Preterm Birth: Risk Factors and Symptoms

A preterm birth, also referred to as a premature birth, refers to the birth of a baby before the 37th week of pregnancy. A pregnancy is considered full-term after 37 weeks. Babies born during a premature birth are known as preemies.

Preemies often experience medical complications. While these complications vary from one preemie to another, the earlier a preemie is born, the more complicated the medical challenges. There are different categories of preterm births. These include:

  1. Late preterm when a baby is born between 34 and 36 weeks of pregnancy.
  2. Moderately preterm when birth occurs between 32 and 34 weeks of pregnancy.
  3. Very preterm is used when birth occurs before 32 weeks of pregnancy.
  4. Extremely preterm is when a baby is born at or before 25 weeks of pregnancy.

A good number of preterm births occur between 34 and 36 weeks of pregnancy. There have been documented cases of births occurring as early as at 23 weeks of pregnancy. In fact, the smallest baby to go on record (as of 2019) was born in December 2018.

Baby Saybie: The world’s smallest surviving baby

Baby Saybie was born at 23 weeks and 3 days at the Sharp Mary Birch Hospital for Women and Newborns weighing just 245 grams. So tiny was she, that doctors considered her to be a micropreemie. According to a report by the BBC, Saybie’s mother delivered through emergency C-section,17 weeks ahead before schedule. This was done following her diagnosis of pre-eclampsia. (Pre-eclampsia is a potentially fatal pregnancy complication whose three main symptoms include: Protein in Urine, Rising Blood pressure and Edema (the PRE triad).

Read More: Preeclampsia and Eclampsia – What you need to know

While Baby Saybie survived, more than 1 million babies worldwide are not as lucky. This is why the World Prematurity Awareness Day is marked every year in November. This day seeks to raise awareness and bring attention to the challenges that preemies and their families face. As part of this awareness campaign, this post seeks to share on preterm birth, associated risk factors and symptoms.

Baby Saybie, micropreemie
Baby Saybie. Image courtesy of AFP

What causes preterm births?

The causes of preterm births are many, complicated and only understood in partiality. The reason for this is that a number of factors come into play with premature labour and birth. These factors revolve around biological, psychosocial and medical aspects. The National Institute of Child Health and Human Development (NICHD) outlines three common situations in which preterm births occur. These include:

  • Spontaneous preterm labor and birth
  • Medically indicated preterm birth
  • Elective (non-medically indicated) preterm birth

Spontaneous Preterm Labor and Birth

This is a term that is used to refer to an unintended and unplanned delivery before 37 weeks of pregnancy. There are several reasons why a pregnant woman may experience a spontaneous preterm birth, including infection in the body. It is important to mention, however, that having had a preterm birth before is one of the strongest risk factors for preterm labour and birth in subsequent deliveries.

Medically indicated preterm birth

This preterm birth is usually recommended by healthcare providers particularly when a pregnant woman has a potentially fatal pregnancy complication such as preeclampsia or placental abruption. In many instances, the team of healthcare providers will take measures to keep the baby in-utero for as long as possible, all the while keeping an eye on the mother and the unborn baby. This is done to allow as much growth and development for the baby without putting either the mother or baby at risk.

Elective preterm delivery

This refers to a preterm birth after induction or a CS, even when there is no medical reason to do so. This practice is not recommended at all for the simple reason that babies born before 37 weeks have poorer infant outcomes and are likely to face significant medical challenges. Ideally, health care providers ought to wait to for a pregnant woman to get to 39 weeks of pregnancy before carrying out a CS or inducing labour.

What are the risk factors associated with preterm births?

Having outlined the three situations in which preterm births occur, it is important to include what the risk factors for preterm labor and birth are. Having these risk factors does not mean that one must experience preterm labour, but it significantly increases the chances of doing so.

In addition to this, some of these factors can be altered or modified in order to reduce the risk, while others cannot be changed at all. The following risk factors have been shown to put women at a higher risk of preterm labor and birth:

  • Women who have previously experienced preterm labor, or have delivered prematurely are known to be at the highest risk for preterm labor and birth.
  • Pregnant women carrying multiples, that is twins, triplets, quadruplets or more are at risk of preterm labor and birth. The same is considered for those who have used assisted reproductive technology.
  • In some instances, preterm birth occurs when women have certain abnormalities that affect the reproductive organs. Anomalies such as a shortened or incompetent cervix that increase the risk or preterm labor and birth.
Risk Factors of preterm birth
Inforgraphic showing risk factors of preterm birth. Source
  • The presence of certain medical conditions also places increases the risk of preterm labor and birth. These include, but are not limited to infections of the urinary tract, sexually transmitted infections, preeclampsia, vaginal bleeding, gestational diabetes and placenta previa (this is where the placenta develops in the lower region of the uterus, thus covering part of or all of the cervix.)
  • Various studies have also shown that the age of a pregnant woman may place her at significant risk of preterm labor and birth. In this regard, women in their teens are likely to deliver prematurely. Women past 35 years are also at risk of premature births largely because other medical conditions may also be present – conditions such as diabetes and high blood pressure.
  • Poor antenatal care
  • Environmental factors such as drugs and alcohol abuse, as well as smoking easily predispose a pregnant woman to preterm labour. Additionally, psychosocial factors such as poor support, mental illness and domestic violence (emotional, sexual or physical abuse) have also been linked to premature births.

Read More: World Prematurity Awareness Month

What are the symptoms of preterm labor and birth?

In many cases, spontaneous preterm birth is preceded by early labor that begins before 37 weeks of pregnancy. Some signs of preterm labor include:

  • Regular contractions that come after every 10 minutes. Unlike Braxton Hicks contractions, these contractions do not ease even with a change in one’s position (for example lying on the side). As a general guide, if you are unsure of what contractions you are having, it is best to call your healthcare provider immediately.
  • Vaginal bleeding that is characterized by a bloody-show.
  • Some women who experience preterm labour may experience intense menstrual-like cramps particularly in the lower back or lower abdominal region. Pain in the back sometimes manifests as a constant dull pain that could be a sign of early labour. This may or may not be accompanied by diarrhea.
  • Pelvic pressure is also another sign of early labor, and many women will experience the feeling of the unborn baby pushing downwards.

What should you do if you think you are experiencing preterm labour?

If you suspect that you may be experiencing preterm labor, call your healthcare provider immediately and head to hospital. This way, if it is preterm labor, the healthcare providers can attend to you as soon as possible for best maternal and infant outcomes. It is better to be safe than sorry.

Keep in mind that the doctor will typically test you for preterm labour through physical examination and/or the Fetal Fibronectin (fFN) Test. With appropriate medical interventions, preemies go on to overcome the medical challenges stacked against them and thrive as they grow older. This is at the heart of the World Prematurity Awareness Month – to bring light to the challenges preemies and their families face.

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