Adelaide Uni study finds preterm births have increased by 40 per cent over 28 years
WHY are more babies being born early? Elisa Black looks at new new research for an explanation.
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WE live in an era where “natural” is seen as best. From the organic food movement to the proliferation of “wellness warriors”, this trend is seen as the enlightened path to better health.
But when it comes to pregnancy, the opposite is often true as debate surrounding elective C-sections, inducements and hospital versus home births as acute as ever.
A new University of Adelaide study, which analysed 550,000 births in South Australia between 1986 and 2014, has found that preterm births have increased by 40 per cent over 28 years, and early intervention by medical professionals has contributed to the majority of the increase.
While “natural” or spontaneous preterm births accounted for the majority of all preterm births during the 28 years of the study – rising from 3.5 per cent in 1986 to 3.8 per cent in 2014, 80 per cent of the increase was attributed to medical professionals ending pregnancies prematurely.
The rate of clinician-initiated preterm delivery increased from 1.6 per cent in 1986 to 3.2 per cent in 2014.
But, importantly, the rate of stillbirths fell by 45 per cent (from 4.2 per cent to 2.3 per cent of total births) in the same time period.
Research author, PhD candidate Dr Petra Verburg, said clinicians may initiate preterm delivery due to pregnancy complications, by either inducing labour or performing a caesarean section.
“Problems such as hypertension or impaired growth of the foetus are the reasons doctors initiate the majority of preterm births” she said.
Jessica Logan had stillborn son, Jackson, in 2013.
It was during a routine pregnancy check-up when she was 28 weeks pregnant that she learned he had died.
The then 23-year-old, from Gulfview Heights, had developed severe pre-eclampsia but had no symptoms, meaning her son died before anyone knew there was a problem. “It was very hard on me, my partner, and my stepdaughter, Evie,’’ she said.
“Being my first pregnancy I was naive that stillbirth still happens, but it happened to us. You go through labour, and pushing, your milk comes in, but there is no baby to take home.
“It took us three years to think about trying to get pregnant again.”
Jessica, now 28, has since given birth to healthy daughter, Olivia, 19 months, and son Angus who was born on December 29, at 33 weeks, when it was deemed the pre-eclampsia Jessica was again suffering from was too dangerous for her and the baby.
“I was hospitalised two weeks before,’’ Jessica said.
“I had no symptoms, again, so without hospital observations it could have turned out really badly. I’m really lucky I was there.”
Now home from hospital for almost a week, Jessica said, despite being born so early, Angus was doing very well.
Study co-author and academic head of the Department of Obstetrics & Gynaecology at the Lyell McEwin Hospital and Adelaide University’s Robinson Research Institute Professor Gus Dekker said the ability to assess which pregnancies were at risk had progressed enormously in the last 20 years.
“In the late 90s we didn’t have many good tools to monitor baby’s condition and the understanding of pre-eclampsia was in theory,’’ he said.
“The thinking then was to keep the baby in as long as possible. When understanding improved it became about whether baby was better off outside or inside.
Prof Dekker was one of Jessica’s doctors during her pregnancy and he said her health was as important a consideration as her child’s. “She developed severe pre-eclampsia again, HELLP syndrome (a serious pre-eclampsia variant that affects the liver), she was getting very sick again. The mother’s safety is always the highest priority.”
He said it was important to ensure “hard-indications” – like severe pre-eclampsia – remained a proviso of clinician-initiated preterm birth.
“All doctors are concerned about the higher C-section rate itself, and would be concerned if too many preterm births were from soft indications,’’ he said. “Most of the interventions are done for babies which have slowed down in growth. This is one of the last things that happens before you lose a baby.
“People should be confident if doctors go for earlier delivery it happens on solid indications.”
Prof Dekker said a change in the health profile of expectant mothers had also altered clinicians’ approach.
“Currently, more than a quarter of the South Australian pregnant population is obese or morbidly obese. Additionally, more than half are 30 years of age or older.
“These factors increase the likelihood of major pregnancy complications and hence, increase the likelihood that these pregnancies will end with a clinician-indicated preterm birth.”
He said ultimately intervention needs to be considered on a case-by-case basis.
“On the one hand, clinician-initiated preterm birth of growth restricted babies, or in cases of pre-eclampsia, may potentially prevent stillbirth, or maternal complications,” Prof Dekker said. “On the other hand, babies born following totally uncomplicated pregnancies at term, have the best long-term health.”