Born Too Soon

The birth of a newborn IS usually a joyful event in the life of a family. The memory of nine often uncomfortable months — not to mention the intense effort of labor and delivery — begins to fade and the focus shifts to a wrinkled little miracle with 10 impossibly cute fingers and toes. Everyone is trying to decide whether the baby looks more like Mom or Dad. There are smiles all around, and in a day or two the happy family will leave the hospital to begin a grand new adventure at home.

Thankfully, this enchanting scenario remains the case most of the time. But the odds of a healthy start in life quickly begin to fall whenever a baby is born more than a few weeks shy of the typical 40-week-long pregnancy. Premature birth — by which doctors mean at least three weeks early — is the leading cause of developmental disability in children, including cerebral palsy and mental retardation, according to Dr. Eve Lackritz of the National Center for Chronic Disease Prevention and Health Promotion. It is also a significant cause of blindness, chronic lung problems and birth defects.

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Yet, for a combination of reasons — not all of them clear--1 out of 8 babies in the U.S. is born at least three weeks before it is due. Even more alarming, that ratio represents a 27% increase since 1980. Advances in neonatal care have saved many children who might otherwise have died. And lots of babies who leave the intensive-care unit grow up to be healthy, vibrant adults. But no incubator — no matter how high tech — will ever replace the womb. The goal, as doctors and nurses who treat ultrafragile preemies will tell you, should be to keep infants from ever needing extraordinary measures in the first place.

Much of the jump in premature births in the U.S. can be tied to the growing number of multiple births — twins, triplets or more — that result from infertility treatments. If you have one baby, your chance of delivering prematurely is just over 10%, according to Dr. Charles Lockwood at Yale University, and your chance of delivering what is called a very preterm baby (one born before 32 weeks) is less than 2%. But if you have twins, the most recent federal data show, your chance of preterm delivery jumps to 58%, with a 12% chance of very early delivery. With triplets, you have almost no chance of reaching full term and a 60% chance of delivering before 32 weeks.

Specialists in the U.S. often transfer several embryos into the womb during in vitro fertilization (IVF) in hopes of boosting the chance that one of them will "take" and therefore boost their clinic's success rate. Studies suggest, however, that the odds of a successful pregnancy may be the same whether you implant one, two or three embryos. Many European countries have decided to restrict their IVF clinics to one or two embryos per pregnancy. Dr. Lockwood and other physicians think such a limit might make sense in the U.S. as well.

Assisted reproduction isn't the only problem. Doctors have long known that smoking, uterine infection, high blood pressure and a prior history of preterm delivery also place an expectant mother at greater risk of delivering early. They're looking into the possibility that other factors, such as stress, diet (both before and after conception) and inflammation may also play a role. But they have something of a medical mystery on their hands. "Nearly half of preterm births are from unclear causes," says Dr. Nancy Green, medical director of the March of Dimes, which is in the early stages of a five-year, $75 million campaign to address the issue. You can do everything right and still give birth to a premature baby.