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Metro Detroit

December 3, 2013

Premature birth rates decline in Michigan for sixth year

By Cari DeLamielleure-Scott
C & G Staff Writer

In the United States, approximately 4 million babies are born each year; however, the number of premature births has led the March of Dimes and individual states to look at contributing factors to prematurity, which is the leading cause of newborn death.

For the sixth consecutive year, Michigan lowered its preterm birth rate, from 12 percent in 2011 to 11.8 percent in 2012.
Despite the continuous reduction, Michigan earned a C grade on the March of Dimes’ annual report card. By 2020, the March of Dimes seeks to lower the percentage of premature births across the nation to 9.6 percent. Currently, the U.S. preterm birth rate is 11.5 percent.

In 2010, Macomb County had 9,108 live births, according to the National Center for Health Statistics, and 1,082 were premature. Oakland County had 13,091 live births in 2010, and 1,444 were premature, which is an increase of approximately 5 percent since 2000.

Premature birth, which the March of Dimes classifies as birth before 37 weeks of gestation, causes serious health problems in infants and costs the U.S. more than $26 billion annually, according to the Institute of Medicine.

A full-term birth with no complications costs about $4,500, according to Kara Hamilton-McGraw, Michigan’s March of Dimes state director of program services and advocacy. However, a baby born in a hospital prematurely runs just over $49,000, and the costs of specialists, equipment, interventions and teams of health care professionals can drive up the rate. In addition, Hamilton-McGraw said, premature births increase health care costs to employers by more than 300 percent.

According to Ray Bahado-Singh, chairman of obstetrics-gynecology for Beaumont Health Systems in Troy and Royal Oak, a majority of preterm births don’t have identifiable risk factors.

In the matter of a year, the number of uninsured women 15-44 years of age decreased from 18.4 percent to 16.3 percent in Michigan, while the national percentage was only reduced from 21.9 percent to 21.3 percent.

Dr. Marc Lewis, service chief of Women’s Health Services at Henry Ford Hospital in Detroit, said health care accessibility is the No. 1 factor that can be addressed to prevent preterm birth. It is not unusual for the doctors of Henry Ford Hospital in Detroit to have women arrive in premature labor with no prior prenatal care due to lack of insurance, he said.
“One of the advantages of being a pregnant woman in Michigan is you are covered under insurance, and you have access to prenatal care. That (lack of insurance) should not be a deterrent to prenatal care,” he said.

Simply because of location and demographics, Henry Ford Detroit typically sees double the rate of premature births than the rates in suburban counterparts, Lewis said. In 2012, 20-22 percent of the approximately 2,500 live births at Henry Ford Detroit were premature.

According to the March of Dimes report card, most premature babies are born under the “late preterm birth” category, or gestation between 34 and 36 weeks. Despite only being born a few weeks early, late preterm infants are still at risk for death and disability.

In the past, Hamilton-McGraw said, the medical field critically defined 37 weeks gestation a full-term pregnancy; on the other hand, the March of Dimes endorses that a full-term healthy, uncomplicated pregnancy is 39-plus weeks. Because 37 weeks was widely accepted as full-term, Hamilton-McGraw said, infants may be born early as a result of non-medically necessary induction or C-section. 

Between 37 and 39-plus weeks, an infant’s brain is still developing. At 36 weeks, the brain is only 2/3 the size it will be at 39-plus weeks, so it continues to grow the last 1/3 in its total size during the final weeks, Hamilton-McGraw said.
With brain development comes coordination issues — sucking, swallowing — lungs maturing and nerve endings evolving. Therefore, the March of Dimes has worked hard to encourage hospitals to stop inducing or performing C-sections prior to 39-plus weeks gestation unless it is medically necessary.

Hamilton-McGraw said hospitals now need to get approval or go through their medical board to induce labor. “If there’s not a reportable health condition from the accredited list, you cannot induce, and we’ve seen great success with that,” she said.

Premature births, even late preterm births, put infants at risk for visual problems, cerebral palsy, developmental challenges and respiratory immune system issues like asthma. Hamilton-McGraw said that researchers are currently searching for a correlation between babies born prematurely and a link to autism, though she said at this time nothing could be called “evidence based.”

Michigan’s percentage of pregnant smokers has increased drastically, from 23.9 percent to 29.1 percent in the past year. In times of stress, Hamilton-McGraw said, more people will smoke, and with government budget cuts, access to programs and resources to help women quit smoking has decreased.

Socioeconomic factors, like transportation and lack of opportunity or access to health care, contribute to the increase of women smokers, Lewis said.

The final measurable factor the March of Dimes addresses in its report is the preterm birth rates by race and ethnicity. In Michigan, the total racial preterm birth rates are

• Hispanic – 12.4 percent
• Caucasian – 10.5 percent
• Black – 17.8 percent
• Native American – 12.1 percent
• Asian – 11.0 percent

According to Bahado-Singh, racial status is an epidemiologic marker for prematurity rates when comparing state to state. Black people have an increased prematurity rate where.

“It is unclear whether that is related to specific genetic reasons or whether it is a metaphor for socio conditions, but that (race) is a significant cause, I believe, of the variation one sees of the prematurity rates between states,” he said.

Gov. Rick Snyder has an enlightened view of premature birth rates and has made the reduction rate of infant mortality one of his major objectives with Michigan health care, Bahado-Singh said. Michigan has helped facilitate a program that rather than relying on a woman’s history, can routinely recommend screening for all women.

Partnering with state health officials and local hospitals, the Perinatology Research Branch of the National Institute of Child Health and Human Development, Wayne State University and Detroit Medical Center have indicated that it is possible to reduce preterm birth rates by a universal risk assessments with a cervical ultrasound at 19-24 weeks gestation, said Dr. Roberto Romero, chief of the Perinatology Research Branch and program director for Perinatal Research and Obstetrics. 

An international, random clinical trial has shown that vaginal progesterone applied daily in the case of a short cervix reduces the risk of preterm birth by 44-45 percent. It reduces the rate of respiratory distress syndrome by 60 percent.
Romero said that combining universal cervical ultrasounds with vaginal progesterone is cost-saving.

“The state of Michigan would save $19 million per year by implementing this policy, and the U.S. would save $500 (million)-$750 million per year,” he said.

Hamilton-McGraw said that the March of Dimes encourages women to educate themselves on preterm births with the information provided on their website www.marchofdimes.com or by talking to a care provider about the options for lowering risk factors. Women who are at risk of premature births are also strongly encouraged to attend a hospital with a Neonatal Intensive Care Unit.

“If the baby is born premature and the hospital doesn’t have a NICU or is not qualified to handle premature birth, they’ll transport the infant to a NICU,” she said.