone with your provider. Weekly injections of progesterone have been proven to reduce the risk of preterm labor in some women with a history of a preterm birth. Discuss with your provider if this is an option for you. 
3. Wait until 39 weeks to deliver your baby. Many women a request to schedule labor inductions or cesarean sections based on convenience for them and family members.  It is important to wait until a gestational age of 39 weeks to consider any non-medically indicated delivery. While a baby after 37 weeks is considered full term we know that before 39 weeks some babies will still need time to develop. Before 39 weeks babies are more prone to breathing problems, difficulty eating, difficulty gaining weight, and problems keeping a warm body temperature. 

The March of Dimes has been a leading non-profit organization in the fight against prematurity. If you are interested in learning more about prematurity or getting involved in the fight to end prematurity, please check out the March of Dimes at www.marchofdimes.org. This year, the March for Babies of Canandaigua and the Finger Lakes will be at Seneca Lake Park in Geneva, New York on May 7, 2017. 

Tara Gellasch, MD, is the Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider.