Preterm birth, a possible outcome to pregnancy
By: Alisa Samuel
Published on: December 15 2022
Over the past two decades, the number of preterm births in Canada has increased. Today, around eight per cent of Canadian pregnancies end with preterm birth. Premature babies are at risk of various life-long medical problems. Such problems include “lung disease, cardiovascular disorder, asthma, and hearing and vision loss.”
What is preterm birth?
The exact causes of preterm birth remain largely unknown. Doctors think women go into labour before their due dates because of infections, stress, obesity, substance use, preeclampsia, fetal growth restriction, and some chronic conditions like high blood pressure and diabetes. Studies, however, find that two risk factors are clearly related to preterm labour: 1) having a history of preterm birth, and 2) being from an ethnic minority.
History as a predictor of preterm birth
All babies delivered alive before 37 weeks of pregnancy are preterm babies. Based on when their mothers deliver them within those 37 weeks, the babies are ranked into three subcategories:
- extremely preterm (less than 28 weeks)
- very preterm (28 to 32 weeks)
- moderate to late preterm (32 to 37 weeks)
Women who’ve had previous preterm deliveries face up to a 50 per cent chance of going into preterm labour in their next pregnancies.
“The mechanism for the recurrence is not always clear,” explains professor of obstetrics and gynecology, Robert L. Goldenberg, and his team in a 2008 article on the causes of preterm birth. “But women with early spontaneous preterm births are far more likely to have subsequent spontaneous preterm births.”
Tiril Tingleff from the faculty of Medicine at the University of Oslo and colleagues recently reviewed national data of all the births in Norway between 1999 and 2014. They focused on over 200 000 women who gave birth to their first and second children in the same period. Their research shows that women with extremely preterm first births have the highest chance of experiencing extremely preterm second births.
Preterm birth research in ethnic minority women
Ethnic minority women, especially those who are black, have more preterm births than white women. This fact is a seemingly unexplainable occurrence.
In a 2017 study published in The Journal of Nutrition, university professors from across Québec suggest that vitamin D insufficiency leads to increased risk of preterm delivery in ethnic minority women in Canada.
Vitamin D is an essential nutrient and hormone. It supports the immune system and bone health by controlling infection and regulating calcium and phosphorous (minerals) in the body. You can get vitamin D through food, supplements, and regular sun exposure.
Dark-skinned people, however, don’t produce as much vitamin D in their bodies as light-skinned people do. The reason for this disparity is melanin. Melanin is a substance in the body that colours hair, eyes, and skin. Dark skin contains more melanin than light skin. Because melanin also protects skin from UV radiation (damaging sunlight), it hinders the absorption of vitamin D from the sun as well.
The researchers collected blood samples from hundreds of women across nine centres in Québec. They then thoroughly measured the samples for maternal vitamin D levels. The results show that the number of preterm births lowered as vitamin D status increased in women of colour.
Coping with death in preterm new-borns
According to the World Health Organization, complications from preterm births are the leading cause of death among children under the age of five internationally. In Canada, nearly two thirds of infant deaths are a result of preterm birth.
Bereaved parents, “especially mothers, commonly blame themselves or feel responsible for their baby’s death,” notes Peter Barr, a senior staff physician at Australia’s Royal Alexandria Hospital for Children in a 2004 article published in Psychology and Psychotherapy.
In trying to understand why and how their babies pass away, women often struggle with guilt. They think along the lines of: “If only I behaved differently during my pregnancy, maybe my baby would be alive today.”
Preterm birth-giving, and the potential loss of child to it, can be emotionally distressing—and not just because of guilt-proneness. Women may also experience shame and loneliness. They feel ashamed in believing that they didn’t carry out their supposed main function as a woman and thereby failed in life somehow. They feel lonely because, since pregnancy loss and perinatal death isn’t openly talked about, it’s difficult for them to share what they’re going through. Though, this doesn’t have to be the case.
Bereavement and counselling support is available and a helpful resource to explore if you are experiencing these feelings of guilt and loss. The Saskatoon-based non-profit organization, Empty Arms, for example, holds peer support groups in-person and online. In these groups you get the chance to not only connect with people who’ve experienced the loss of an infant, but will also find a safe space to grieve and be understood.
While some natural risk factors for preterm birth can’t be avoided, things can be done to help ensure a healthy, happy pregnancy. The Society of Obstetricians and Gynaecologists of Canada provides extensive resources on its website to help you prepare for all stages of pregnancy.