Florida gets 'D' from March of Dimes as premature births rise
Published: Friday, November 1, 2013 at 4:10 p.m.
Last Modified: Friday, November 1, 2013 at 4:10 p.m.
Florida received a "D" on the March of Dimes Premature Birth Report Card because its rate of premature births rose last year after having declined steadily since 2008.
The 2012 premature birth rate was 13.7 percent, up from 13 percent in 2011. From 2006 to 2008, the premature birth rate was 13.8 percent, and then it started dropping until it hit its 2011 low.
"For more than 25 years, it's been very hard to get the rate to go down because prematurity is such a complicated issue," said Dr. Karen Harris, the March of Dimes Florida Chapter Program Services Chair. "A one-year setback might not be dramatic."
Harris added that the goal is to reduce Florida's prematurity to 9.6 percent by 2020.
Florida was one of five states to receive a D grade. Three states fared worse, with an F grade.
Harris said there are several reasons for prematurity in the U.S.: The trend of older mothers might increase the risk of premature babies, but even more so, the risk for prematurity is greater for pregnant women who are sick.
Women with conditions such as heart disease, high blood pressure and obesity, for example, are especially at risk of having premature babies. STDs such as chlamydia and gonorrhea also can put women at risk of having a premature baby.
Harris said more effort needs to be made to ensure that women are healthy before they get pregnant.
"Your health before you get pregnant can have a big influence on whether you have a premature baby," Harris said. "(The mother's) health needs to be excellent to give the mother and baby the best chance."
She added that cutting out tobacco use and excessive use of alcohol are critical to preconception care.
Ensuring that pregnant women have access to medical care early on in their pregnancy is also crucial to successful pregnancies, Harris continued.
"If someone comes in for prenatal care late in their pregnancy, they don't have the best outcomes," Harris said. "The only way to know gestational age of a baby is to do an ultrasound in the first 20 weeks."
Prenatal care can be especially challenging for poor women in rural areas, Harris said.
"There's a direct correlation between poverty and prematurity, especially for rural populations."
A full-term pregnancy lasts 40 weeks, and only 2.2 percent of babies born at full term are admitted to neonatal intensive care units. Babies who are born at 37 weeks have a 6.6 percent chance of being in the NICU.
One exception is twins, Harris said. "Very few twins go to 39 weeks … the uterus simply won't hold the babies."
She added that older mothers tend to have more twins — both naturally and because of IVF treatments.
But generally, if a mother is not having twins, "every week (of delivery) under 36 weeks doubles their chance of being in the neonatal intensive care unit," Harris said.
That's because babies' organs — and especially their brains — usually have not fully developed before 40 weeks, putting them at risk for conditions such as intellectual disabilities, cerebral palsy and breathing problems, according to a March of Dimes media release. Prematurity also can lead directly to the baby's death, and prematurity is the leading cause of newborn death, according to the Institute of Medicine.
It's also one of the main contributors to the relatively high infant mortality rate in the U.S. compared with other developed countries, Harris added.
Despite the bad news about this year's rise in premature babies, the rate of early-term deliveries — those at 37 and 38 weeks — has declined, thanks to an initiative that five hospitals in Florida were part of, which was a toolkit called "Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age."
Although no area hospitals participated, North Florida Regional Medical Center successfully reduced early-term pregnancies several years ago, and its rates continue to be very low, Harris said.
"I think what all this means for Florida is that we really need to redouble our efforts and put even more funding into working on the issue of prematurity. This requires lots of research," Harris said.
The Florida Perinatal Quality Collaborative, American College of Obstetricians and Gynecologists, the Florida Department of Health, and Healthy Start are a few of the organizations behind the research. One area of focus for the research is the possible causes of spontaneous labor (as opposed to early-term induced labor), such as infection or chemicals in the environment.
Worldwide, prematurity research is increasing: Nov. 17 marks the third year of the United Nations' World Prematurity Day, and November is prematurity awareness month.
Locally, the March of Dimes is promoting an initiative called "Blue Jeans for Babies" on Nov. 8. The grass-roots campaign involves employers or schools making a donation to the local March of Dimes in exchange for buttons and pins promoting prematurity awareness, said Esteban Meneses, the public relations coordinator for the March of Dimes in Florida.
Employees of participating employers then wear blue jeans on Nov. 8, along with a purple shirt.
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