The phrase ‘preterm birth’, or ‘premature birth’, refers to babies that are born too early.

Babies born before 37 completed weeks of pregnancy are referred to as premature.

Premature babies are likely to spend a greater amount of time in hospital (usually in a neonatal intensive care unit, or NICU) compared with babies born later. A baby born early, especially if extremely premature (at a gestational age under 28 weeks), will often have complicated health problems.

These might be resolved in the short term, or could have a longer term or life long impact.

Generally, infants born at earlier gestational ages have the greatest risk factors for chronic diseases in later life.

The medical, societal, and economic cost to families affected by premature birth is huge; therefore, we must do all we can to try to prevent preterm birth.

It’s also important to familiarise yourself with the commons signs of preterm labor, especially if you’re at increased risk of giving birth early.

Read our article ‘Premature Labour – Signs, Symptoms & Management‘ to learn more.

Preterm birth rates

Premature birth is a huge global problem; about 1 in 10 babies are born prematurely.

It’s estimated by the World Health Organization (WHO), that 15 million babies are born too early each year around the world.

Although there have been huge medical advances made in the care of preterm infants, premature birth is still the leading cause of death in children under the age of 5.

Those at higher risk of preterm delivery

Medical professionals agree that there are certain factors associated with a high risk of early labor and preterm delivery:

History of previous preterm birth (or previous preterm labor)
Having a shorter cervix (less than 20mm)
Multiple births (being pregnant with more than one baby) and the use of assisted reproductive technology (including in vitro fertilization) are associated with a greater risk of preterm delivery. More than half of all twins are born early, compared with singleton pregnancy, and triplets, or more, are almost always born early
Childbearing age: women under 18 years, or older than 35 years, are most at risk of giving birth early.

You can read more about risk factors for an early birth in our article ‘Preterm Birth – Ways To Prevent Preterm Birth‘.

What’s the most common cause of preterm labor?

The most common causes of preterm birth are:

Multiple pregnancies – twins, triplets, or more
Infections – recurrent kidney, bladder, or urinary tract infections (UTIs), infections of the uterus, amniotic fluid or placenta, known as chorioamnionitis
Chronic maternal conditions, such as high blood pressure or diabetes.

Often, however, there is no known cause for preterm labor.

How to reduce preterm birth

It’s important to realize that not all preterm births can be prevented.

However, there are a number of lifestyle changes pregnant mothers can adopt, and basic health promotion advice they can follow, which can reduce the chances of their babies being born prematurely:

Smoking cessation. Quit smoking and avoid second hand smoke
Avoid alcohol. Do not drink alcohol during pregnancy, as there is no proven safe amount that can be consumed
Avoid street drugs, recreational drugs, and misuse of prescriptions drugs
Eat a balanced diet. Include lots of fresh fruit and vegetables, foods containing folic acid, and Iron Rich Foods For Pregnancy. Do not eat raw meat
Medical conditions. Get any medical conditions, such as high blood pressure or diabetes, under control before getting pregnant. If that isn’t possible, seek advice from your care provider as early as possible in your pregnancy
Maintain a healthy weight. Being either underweight or overweight can cause significant complications for your health and your baby’s
Avoid or minimize excessive Stress During Pregnancy
Stay active: 30 minutes of light exercise during pregnancy is recommended.

After finding out you’re pregnant, seek prenatal care early. Access to early antenatal care can help detect any risk factors or problems, meaning earlier access to treatment, if necessary.

Research has shown that women who access prenatal care services are at a lower chance of having a preterm birth and have a greater chance of a healthy pregnancy.

Related reading: Did you know that Exercise During Pregnancy Could Shorten Your Labour?

Can folic acid reduce premature birth?

Some preterm births are indicated, due to pregnancy complications, but the majority occur spontaneously, meaning preterm labor begins by itself.

Although there are some medications (known as tocolytics) that can be given to try to halt or delay preterm labor once it’s begun, the effectiveness of these drugs is unclear.

The focus has shifted to ‘just in case’ (prophylactic) treatments, which are designed to try to prevent preterm labor from occurring in the first place, rather than trying to stop it once it’s already started.

This is where folic acid comes in. It’s common practice that Folic Acid For Pregnancy is recommended to reduce the risk of neural tube defects, such as spina bifida. It’s also known to reduce certain birth defects such as cleft palate and some heart abnormalities.

But could taking folic acid before pregnancy help reduce the preterm birth rate?

Evidence has suggested that taking a supplement of folic acid in the pre-conception period can significantly reduce preterm birth rates in those most at risk of preterm birth.

The study found that women who took the supplement one year prior to conception had a 70% reduction in extreme preterm birth (between 20 and 28 weeks gestation), and a 50% reduction in premature birth (between 28 and 32 weeks) when compared with women who didn’t take the supplement.

Centering pregnancy

Centering is an innovative approach to receiving prenatal and postnatal care. It combines care with an emphasis on risk assessment, education, and support within a group setting. It facilitates both medical care and childbirth education simultaneously with a midwifery focus, to create a collective experience.

Instead of receiving individual prenatal care visits, care is usually provided in groups of around 8-10 women with similar due dates. Groups meet monthly until the end of pregnancy.

This type of care encourages women to take responsibility for their care and shifts the client-provider power dynamic.

The aim is to increase women’s involvement and interaction; it offers the opportunity for them to share pregnancy and birth experiences with each other.

It promotes a more social, nurturing, and relationship-centered model of care, rather than focusing purely on a medical model. It provides a more holistic approach to care.

Not only are there numerous benefits for healthcare providers – including greater efficiency and effective delivery of care – it’s also a model favored by pregnant women receiving the care.

In the research involving women participating in this type of care, these common themes emerged from their reactions:

Getting more in one place at one time – a more efficient model
Feeling supported
Learning and gaining meaningful information
Not feeling alone in the experience
Connecting
Actively participating and taking ownership of care.

Centering pregnancy reduces preterm birth

Centering pregnancy or group prenatal care is an innovative strategy which has been shown to be cost effective and efficient and which provides greater satisfaction for providers and moms to be.

Group prenatal care also resulted in significantly improved pregnancy outcomes, including reduced preterm birth rates and low birth weight, compared with individual care only. In terms of these results, women experienced greater benefit with 5 or more visits.

Centering pregnancy has been shown to eliminate nearly all racial disparities in preterm birth. Black women who are at a higher risk of having a premature baby experience a lower risk of preterm birth when enrolled in this type of care.

It also has the potential to reduce other health problems, such as:

Lower rates of gestational diabetes
Early detection and improved treatment for postpartum depression
Improved breastfeeding rates.

The cost of having a baby born preterm is more than 10 times greater than for healthy babies born at full term.

It’s estimated that centering pregnancy could save health care systems around $8 billion each year by preventing or reducing early labor and preterm delivery.

Interventions to reduce preterm birth

If you are known to have risk factors that put you at a higher chance of having a premature baby, you may be seen by your health care provider in a specialist preterm birth prevention clinic.

There are several interventions that might be discussed with you to help reduce your risk of preterm labor and birth.

Progesterone therapy

Progesterone treatment might be suggested for women with a history of preterm labor or premature rupture of membranes, and who are carrying a single baby. There is also strong evidence to suggest that vaginal progesterone might also prevent preterm birth in women who are known to have a short cervix.

Progesterone is taken daily, from 16-20 weeks of pregnancy until 37 weeks.

The aim of progesterone therapy is to reduce the major complications of prematurity, such as perinatal death, respiratory distress syndrome, and the need for assisted ventilation to support breathing, and admission to NICU.

However, this form of intervention might not be suitable for everyone. It is known to be non-effective in multiple pregnancies, or once premature labor or premature rupture of membranes has already occurred.

Cervical stitch (cerclage)

For most women who have already had a premature birth, the option of a cervical suture or stitch, known as a cerclage, will probably be offered in subsequent pregnancies.

The suture is usually performed at about 12-14 weeks of pregnancy and is used to keep the cervix from opening too soon.

It can be performed later on in the pregnancy (up to 24 weeks) but beyond this point the procedure runs the risk of puncturing the membranes around the baby, causing further complications.

The stitches will be removed before you have your baby, ideally around 37 weeks, but if you go into labor sooner, they will need to be removed beforehand.

Can bed rest prevent preterm labor?

There is no evidence to suggest that strict bed rest, either at home or in the hospital, is effective in treating preterm labor, or preventing preterm delivery.

In fact, restricting your activity levels can pose certain health risks, including:

Deep vein thrombosis (DVT) – developing blood clots in the legs or lungs
Reduced muscle and bone mass (muscle wastage and bone demineralization)
Increased stress, and deterioration in emotional and mental well being.

There could be circumstances in your pregnancy where restricting certain activities, such as heavy lifting, or sexual activity, might be recommended by your health care provider.

However, as a general rule, strict bed rest will not prevent you from giving birth early, and should not be advised.

Can caffeine cause preterm labor?

Limiting caffeine in pregnancy is important, as consuming high levels have been linked to pregnancy complications, such as miscarriage, stillbirth, premature birth, and low birth weight babies.

Caffeine is a stimulant that raises the blood pressure and heart rate slightly and reduces the amount of urine produced by the body.

Although, as adults, we might be used to consuming caffeine in our everyday lives, during pregnancy women are more sensitive to caffeine. This is due to a slower metabolism, which means the caffeine stays in the bloodstream for longer periods of time.

Caffeine is also known to pass through the placenta and on to the baby. Babies are not used to the effects of caffeine and they are not equipped to process caffeine in the same way as adults.

Any amount of caffeine can alter your baby’s patterns of movement and sleep.

Research suggests that the risks of caffeine increase in line with the amount of caffeine consumed, so it’s best to limit as much as possible.

Remember that even decaffeinated tea and coffee will still contain small amounts of caffeine.

How much caffeine is safe in pregnancy?

Most health care providers will advise you to limit caffeine intake to 200mg per day. You might be wondering what that looks like in real terms. Remember, it’s not just tea and coffee that contain caffeine.

A mug of instant coffee = 100mg
A mug of filter coffee = 140mg
A mug of tea = 75mg
Energy drinks = 80-100mg
A can of cola = 40mg
A bar of chocolate = 25mg

Can stress cause preterm labor?

It’s possible that chronic stress or high levels of Stress During Pregnancy can cause some women to go into early labor.

We tend to think about stress in later pregnancy possibly causing the onset of preterm labor; however, this might not be the case.

There is a cocktail of hormones circulating in the body at any one time, and each hormone plays a role during pregnancy.

Research has shown that one of these hormones, known as CRH, or Corticotrophin Releasing Hormone, is released in the brain and by the developing fetus and placenta during pregnancy. An increase in CRH leads to increasing levels of the stress hormone cortisol.

Interestingly, it’s thought that women with high circulating levels of CRH in early pregnancy are most at risk of premature labor and birth.

How to prevent premature birth in second pregnancy

If you’ve already had a preemie and you’re concerned about what will happen next time, try to plan the spacing of your next pregnancy.

For most women it’s best to wait at least 18 months from giving birth to getting pregnant again. This gives the body a chance to fully heal itself from the previous pregnancy and get ready for the next.

Pregnancy and breastfeeding can leave the body a little depleted. Waiting until your baby is at least 18 months old before becoming pregnant again will allow time for your body to build itself up.

Getting pregnant within 18 months can increase your chance of premature labor and birth and having a baby that is small for gestational age, with low birth weight.

Ways to prevent preterm birth with twins

If you’re carrying more than one baby (multiple pregnancy), you’re probably aware that most twins and triplets are born early.

You might be wondering whether there is anything you can do to keep your precious little ones inside for as long as possible.

As well as the points discussed earlier, there are some additional tips to reduce your chances of going into labor early:

Stay hydrated. One cause of preterm labor is dehydration. Aim to drink at least 2 liters of water a day
Do light exercise. Stay active but avoid heavy or strenuous exercise
Rest. Prioritize making time to rest during the day. Put your feet up, or take a nap during the day. It could make all the difference
Sleep. Aim for at least 8 hours of sleep a night.

Report any new or unusual symptoms to your health provider. Pay attention to any change in vaginal discharge or loss, as this could be a sign of infection or that the waters around your babies are leaking.

Reporting any concerns early will help you and your care provider plan your care accordingly, and give your babies the best start in life.