The USA received a "D" overall on the March of Dimes' first state-by-state "Premature Birth Report Card," released today.
Each year, more than 530,000 babies are born before 37 full weeks of gestation, which is considered preterm. Preterm birth is the leading cause of newborn death and a major cause of lifelong disability, according to the March of Dimes.
Based on the percentage of 2005 live births that were preterm, Vermont ranked at the top with 9%, slightly less than half the figure in Mississippi, which ranked at the bottom with 18.8%.
"We were surprised by how dramatic the report card is when you actually look at the data on a state-by-state basis," says March of Dimes president Jennifer Howse. "When the map came up, we really had an 'ah-ha' moment."
Even Vermont earned only a "B," though. The reason: The cutoff for an "A" was a preterm birth rate of 7.6% or less, the government's "Healthy People 2010" goal for the country. In 2005, the U.S. preterm rate was 12.7%, up from 11% in 1995.
More research into the causes of preterm birth is needed, Howse says, but "we believe that there are some solutions that are at hand." Among them:
*
Pregnant women who have had a previous preterm birth, the main predictor of another, should get weekly shots of the hormone progesterone starting at 16 to 20 weeks' gestation. Research has shown that can cut preterm birth risk by one-third.
*States need to expand health insurance coverage of childbearing-age women. Covered women are more likely to receive proper prenatal care.
*Hospitals need to review the reasons for labor inductions and cesarean sections performed before 39 weeks' gestation. Studies show that some are scheduled early for the doctor's and/or mother's convenience, not medical reasons.
Roger Young, director of obstetrics and gynecology at the University of Vermont, emphasizes that "the goal is not preterm birth reduction, period. The goal is healthy babies." If the preterm birth rate falls but the stillbirth rate rises because babies in distress haven't been delivered quickly enough, nothing has been accomplished, says Young, a March of Dimes board member.
A combination of factors has helped Vermont hold its preterm birth rate steady while the country's has been rising, he says. The development of ways to measure the quality of prenatal care has helped improve it, Young says. And, he adds, "you really can't ignore the fact that we have a high number of insured patients."
In Mississippi, on the other hand, "poverty and not having insurance and not having prenatal care probably plays a big part" in the state's poor showing, says Gina Fiorentini-Wright of the Southern Mississippi Area Health Education Center at the University of Southern Mississippi in Hattiesburg.
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