Increasing Frequency of Preterm Births
As a Connecticut ob/gyn for the past 20-plus years, I’ve seen a several trends develop. One of the most disappointing trends has been a widespread increase in the frequency of preterm births, or babies born before the 37th week of pregnancy. Preterm births are closely associated with developmental disabilities, other complications and infant mortality during the first year after birth. Preterm births in the United States have increased by an estimated 36% since 1981, partly due to the increased use of assisted reproductive technology. In the United States and Europe, approximately 1 million “preemies” are born every year.
Good News for Preventing Preterm Births
With all of this in mind, I was encouraged to see a recent article in the February 2012 American Journal of Obstetrics & Gynecology (ACOG), which described a study that pooled the results of several independent tests around the world from the past few years — and found remarkably consistent results. The focus of the study was progesterone (a hormone involved in menstruation and pregnancy), and its relation to the cervix (the lower, narrow portion of the uterus where it joins with the top of the vagina). This ACOG article on preventing preterm births made several important points, including the following:
– When a woman’s progesterone levels decline, labor often follows soon afterwards. When progesterone levels are low or if they decline early, preterm births often occur.
– Low progesterone levels are associated with short cervical length.
– The shorter the cervix and the earlier in pregnancy the short cervix is detected, the higher the risk of a preterm birth.
– Vaginal application of progesterone to women with a cervical length of 10-20 millimeters can reduce the rate of preterm births (and related complications) before 33 weeks of pregnancy by 42% or more. There was also a significant reduction in the risk of preterm birth before 35, 34, and 28 weeks.
Ultrasound and Pregnancy
I was especially interested in these findings since a short cervix can be spotted during prenatal care visits using routine ultrasound tests. The authors of the study recommend ultrasound cervical measurement for women between 19 and 24 weeks of pregnancy to assess the risk of preterm delivery. In addition, vaginal progesterone is a less expensive and less invasive alternative than a common alternative treatment: placement of a cervical suture.
Most premature births occur in women with no risk factors, so the use of vaginal progesterone has the potential to significantly reduce the overall premature birth rate, as well as the wide variety of complications associated with premature birth, including cerebral palsy, respiratory distress, pneumonia, infection, anemia and jaundice.
In the words of American Journal of Obstetrics & Gynecology co-editor-in-chief Thomas J. Garite, M.D., these results “have the potential to result in a sea change in obstetrical practice in the U.S. and Europe and eventually in the rest of the world. Prematurity is the leading cause of death and damage for newly born babies and despite enormous efforts, no impact has been made in the rate of preterm birth, which is actually rising in recent years.”
Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobgyn.com. Dr. Garofalo can be reached for a personal consultation at 203.855.3535.