ATLANTA (AP) _ Premature births, often due to poor care of
low-income pregnant women, are the main reason the U.S. infant
mortality rate is higher than in most European countries, a
government report said Tuesday.
About 1 in 8 U.S. births are premature. Early births are much less
common most of Europe; for example, only 1 in 18 babies are premature
in Ireland and Finland.
Poor access to prenatal care, maternal obesity and smoking,
too-early cesarean sections and induced labor and fertility
treatments are among the reasons for preterm births, experts said.
Premature babies born before 37 weeks tend to be more fragile and
have under-developed lungs, said the lead author of the new report,
Marian MacDorman of the U.S. Centers for Disease Control and
Prevention.
Premature births are the chief reason the U.S. ranks 30th in the
world in infant mortality, with a rate more than twice as high as
infant mortality rates in Sweden, Japan, Finland, Norway and the
Czech Republic. For several years, the U.S. has ranked poorly among
industrialized nations. MacDorman's report scrutinizes the reasons
for that.
If U.S. infants were as mature as Sweden's are at birth, nearly
8,000 infant deaths could be avoided and the U.S. infant mortality
rate would be about one-third lower than it is, according to a
calculation by MacDorman and others at the CDC's National Center for
Health Statistics.
Why so many more premature infants here? Experts offered several
possible explanations:
_Fertility treatments and other forms of assisted reproduction
probably play a role because they often lead to twins, triplets or
other multiple births. Those children tend to be delivered early.
_The U.S. health care system doesn't guarantees prenatal care to
pregnant women, particularly the uninsured, said Dr. Alan R.
Fleischman, medical director for the March of Dimes.
_Maternal obesity and smoking have been linked to premature births
and may also be a factor.
_Health officials are also concerned that doctors increasingly are
inducing labor or performing C-sections before the 37th week.
However, Fleischman said most infant deaths do not occur in babies
just shy of 37 weeks gestation, but rather in those much younger,
Labor was induced in nearly 16 percent of premature births in 2006,
up from about 8 percent in 1991. Cesarean sections were done in 36
percent of preterm births, up from 25 percent in 1991, MacDorman
said.
The report used 2005 statistics to make comparisons to 14 European
countries. There is more recent data: International infant mortality
statistics for 2006 and 2007 indicate that since 2000, the U.S. rate
has stood at about 7 infant deaths for every 1,000 live births.
The report also found that while the United States more commonly saw
premature births, survival rates for infants at that gestational age
were as good or better than most European countries.
"So, once the baby is born too early, we do a good job of saving it.
What we have trouble with is preventing the preterm birth in the
first place,'' MacDorman said.
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On the Net:
CDC report: http://www.cdc.gov/nchs
