Premature birth:
A vexing problem for black moms
Marilyn Simmons was more frightened than surprised.
Twenty-eight weeks pregnant at the time, she did not expect a problem. After all, she had a healthy baby boy a few years back without incident. But when her contractions became more and more frequent, she thought of her mother, who had a premature birth. That baby lived for only three days.
Anxiety aside, Simmons had more immediate problems. Her water had broken and she had begun dilating. Rushed to Boston Medical Center, Simmons was admitted on a Friday, and despite efforts by doctors to delay the birth, she delivered the baby that Monday morning.
A baby girl.
She weighed in at just under three pounds, and by most accounts, her chance of survival was anyone’s guess.
According to a recent report by the Institute of Medicine, babies born before 32 weeks of gestation or pregnancy have the greatest risk for poor health outcomes and even death.
Preterm, or premature, babies who survive experience a multitude of complications, including mental retardation, social and emotional problems, defects of the respiratory and nervous systems, and poor health and growth, to name a few. What’s worse, a large percentage of preterm babies do not survive — a result seen often in African Americans.
Simmons was one of the fortunate ones. For eight weeks, her baby was in the Neonatal Intensive Care Unit, spending the first four in the critical section. Her heartbeat was slow and her “immature” respiratory system, common in preterm births, often caused her to choke.
Following Simmons’ release from the hospital a week after delivery, she and her three-year old son would trudge to the hospital every day to take breast milk to nurses who then injected the liquid into a tube through which her daughter was being fed.
It’s a good thing the doctors said that the baby was a “live wire.” Celeste is now 25 years old, and is completing a master’s degree in mental health counseling at Springfield College.
For her part, Simmons has been an outspoken advocate for women who have experienced premature births. She became one of the first clients of the Healthy Baby/Healthy Child Program, sponsored by the Boston Public Health Commission.
The program offers free home visits conducted by public health nurses and advocates, who provide health education and case management services. These services are available to pregnant women and parenting families with children up to three years of age.
When it comes to prenatal and infant health care, she said, “No question is a dumb question. If you don’t ask, you will never know. If you have concerns, voice them.”
Of all the maddening medical conditions African Americans face, none is more challenging than the relatively high number of infant mortalities — the deaths of infants within the first year of life.
The infant mortality rate (IMR), often used as an indicator of the health or quality of life of a population, measures the number of infant deaths per 1,000 live births. Of the 192 members of the World Health Organization, in 2004, the United States ranked 36th with an IMR of almost 7.0, considerably higher than Iceland, Japan, most of Europe — and lagging behind the less-developed Cuba.
Massachusetts fares much better. According to the Centers for Disease Control and Prevention, data from 2002-2004 indicate that the Commonwealth’s rate of 4.24 ranked second-lowest in the U.S. behind only Vermont.
The numbers in 2005, however, revealed an upsurge across the country, especially in the District of Columbia (11.4) and Mississippi (10.3). In Massachusetts, the IMR rose to 5.1.
The good news is that at 9.4, the IMR for blacks in Massachusetts is steadily decreasing. The IMR for blacks dropped by 22 percent between 2004 and 2005, and 36 percent from 2000. The numbers in Boston mirror those across the state.
Yet the disparity remains. The IMR for blacks in the state is more than twice the rate in whites and Asians, and 22 percent higher than Hispanics.
While there has been much discussion recently about different causes of disparity — everything from stress associated with racism to unhealthy eating habits — no one can pinpoint an exact reason for the persistent gap.
More than likely, it’s a combination of several factors — poverty, inadequate prenatal care, teen pregnancy, sexually transmitted diseases, heredity, high blood pressure, stress, obesity, education, housing, employment and others.
A significant cause of infant mortality is preterm birth and low birth weight. Preterm birth is the birth of an infant before 37 weeks of pregnancy. Simply put, the baby is born too soon, which can result in short- and long-term medical complications or life-threatening health problems.
In Massachusetts in 2005, the percentage of preterm births was higher in blacks than in Hispanics, whites and Asians. At less than 28 weeks of gestation, the disparity widens even further. The percentage in blacks is more than twice that in Hispanics, three times that in whites and five times that in Asians.
The percentages for low birth weights, which often correlate to short gestations, show similar numbers.
Preterm births in this country are a growing public health problem that costs society at least $26 billion a year. It is not possible to predict a preterm birth with accuracy, nor is it preventable. But many factors are associated with it — medical illnesses, such as hypertension, infections or diabetes. Even heredity may play a role.
One of the most significant factors impacting preterm births is prenatal care, which is measured by the timing and number of visits during pregnancy. According to the American College of Obstetricians and Gynecologists, an “adequate” level of prenatal care can be as high as 14 visits for a gestational period of 40 weeks for an uncomplicated pregnancy.
And, explains Dr. Laura Riley, director of labor and delivery at Massachusetts General Hospital, lack of awareness contributes to the array of causal factors.
“It is possible for black women to avoid or reduce the complications leading to preterm [births],” Dr. Riley said. “One is to plan for pregnancy, and take stock of your current physical condition before conception. Check your blood pressure and glucose level for diabetes. Find out your body mass index to determine if your weight is a threat to your medical health.”
Riley was particularly outspoken on obesity.
Recently, a young black woman visited Riley’s office seeking advice on her pregnancy. At 5-feet-3-inches and 204 pounds, the woman is technically considered obese, but didn’t know that her weight could cause troubles. And that’s just one of the problems, Riley said.
“Obesity is strongly correlated with hypertension, preeclampsia (toxemia), diabetes — all risk factors for a preterm birth,” Riley said. “We have not made people realize that obesity is an illness. Women are concerned about how they look; they really should be concerned more about the negative effects of obesity on their health. Just losing 20 pounds can decrease the likelihood of a preterm birth.”
In the case of Simmons, now 55 years old, she said she didn’t even know that she could be at risk for a preterm delivery. She considered herself a little overweight, but still a very healthy person who didn’t smoke or drink alcohol — two very high risk factors. She was diligent in her prenatal care, ate the right kinds of food and had no history of hypertension or diabetes.
There is now some good news for people like Simmons. If a woman has a preterm birth, it is important to ask why, since all subsequent pregnancies are also at increased risk. Yet some may be preventable, according to Riley. For instance, if there is no apparent cause of spontaneous preterm birth, as was the case with Simmons, women should ask their providers if they are candidates for shots of 17 alpha hydroxyprogesterone caproate — a treatment shown to decrease the rate of preterm birth significantly in all women, including African American women.
For her part, Simmons remains active in her cause — she became a patient advocate in the very same program that helped her through her first few years with her newborn. She wants to do everything that she can to make sure that other pregnant mothers get all the care and support they need.
|
| In a normal birth, the period of gestation is 37 to 42 weeks with a birth weight of at least five-and-a-half pounds. It may be possible to reduce or avoid some of the risks of a preterm birth. |
|
Dr. Laura Elizabeth Riley is the director of labor and delivery and the director of infectious disease at Massachusetts General Hospital. Riley specializes in medical complications of pregnancy.
|
|
