Helping the unborn wait their turn

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It s not often that the U.S. gets grouped along with developing countries such as Kenya, Honduras, and East Timor in measures of health. But a new report from the World Health Organization (WHO) and other agencies indicate that the rate of premature birth in this country is worse than in any Western European country, and ranks similarly to rates in many developing regions of the world.

According to the report which is the first ever to compare premature birth rates among 184 countries 12 percent of all U.S. births are premature. The worst premature birth rate, 15 percent, was seen primarily in countries in Africa. Most European countries, on the other hand, along with Canada and Australia, reported rates of premature births ranging from 7 to 9 percent. This report defined full-term as 39 weeks, although different authorities define full-term as anywhere from 37 to 40 weeks.

In the U.S., the premature birth rate has actually risen by 30 percent since 1981. While much of the reason behind the country s surprisingly high rate remains a mystery, the fact that there are many teenagers who become pregnant in this country, coupled with the high frequency of women giving birth over the age of 35, certainly contributes to the number of premature births. Older women may also be more likely to use in vitro fertilization to conceive, which can result in twins or triplets; these are often are delivered prematurely by Caesarean section in order to avoid the risks of multiple full-term vaginal births.

Furthermore, many American women do not have health insurance, so they may not be able to see a doctor for prenatal appointments; lack of prenatal care is a known risk factor for premature delivery, among other adverse outcomes. Other factors that contribute to premature births in the U.S. include obesity, high blood pressure, diabetes, and smoking.

In the developing world, however, an entirely different set of factors is responsible for the high frequency of premature births: This includes infections, adolescent girls having children, and women having many children. Dr. Alan Guttmacher, director of the National Institute of Child Health and Human Development, warns against comparing U.S. premature birth rates to those in Africa, noting that, in developing countries, a fetus that is having serious problems would be much more likely to be stillborn, and thus would not be counted in this report. In the U.S., however, an infant born with these complications would be likely to live, thus contributing to the high number of premature births. In fact, an infant born in the U.S. before 28 weeks gestation has a 90 percent chance of survival; whereas, in much of Africa, such an infant would have only a 10 percent chance of living.

While the United States in general does an excellent job of keeping premature infants alive, says ACSH's Dr. Gilbert Ross, there is clearly a lot that remains to be done in order to help keep babies from being born prematurely in the first place.