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US babies fare poorly on preterm births

Despite all the dollars we spend on health care, American babies are getting short shrift when it comes to good health outcomes. The premature birth rate in the United States is abysmal; our country ranks 131st — with a preterm birth rate of 12 per 100 live births — which puts us near Somalia, Thailand, and Turkey, according to a report released Wednesday by the March of Dimes and the World Health Organization.

Premature births — defined as before 37 weeks — are a leading cause of newborn fatalities and developmental disabilities; causes are still largely unknown, but certain factors like smoking, obesity, and regular prenatal care can help reduce the rate. (About 13 percent of women who become pregnant each year have no health insurance, often resulting in inadequate prenatal care, according to the American Pregnancy Association.)


Babies born in America are also far more likely to have their heart problems missed during routine ultrasound screening compared with those born in Europe. For unexplainable reasons, ultrasound technicians in this country catch only about half of heart defects in the womb. “If an ultrasound is being done properly, it should be catching a much higher percentage of abnormalities,” said Dr. Wayne Tworetzky, director of the fetal cardiovascular program at Children’s Hospital Boston.

Catching more of these defects — which occur in 8 out of every 1,000 babies born — before birth could enable some fetuses to have the defect fixed in the womb or enable doctors to prepare for treatment shortly after birth.

Tworetzky recommends parents ask the following questions during their baby’s ultrasound to ensure that the technician is doing a thorough check: Do you see two upper and two lower chambers in the heart with valves controlling blood flow into the heart? Do the two valves and vessels (aorta and pulmonary arteries) exit the heart in a crossing fashion? Do you see any large holes between the lower chambers of the heart?


Another non-invasive test performed right after birth — called pulse oximetry — can catch more than 76 percent of heart abnormalities in newborns, according to a study published Wednesday in Lancet. Yet many hospitals don’t offer it routinely. “They should,” said Tworetzky. Babies sent home with serious heart conditions that go undetected could develop life-threatening conditions such as an erratic heartbeat or cardiac arrest.

Lastly, American babies could certainly benefit from more efforts to reverse the obesity epidemic in pregnant women. A growing body of evidence suggests that a mother-to-be’s diet, exercise habits, and body weight all play a role in programming certain genes that her baby carries and could set the stage for the child to become obese later in life. More information on fetal programming is available from a new obesity prevention website launched by the Harvard School of Public Health.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.