We will help you understand what causes premature birth and offer tips on how to minimise the chances of it. This article is part of the DreamBig, an education series by Abbott, which aims to spread awareness on prematurity and help turn small starts into big futures.

Premature Births

Pregnancy is a time of much joy and anticipation for a woman. It is also a time of caution and for first time mums, fear of the unknown. As a mum-to-be, you need to take utmost care – of yourself and your unborn baby, and plan ahead for your baby’s arrival.

What you don’t plan for however, unless there are early complications, is that your baby could arrive earlier than planned. You believe that your baby will stay safely tucked in your womb till at least the 37 weeks of gestation.

However, some women do go into early labour and their babies arrive into this world not quite ready to face the challenges of the first year of life.

Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation).

Across countries, the rate of preterm birth ranges from 5% to 18% of babies born.

Three-quarters of these deaths could be prevented with current, cost-effective interventions.

About 25 million children are born every year in India. As per the estimates, about 1.7 million of these births are preterm, and thus at higher risk of death during early neonatal, late neonatal, and postneonatal periods. ^1,2

These babies born-too-soon miss out on the last few crucial weeks in the womb, which is when the brain and other vital organs become fully developed to equip them to survive successfully outside. As a consequence of that, these babies almost always require longer hospital stays, and at times they may also have health complications.^3,4

So what causes premature birth? Not all causes of premature births can be explained. However, there are certain factors that place some women at a much higher risk of preterm labour⁴. This could be because of their personal medical histories, complications developed during pregnancy or simply because of certain lifestyle choices.

Here are some tips based on what causes premature birth to assess your risks of having a preterm baby and minimise the risk of premature labour.

Know Your Own Medical History

Be extra mindful of your own personal medical history. One is more likely to have a premature baby under these circumstances:⁵

1.  Previous premature births. One of the main risk factors for premature delivery is a previous premature delivery.
2. Multiple pregnancy. Being pregnant with twins, triplets or other multiples increases the risk of premature delivery.
3. Under 17 years old or over 35 years old. The chances of going into preterm labour are heightened significantly.
4. Have cervical insufficiency This means that the cervix could open or shorten before one reaches full term, leading to preterm births. Cervical insufficiency could be attributed to the cervix being inherently weak, or the weakness may be caused by previous pregnancy, obstetric trauma or childbirth.
5. Have had Premature Rupture of the Membranes (PPROM) previously.

Watch Out for Complications During Pregnancy

Even though none of the above mentioned factors may be part of one’s personal medical history, pregnant women could develop complications that could lead to preterm labour. Some of the more common causes:

1. Intrauterine infection. Infection within the womb is one of the leading causes of preterm births.⁶ At times, bacterial infections such as E-Coli and Group B Streptococcus (GBS), chlamydia, trichomona, gonorrhea and syphilis travel up from the vagina and infect the womb, causing the fetal membranes to become inflamed and infected. This is called chorioamnionitis. An infection of the membranes may in itself trigger preterm contractions or lead to preterm premature rupture of the membranes (PPROM)⁷.
2. Pre-eclampsia. This is a relatively common condition, affecting between two to eight in 100 women during pregnancy⁸. Pre-eclampsia is a combination of hypertension (high blood pressure) and proteinuria (protein in urine) and usually sets in after the 20th week of pregnancy.⁹ In some cases, organs such as liver or kidneys can become affected and there can be problems with blood clotting. This can lead to intrauterine growth restriction/fetal growth restriction (IUGR).
3. Gestational Diabetes. Some mothers develop this complication during pregnancy. It usually happens because your body cannot produce enough insulin to meet its extra needs in pregnancy, resulting in an increase in blood sugar levels. While most women who have gestational diabetes have healthy pregnancies and healthy babies, some women develop more serious complications which could lead to preterm labour and even still births.¹⁰

Take Care, Be Cautious and Change Lifestyle To Prevent Preterm Labour

Here are some do’s and don’ts that can help reduce the risk of preterm labour.

1. Don’t ignore any symptoms. Even at the risk of being labelled as a “paranoid” mum-to-be, it is better to err on the side of caution. Look out for any signs of fever, vomiting, unusual pains or aches, prolonged swelling or discomfort and speak to your doctor immediately. This could help detect an infection earlier.
2. Do be regular with antenatal checkups. The importance of this cannot be emphasized enough. Mums may not be aware of many early signs of foetal distress or pregnancy complications, but a doctor or a mid-wife should be able to detect them during antenatal check-ups. Therefore, regular antenatal care is a must. It has been found that many women who have premature babies have less frequent contact with antenatal services.
3. Do eat healthily and exercise regularly. This will help maintain a healthy body weight and possibly reduce risk for developing pre-eclampsia and gestational diabetes.
4. Do seek help. If you are struggling with depression, abuse or very high levels of stress, don’t cope with it alone. Seek out a friend or professional help.
5. Don’t drink alcohol. While no one will frown upon a mum-to-be having an occasional glass of wine, it is safest not to drink at all during pregnancy as the alcohol passes through the placenta and may affect the baby.
6. Don’t smoke. Smoking has been linked with premature labour, and the more you smoke the more likely you are to have your baby prematurely.
7. Do maintain high levels of hygiene. Wash your hands, keep contact surfaces clean, and avoid contaminated sites – to reduce the possibility of catching an infection.
8. Don’t plan a caesarean section unless medically necessary Several families plan for their baby to arrive on a certain date because of auspicious or other reasons. It is strongly advised not to do so. The pregnancy should be allowed to go through the full term if both the future mum and the baby are healthy.

While most preterm babies arrive early without any warning, in many cases the risk of a premature birth can be reduced. Mums-to-be need to take greater care, be watchful of their health and be diligent about their antenatal appointments.

In India, about 1.7 million babies are born preterm every year¹.Support prematurity awareness by sharing this with other mums and mums-to-be.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Please consult your doctor or a nutrition advisor for any specific health and wellness concerns or questions.

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References

1. Adapted from https://www.who.int/news-room/fact-sheets/detail/preterm-birth dated 14th Nov 2022. Accessed on 28^th Nov 2022

2. Kannaujiya AK, et al. Effect of preterm birth on earlyneonatal, late neonatal, and postneonatal mortality in India. PLOS Glob Public Health 2022; 2(6): e0000205.https://doi.org/10.1371/journal.pgph.0000205

3. Callander EJ, Atwell K. The healthcare needs of preterm and extremely premature babies in Australia-assessing the long-term health service use and costs with a data linkage cohort study. Eur J Pediatr. 2021 Jul;180(7):2229-2236. doi: 10.1007/s00431-021-04009-y. Epub 2021 Mar 10. PMID: 33693978.

4. Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes; Behrman RE, Butler AS, editors. Preterm Birth: Causes, Consequences, and Prevention. Washington (DC): National Academies Press (US); 2007. 10, Mortality and Acute Complications in Preterm Infants

5. https://www.nichd.nih.gov/health/topics/preterm/ conditioninfo/who_risk#:~:text= Other%20factors%20that%20may%20increase%20risk %20 for%20pretermincluding%20physical %2C%20sexual%2C%20or%20emotional%20abus e%20More%20items. Accessed on 28^th Nov 2022.

6. Gonçalves LF, Chaiworapongsa T, Romero R. Intrauterine infection and prematurity. Ment Retard Dev Disabil Res Rev. 2002;8(1):3-13. doi: 10.1002/mrdd.10008. PMID: 11921380

7. Hidalgo-Chicharro A, Abad-Torreblanca R, Navarro-Marí JM, Gutiérrez-Fernández J. 32-week premature rupture of membranes caused by oropharyngeal microbiota. JMM Case Rep. 2017;4(10):e005121. Published 2017 Oct 12. doi:10.1099/jmmcr.0.005121

8. Melchiorre K, Sharma R, Thilaganathan B. Cardiovascular implications in preeclampsia: an overview. Circulation. 2014 Aug 19;130(8):703-14.

9. Garovic VD, August P. Preeclampsia and the future risk of hypertension: the pregnant evidence. Curr Hypertens Rep. 2013;15(2):114-121. doi:10.1007/s11906-013-0329-4.

10. https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/gestational-diabetes/. Accessed on 28^th Nov 2022.