Making sense of prematurity in the South

Would it surprise you to learn that the United States’ rate of premature birth is higher than that of most high-income countries? One in 10 American babies are born too soon, accounting for about 380,000 births each year.

According to the March of Dimes, a premature birth is one that occurs before 37 weeks gestation. When a woman reaches weeks 39 to 40 of pregnancy, her pregnancy is considered full term.

The March of Dimes regularly prepares report cards for the country, states and some large cities, based on the number of premature births. While the United States overall has a high rate of prematurity, the numbers are even worse in the South.

In the 2019 report card, Tennessee as a whole garnered a D, with premature births making up 11.1 percent of all births in the state. So why are premature births so common in the South?

A look behind the numbers

There are probably a number of reasons behind the high rates of prematurity in the South, but the overall lifestyle of southern states definitely plays a role.

“The state of Tennessee is one of many southern states identified as being in the stroke and diabetes belt,” said Anuj Sinha, DO, medical director of the neonatal intensive care unit (NICU) at Children’s Hospital at Erlanger. “People living in this belt have a higher incidence of Type 2 diabetes, obesity and hypertension — all of which increase a woman’s risk of preterm birth.”

Beyond chronic health conditions, lower socioeconomic and education status, combined with a sedentary lifestyle, also increase the risk of premature birth.

The role of race

March of Dimes data shows that premature birth rates are highest among non-Hispanic African-Americans. On the 2019 report card, African-Americans in the state had a 14.8 percent premature birth rate, in comparison with the overall rate of 11.1 percent.

“There are many factors in the higher rate of prematurity, including both genetic and environmental factors, such as social, educational, occupational and economic background,” Dr. Lowery-Smith said. “A woman’s race and ethnicity may even influence her vaginal microbiome. Certain bacteria found there are associated with a higher likelihood of preterm birth.”

The impact of prematurity

Babies born prematurely may require a range of medical care, depending on how early they were born and the type of complications they experience. Premature infants, specifically those born before 35 weeks gestation, are typically admitted to the NICU, where they receive specialized care designed to regulate their body temperature and track their breathing, heart rate and oxygen level.

“Preterm infants require special support until their organs have developed enough to survive without medical support,” Dr. Lowery-Smith said. “This development can take from weeks to months. Basically, this care continues until infants can breathe without support, successfully get the necessary amount of milk and maintain body temperature on their own.”

Potential long-term complications from premature birth include chronic lung disease, delayed growth and development, mental or physical delay, and retinopathy of prematurity, an eye condition that can lead to vision loss or blindness.

Practicing prevention

A combination of lifestyle habits and medical interventions can help lower the risk of premature birth. Step one is for moms to be in good health before pregnancy.

“Once pregnant, women should seek prenatal care as early as possible and continue this care until delivery,” Dr. Lowery-Smith said. “Women with chronic health conditions will likely be referred to a maternal-fetal medicine specialist for more advanced prenatal care. And women who have had a preterm baby previously should also receive careful monitoring during pregnancy, as they’re at a high risk.”

If your baby requires special attention after birth, Children’s Hospital at Erlanger is here for you. The hospital is home to the region’s only Level III NICU, meaning physicians and other providers can care for babies born at all stages of gestation.