Remembering the Mother in Preterm Birth

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

As the world recognizes World Prematurity Day today, the Maternal Health Task Force is ever mindful of the key role a woman’s and mother’s health plays in the prevention of premature birth. While improving neonatal care and promoting interventions—such as kangaroo care are important—the rising rate of preterm births suggests prevention is key for decreasing neonatal mortality rates. And what would prevention be without ensuring the health of the woman before and during pregnancy?

The health of a pregnant woman is paramount, not only for her own survival and health, but also to prevent the number one killer of neonates: prematurity. While it is true that a large percentage of preterm births are iatrogenic, meaning the cause is unknown, there are several preventable factors that increase a woman’s risk of delivering prematurely. Ensuring women’s rights; preventing and treating infectious and non-communicable diseases; providing quality preconception and antenatal care; and promoting facility delivery to prevent maternal death will not only improve the lives of mothers, but also aid in preventing prematurity and neonatal death.

Women’s Rights

Respecting a women’s right to live a violence-free life and plan her family is basic and essential, yet women around the world still suffer violence, often in their own homes, and many are not given the choice to plan their families. Domestic violence plays a significant role at putting a woman at risk for delivering prematurely. Family planning also plays a key role in decreasing premature birth; meeting the unmet need for family planning is estimated to decrease the number of premature births and neonatal mortality. In addition, appropriate birth spacing decreases a woman’s odds of giving birth prematurely by 16 percent.

Preventing and treating infectious and chronic disease

While the prevention and treatment of infectious diseases has long been a focus of antenatal care, more recently the importance of mitigating the effects of non-communicable diseases (NCDs) through preconception care has been realized as key for decreasing prematurity and birth complications.

Providing a women with the education and means to prevent sexually transmitted infections (STIs) and treatment if needed is not only key for her health, but can significantly decrease birth complications and prematurity. In addition to STIs, rubella—a vaccine-preventable disease—and malaria significantly increase the risk of preterm birth. Providing methods of prevention and appropriate treatment for these infections will have a significant impact on the rate of prematurity and the health of women and their children.

A life course approach to preventing prematurity necessitates the need for ensuring the overall health of women prior to pregnancy. Non-communicable diseases—such as low BMI, high BMI, high blood pressure, asthma, diabetes, and thyroid and heart disease—are significant contributors to prematurity. Providing regular care before conception and antenatal care during pregnancy to address chronic health problems will improve the chances for a healthy pregnancy for both the mother and her newborn.

Antenatal Care and Facility Births

Skilled care is a key intervention for the health of the mother and the prevention of birth complications, including prematurity. Regular antenatal care visits allow complications to be addressed, familiarization with the health sector, and increased chance of delivering in a facility. Since not all preterm births can be prevented, a facility birth, which has an incredible positive impact on maternal mortality, also situates the premature infant in a setting where emergency services may be provided. Given that 36% of neonatal deaths occur in the first 24 hours of life, this indicates the need for immediate emergency and supportive facility-based care, such as resuscitation, treatment of sepsis, and thermoregulation.

The rate of preterm birth—the number one cause of death in children under-five—can be reduced through integrated maternal and neonatal health. By addressing the health of both the mother and the newborn, complications can be mitigated and lives saved.

For more information on preventing and mitigating the effects of preterm birth, access our Preterm Birth Topic Page and the recently published standards on pregnancy dating.