Preterm birth is when a baby is born too early before 37 weeks of pregnancy have been completed. Premature birth is a very serious health problem and a leading cause of death among children younger than five years worldwide. Premature babies have more health problems than babies born on time and may experience long-term health problems that affect the brain, lungs, hearing or vision. 

Worldwide, more than 1 in 10 babies are born prematurely each year, resulting in an estimated 15 million preterm births per year. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. In India, out of 27 million babies born every year (2010 data), 3.5 million babies born are premature and over 300,000 of these preterm babies die each year because of associated complications.

The World Prematurity Day is annually observed on November 17th to raise awareness about this serious health crisis. On this day, several webinars and events are being conducted to highlight the critical importance of neonatal care during this vulnerable period of life. We at Medicircle are conducting the World Prematurity Day Awareness Series wherein we will be featuring experts in this field to understand and create more awareness about premature birth.

Dr Renubala Rout is a Gynaecologist with having total experience of 12 years in Government and private setup. She works at the “For Woman” clinic, Mumbai and is also associated with BMC. She has vast experience in handling High-risk pregnancies and infertility treated pregnancies. She is well versed with LSCS, MRP, minor OT procedures like S & Es, D & C, polypectomies, Cervical Encirclage. She has adequate exposure to Abdominal and Vaginal Hysterectomies, Laparoscopy and Hysteroscopy. She has a keen interest in handling and creating awareness among the public on issues like prematurity, Anaemia, sexually transmitted diseases through camps, public talks and panel discussions.

Premature births and how common they are?

Dr Rout begins, “Usually the doctors speak about pregnancy in ‘weeks’ and ‘terms’, whereas the general public use ‘months’. This often causes confusion. So let me clear things up. We generally count a pregnancy for 40 weeks. In the context of preterm birth, any delivery that happens before 37 weeks is labelled as preterm and the one that happens after 37 weeks is called a full-term pregnancy.”

“There are instances where the delivery happens in 32 weeks or 34 weeks. Such babies are premature babies. We categorize the weeks within which the premature baby is born. 28 to 32 weeks, 32 to 34 weeks and 34 to 37 weeks are the three categories. A delivery that takes place in the 28th week is difficult as the baby will not have the strength to live without the mother’s support.”

“The earlier the delivery the more risk the baby has of getting infected with prematurity and its associated diseases and complications. So a delivery that occurs before 37 weeks or 259 days is preterm delivery." 

"The first three months of pregnancy translates into 12 weeks. The first 6 months translates into 24 weeks. In the 18 to 20 weeks bracket we do an Anomaly Scan. In a month we usually have 4 weeks, but they sometimes remain 2 to 4 extra days. These days later catch up and become extra weeks. So the calculation total becomes 40 weeks.”

Causes of Preterm Births

Dr Rout explains, “Globally 15 million births are preterm out of which 3.5 million of those births happen in India. That means, 1/5 preterm births happen in India. One of the reasons behind this is our ethnicity. As Asians, we have certain cultural, emotional and societal factors that cause preterm births. These factors are genetic and cannot hence be changed.”

“Socio-economic factors, multiple pregnancies, previous abortion, infections, bleeding, diabetes, blood pressure, autoimmune disorders and PPROM (Preterm premature rupture of the membranes) are some factors that can cause premature births. If the mother is occupationally exposed to laborious work or chemicals then there is added risk. Smoking and alcohol are also factors that cause premature births.”

“It is always recommended to go for at least 4-5 checkups throughout the pregnancy. This will help take care of the mother and the baby. Any infection or problem could then be detected and solved earlier.”

Is prematurity fatal?

She says, “Yes, prematurity can be fatal. As a rule of thumb, babies born between 28 to 32 weeks or between 32 to 36 weeks are more at risk. If they are not immediately provided NICU care then they can get short and long term disabilities and problems."

"In the short term, they can suffer breathing problems, gastrointestinal problems, weaker immunity and slow cognitive development.”

“In the long term, they can have a motor, cognitive, behavioural, emotional and social impairment. They could also suffer from visual impairment and hearing problems. This causes preterm babies to lag behind full-term babies.”

Care for Preterm Babies

She mentions, “I would stress that it is better to take care that preterm delivery is avoided altogether. If you are thinking of being pregnant then check whether you are suffering from any chronic diseases or anything else. As diabetes, BP and autoimmune diseases can affect pregnancy. Therefore, visit your doctor first and get your medicines approved before trying to conceive.”

“If you are trying for your second pregnancy then keep at least a gap of 18 months. This gap will ensure that both the baby and mother are healthy in the second pregnancy. If you already had a preterm birth then tell your doctor to give you supporting advice and medication for your second pregnancy. Avoid being overweight and underweight.”

“It is very important you avoid smoking, alcohol and recreational drugs. Make sure you have a healthy diet. If necessary take iron and calcium supplements. Follow moderate and mild exercise and yoga to keep your mind and body moving and at peace.”

(Edited by Priyal Shah)