Prematurity and Low Birth Weight Overview

Prematurity and Low Birth Weight

• Prematurity is the delivery of a baby before 37 completed weeks of gestation.
• In 2022, preterm birth affected about 1 in 10 infants born in the US.
• The preterm birth rate declined by 1% in 2022 following a 4% increase from 2020 to 2021.
• Racial and ethnic differences in preterm births persist. African-American women have a higher rate (14.6%) compared to white (9.4%) and Hispanic (10.1%) women.
• Approximately 1 in 10 babies are born prematurely.

Definition of Low Birth Weight

• Birth weight is the body weight of a baby at birth.
• Low birth weight (LBW) is a birth weight of less than 2500 grams.
• Very low birth weight (VLBW) is a birth weight of less than 1500 grams.
• Extremely low birth weight (ELBW) is a birth weight of less than 1000 grams.

Determinants of Birth Weight

• Birth weight is related to gestational age.
• A baby born at 28 weeks has a birth weight closer to 900 grams.
• A baby born at 36 weeks has a birth weight closer to 2750 grams.

Epidemiology of Prematurity

• The global current preterm birth rate is 10.5%.
• In 2020, 15% of all preterm births occurred before 32 weeks of gestation.
• Rates in Iraq are between 15-16%.

Epidemiology of Low Birth Weight in Iraq

• The preterm birth statistics in Iraq show rates of LBW are around 15-16% of births, which equates to more than 1/3rd of the babies born in Iraq.

Risk Factors for Preterm Birth

• Several factors contribute to the rise in preterm births (including):
  • Increased rates of multiple births
  • Increased use of assisted reproductive techniques
  • More obstetric interventions.
• Part of this increase might be due to changes in clinical practice.
• Studies have found that climate change exacerbates the risk of preterm birth and stillbirth in expectant mothers.
• Increased maternal autistic traits correlate with increased risks of preterm birth and small for gestational age.

Leading Causes of Death

• The leading causes of death for preterm babies are:
  • Atelectasis, Hyaline membrane disease, and surfactant deficiency.
  • Life-threatening malformations
  • Pulmonary haemorrhage
  • Intracranial bleeding following anoxia and trauma
  • Pneumonia and infections

Types of Deliveries

• Spontaneous preterm births (40-45%): these births follow preterm labour.
• Induced preterm births (25-30%): these are due to premature rupture of membranes.
• Cesarean section preterm births (30-35%): these are due to obstetric reasons like infection or intrauterine growth retardation

Clinical Impact of Prematurity: Immediate

• Respiratory problems are significant, including apnoea, RDS, and asphyxia.
• Neurological issues are prevalent, including intracranial haemorrhage.
• Cardiovascular problems include bradycardia and hypotension.
• Haematological problems include anaemia and bleeding tendencies.
• Gastrointestinal problems include hypoglycaemia.
• Renal problems include reduced G Filtration.
• Temperature regulation issues.
• Immunity and ophthalmic concerns also exist.

Clinical Impact of Prematurity:Late

• Chronic lung diseases
• CNS issues, especially cerebral palsy
• Poor growth
• The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability.

Pathways Leading to Preterm Birth

• Preterm birth can be due to precocious fetal endocrine activation.
• Uterine over-distension
• Decidual bleeding
• Intrauterine inflammation or infection

Prevention of Preterm Birth

• Direct interventions:
  • Identifying women at risk for maternal malnutrition, heavy work load, medical illnesses, urinary infections, and raised blood pressure.
  • Identifying women at risk for too many pregnancies, close spacing between births, multiple pregnancy, being under 18 or over 35, short stature, poor weight gain in pregnancy, ethnicity, psychological stress and rural residence.
• Indirect interventions:
  • Family planning
  • Sanitation
  • Avoid smoking
  • Nutritional care
  • Combating poverty and deprivation

Strategies to Improve Outcomes

• Kangaroo care can improve outcomes
• Increased access to warmth, breastfeeding, treatments for infection and breathing supports
• Support for mothers with low birth weight babies and their families is very important

Recommendations

• It's recommended that labor be not medically induced before 39 weeks unless medically necessary. The same applies to Cesarean sections.
• Long-term folic acid supplementation before pregnancy may reduce preterm birth.

Further Considerations

• High prevalence of LBW in Iraq is linked to deteriorating health status of pregnant women, younger age at marriage, and inadequate prenatal care.
• Some historical and contemporary figures endured preterm birth complications.

Additional Notes

• War in Iraq may have contributed to elevated LBW rates in certain areas.

This quiz explores key concepts related to prematurity and low birth weight, including definitions, prevalence rates, and determinants affecting birth weight. Understand the impact of gestational age and racial disparities in preterm births. Test your knowledge on these crucial topics in maternal and infant health.