The Role of Environmental Hazards in Premature Birth Workshop Summary (2003) / Chapter Skim
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1. Preterm Birth and Its Consequences
1. Preterm Birth and Its Consequences
Pages 13-26
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From page 13... ...
Disorders relating to short gestation and low birth weight are among 10 leading causes of infant mortality (Hoyert et al., 2001~. Earlier estimates suggest that approximate*
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From page 14... ...
Approximately 30 percent of total preterm births follow spontaneous rupture of the membranes, while the remaining 50 percent follow spontaneous preterm labor, noted Goldenberg. Spontaneous preterm births are often divided into those that occur early and those that occur later.
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From page 15... ...
are also independent risk factors for spontaneous preterm birth, stated Goldenberg. Some risk factors may be shared across spontaneous and indicated preterm births, while others are likely to differ.
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From page 16... ...
Interestingly, although African Americans have a higher rate of preterm birth, their incident rate has decreased consistently since 1990. During the same period, the preterm birth rate has remained the same for Hispanics, but the preterm birth rate for non-Hispanic whites has shown a steady African Americans in the United States have a higher incidence of preterm birth (17.4 percent)
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From page 17... ...
LONG-TERM OUTCOMES OF PREMATURE INFANTS Numerous advances, both technological and therapeutic, in neonatal intensive care have led to the improved survival of premature infants. Prior to 1940, the deaths associated with a preterm birth occurred either at or immediately following birth, according to Maureen Hack, Rainbow Babies and Children's Hospital.
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From page 18... ...
Overall, premature children require more services beyond routine care throughout childhood, including counseling, occupational therapy, physical therapy, special education, and special school arrangements. Currently, health care professionals are reporting fewer incidences of blindness due to the increased use of laser and cryotherapy; however, other complications, such as cerebral palsy, have been on the rise for infants born at less than 28 weeks' gestation since 1975 (Figure 1.3~.
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From page 19... ...
_ lo 8 _ 40— < 28 Weeks Gestation 0 _ 75-78 79-82 83-86 87-89 91-94 Birth years Unclassifiable ~ Prenatal 0 75-78 79-82 83-86 87-89 91-94 32-36 Weeks Gestation Birth years FIGURE 1.3 Since 1975 the prevalence rate of cerebral palsy in infants, whether the result of prenatal, perinatal, or unclassified causes, has been increasing for infants born at less than 28 weeks gestational age compared to infants born at age 32-36 weeks of gestation. SOURCE: Hagberg et al., 2001.
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From page 20... ...
additional research has found that when these low-birth rate women have children, they have a greater probability themselves of giving birth to a low birth weight baby. The results of these studies need additional work in order to better understand the long-term and transgenerational effects of preterm birth.
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From page 21... ...
He suggested that the idea of dividing preterm birth based on clinical presentation is of potential value but may be misleading in identifying subgroups with differing etiology. Providers often act in practice as though the determinants or risk factors are similar across the spectrum of severity of preterm birth.
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From page 22... ...
Robert Goldenberg Antibiotics Infections, such as bacterial vaginosis, syphilis, gonorrhea, and periodontal disease, have all been associated with increased rates of preterm birth and may account for the preterm births of unknown etiology. In the 1980s and 1990s, clinicians began to hypothesize that subclinical infections in either the umbilical cord, the deciduous space, or the amniotic cavity may result in a preterm birth, according to James Roberts, Magee-Women's Research Institute.
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From page 23... ...
Treating pregnant women with asymptotic bacterial vaginosis with two doses of 2 grams of metronidazole 48 hours apart on two occasions was not effective in reducing preterm birth. However, some studies suggest that antibiotic administration for the treatment of bacterial vaginosis was effective in women who have had a prior preterm birth.
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From page 24... ...
kainen-Sorri et al., 1984; Saunders et al., 1985; Crowther et al., 1989; Maclennan et al., 19901. Nutritional Interventions Epidemiological studies have found a relationship between women who gain very little weight during pregnancy and the incidence of preterm birth, stated Goldenberg.
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From page 25... ...
Currently, researchers have found that the majority of the success has occurred in developing countries where evidence suggests that nutritional intervention has substantially improved pregnancy outcomes, including a reduction in preterm birth. This improved outcome was seen in Gambia, where women worked hard in the field and were nutritionally deprived during certain seasons of the year (Prentice et al., 1983~.
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From page 26... ...
Chapter 3 provides an overview of the biological causes of preterm birth. Chapters 4 and 5 explore environmental factors, including the social environment, gene-environment interactions associated with preterm birth, and research protocols used by federal agencies that may detect toxicant effects on gestation length.
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