BY JENNIFER AMATO
Staff Writer
NEW BRUNSWICK – People say that nothing is more glorious than the birth of their child, but a premature birth usually causes parents to worry about the health of their newborn. However, a new faculty study by the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School has found that premature births do not always result in a bad outcome if the woman is under the care of a physician.
Cande Ananth, a Plainsboro resident, professor at the UMDNJ-RWJMS and the director of the Division of Epidemiology and Biostatistics at RWJMS, has found that premature births can save babies from being stillborn. Over the last two years, he and Dr. Anthony Vintzileos, the chairperson of the Department of Obstetrics, Gynecology and Reproductive Sciences at RWJMS, have studied premature births and published their findings in the December 2006 issue of the Journal of Maternal-Fetal and Neonatal Medicine.
“Stress is definitely a major contributor to preterm births, but the bigger picture is related to what the health care physician can do,” Ananth said. “I showed for the first time, in my work, that increased intervention in pregnancy is beneficial … so intervention [by a doctor] is good.”
Ananth examined 46 million single births in the United States between 1989 and 2000; multiple births were excluded because of the overwhelmingly increased likelihood of medical complications in such cases. He noted that premature births can occur if a woman’s water breaks early, if a woman goes into labor prematurely, or if the baby is in trouble and the mother needs to be induced or have Cesarean surgery.
He found that the database showed that the rate of death either at birth or within a month thereafter declined more than 25 percent from 1989 to 2000 even though the rate of premature births had increased. However, early water-breaking incidents had declined whereas premature births due to medical intervention had increased rapidly. Ananth concluded that the inducement of labor or the performance of a C-section under the advisement of a doctor saved babies’ lives because of the quick attention to serious issues that could affect the health of both the baby and the mother.
“Why keep bashing preterm births if physicians are doing something good?” Ananth said. “In terms of preventing death, it’s a success.”
Ananth also found common trends in premature births. Although African American women remain twice as likely as white women to have a preterm birth, African-American women’s rate of premature births has gone down slightly in recent years, shrinking the disparity in the rate of premature births compared to white women. However, the 12-year faculty member of RWJMS found that white women’s rate of premature births have gone up in recent years.
He thus found that the rise in white premature births were healthy preterm births under the intervention of a doctor while African-American women benefited 40 percent less from this trend. He said that as a generality, African American women are at a disadvantage when it comes to family income, proper health behaviors, appropriate nutrition and pregnancy education.
Furthermore, in working with Vintzileos, Ananth learned that the placenta is more than just nourishment for the fetus, it is also a critical factor in determining the heath of both the baby and the mother during pregnancy, because the overall health of a baby is affected by the intrauterine environment of the mother.
“Most of our physical and intellectual health in life depends on genetics, which we can’t help, and environment, and no environment is more important than the uterus,” Vintzileos said. “Children come from mothers.”
Studies by Ananth and Vintzileos also show that 54 percent of premature births occur because a doctor intervenes due to preeclampsia (very high blood pressure in the mother), small-for-gestational-age syndrome (when a fetus’ growth is severely stunted for that stage in the pregnancy), fetal distress (when a fetus’ heartbeat or movement suddenly weakens) and placental abruption (the separation of the placenta from the uterus).
The researchers realized that all four cases are directly related to a blockage of blood circulation between the mother and the fetus through the placenta. They invented the term “ischemic placental disease” to cover the commonality of these four causes of premature birth that force medical intervention and thus believe that doctor intervention in births do not vary nearly as widely as previously thought.
In addition, the research team also found that if a woman gives birth to her first child prematurely, whether on her own or with medical intervention, she is likely to give birth to her second child prematurely as well. She is also most likely to give birth within a week to 10 days, either way, in her second pregnancy compared to when her first child was born.
“Our research is so new that we cannot pinpoint yet what criteria pregnant women can follow” in terms of preventing preterm births, Ananth said. However, with the work of Morgan Peltier, a perinatal biologist and an assistant professor in the Division of Maternal-Fetal Medicine, cellular and molecular studies of the uterine-level structure could provide information about what triggers preterm births.
The next step is to identify which women are more predisposed to premature births, either spontaneously or indicatively, based on demographics, medical history and obstetrical conditions. However, more funding must be secured to continue the research.
For more information visit www.umdnj.edu.