Premature birth: Causes and risk factors

etimes.in / Jul 8, 2024, 20:00 IST

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WHO’s 2023 report states premature birth, occurring before 37 weeks, risks newborn health, causing 900,000 deaths in 2019 and 13.4 million premature births in 2020. Causes: infections, multiple pregnancies, gestational diabetes, chronic conditions, and genetics. Risk factors: previous preterm births, maternal age, lifestyle, socio-economic factors, and short inter-pregnancy interval. Effective prevention and improved neonatal care are crucial.

Premature birth: Causes and risk factors

Premature birth, which is birth before 37 weeks gestation is a major concern globally because it exposes the newborn to several health complications. As per WHO’s 2023 report, “An estimated13.4 million babies were born too early in 2020. That is more than 1 in 10 babies. Approximately 900,000 children die in 2019 of complications of preterm birth. Many survivors face lifetime disability, including learning disabilities and visual and hearing problems.” Thus, understanding the causes and risk factors of preterm birth are crucial for developing effective prevention strategies and improving neonatal care.

Causes of premature birth

Infections and inflammation: A major factor that leads to preterm delivery is infection during pregnancy. The body’s immune response to the infections may lead to the production of
substances such as prostaglandins that trigger contractions of the uterus and early labor in pregnant women. Multiple pregnancies: Women with twins, triplets, or higher-order multiple pregnancies are at a much higher risk of preterm delivery. The pressure on the uterus and the higher risk of
preeclampsia and gestational diabetes also play a part in the high rate of premature births in multiple pregnancies.
Chronic conditions: Maternal diseases including hypertension, diabetes, obesity and others, are associated with preterm birth. These conditions can alter the placental function, and fetal development, and raise the risk of complications that call for preterm delivery.
Genetic factors: Studies show that there is a genetic component to preterm birth. This risk is higher if a woman’s mother or sister has had a preterm birth before.
Structural Abnormalities: Medical conditions of the uterus or cervix including an incompetent cervix or fibroids may also cause preterm birth. An incompetent cervix, which is likely to dilate before the due time, is most commonly linked to second-trimester abortions and premature births.

Risk factors for Premature Birth

Previous preterm birth: It is also important to know that women who have had a preterm birth in the past are more likely to have another one.
Maternal age: Young maternal age and advanced maternal age are two factors that put a woman at a higher risk of experiencing premature pregnancy.

Lifestyle factors: Certain behaviors and environmental situations can raise the likelihood of premature delivery. Tobacco, alcohol, and illegal drug usage during pregnancy are closely connected to preterm labor.
Socio-economic factors: Socio-economic status is also another factor that will influence preterm birth. Women from lower socio-economic status are likely to receive inadequate healthcare services, have poor nutrition and live in high-stress and polluted environments which are some of the causes of preterm birth.
Short Inter-pregnancy interval: A pregnancy interval of less than six months also poses a risk of preterm birth to the baby. The body requires time to rest and also regain the nutrient stores and if this is not well observed then complications are likely to occur.

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Premature birth remains a significant public health challenge due to its numerous and diverse causes and risk factors. While some causes, such as genetic inheritance and physiological abnormalities, are unavoidable, addressing modifiable risk factors through enhanced healthcare, improved lifestyles, and other interventions can significantly reduce the incidence of preterm births.
(Author: Dr. Phani Madhuri, MBBS, MS - Obstetrics & Gynaecology, Apollo Cradle & Children’s Hospital, Jayanagar, Bangalore)

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