Siobhan Dolan, MD, MPH: Answers Questions about Premature Births

Siobhan (pronounced “Shiv-ANN”) Dolan, MD, MPH, is Associate Medical Director of the March of Dimes, where she is involved with the team spearheading the organization’s National Prematurity Campaign. Dr. Dolan is trained as an obstetrician-gynecologist and geneticist. She is an Assistant Professor of Obstetrics and Gynecology and Women’s Health at the Albert Einstein College of Medicine in New York City. She maintains her clinical practice at Albert Einstein in the Division of Reproductive Genetics, and is an instructor of public health in the Human Genetics Program at Sarah Lawrence College in Bronxville, NY. She has co-authored publications on the importance of prenatal diagnosis and quality improvement in reproductive medicine and has presented numerous abstracts at scientific and professional meetings. Recently, we had a chance to speak with Dr. Dolan about the causes and risks of premature births and the March of Dimes’ “Prematurity Day” in November.

Q. What is prematurity and what are the primary causes of premature birth?

A. Most pregnancies last around 40 weeks. Babies born between 37 and 42 weeks of pregnancy are considered full term. However, babies born before 37 completed weeks of pregnancy are called premature or preterm. About 12 % of babies born in the US are born preterm.

We know a tremendous amount about individual risk factors that contribute to premature birth in many women but we don’t have a simple, single answer, which is why there is such a need for research. What we do know is that there are some risk factors associated with preterm birth. For instance, a woman is more likely to have a preterm birth if a previous birth was preterm, if she is pregnant with twins or triplets or if she has uterine or cervical abnormalities. Other risks include smoking, illicit drug use, drinking alcohol, bacterial vaginosis and sexually transmitted infections, nutritional issues, obesity and being underweight. Also, women at the extremes of maternal age (less than 17 years or greater than 35 years old) are at higher risk of many complications, including prematurity.

Q. What can expectant mothers, or those who are trying to get pregnant, do to reduce the risks of a premature birth?

A. If a woman is trying to get pregnant or is a new expectant mother, she should focus on healthy behaviors and reducing risk factors to increase her chances of having a healthy, full-term baby. Some of the things she can do are: consult with her health care provider before she becomes pregnant and review the medications that she’s on to be sure they’re safe during pregnancy; review her risk factors and behaviors that might lead to preterm birth—overweight or underweight, nutrition and exercise, smoking, drinking alcohol or using illicit drugs or other unhealthy behaviors that can lead to negative pregnancy outcomes; review and assess her medical conditions, including hypertension or diabetes, which can affect a pregnancy; start taking prenatal vitamins with folic acid before she becomes pregnant to reduce the risk of birth defects to the brain and spine known as neural tube defects; have any infections (e.g., urinary tract or sexually transmitted infection) treated and have general screening with a pap smear; and establish prenatal care with her health care provider as soon as she becomes pregnant and follow through with regular visits.

Q. What are the dangers/risks inherent with premature births?

A. The earlier a baby is born, the greater the complications. For example, the lungs develop late in pregnancy, so babies that come early often have pulmonary problems or trouble breathing on their own when they’re first born, which can require treatment. Some babies born prematurely develop a potentially dangerous intestinal problem called necrotizing enterocolitis (NEC). This is when a portion of their bowel doesn’t keep its blood supply and therefore dies, requiring surgical removal of that portion of the bowel. Bleeding in the brain, called intraventricular hemorrhage (IVH) is another risk, and the more premature the baby, the higher the risk for IVH. Premature babies may also have vision and hearing problems, and a broad range of developmental and neuro-developmental issues can occur. However, there is no way to predict that they will occur, thus, some babies born at 28 weeks do very well while others suffer more serious consequences.

Q. Can women be screened parentally for possible premature birth risks?

A. We don’t have a particular swab or a blood test that says with certainty that a woman will or won’t deliver preterm, but we have a whole spectrum of risk-factor reducing strategies that women can take. So, we try to educate women and health care providers about these risks to help them decrease the potential of a preterm birth. Women should also be aware of signs and symptoms of preterm labor, including painful, regular uterine contractions well before their due date; a gush of fluid, like the rupture of membranes, and bright red bleeding. If a pregnant woman experiences any of these signs she should see her health care provider immediately or go to the hospital to be assessed.

Q. What is the March of Dimes’ campaign to prevent premature birth and what is the status of the current research projects?

A. In 2003, we launched a five year, $75 million prematurity campaign to decrease the rate of preterm birth by at least 15%. Our five goals are to:

  1. Raise public awareness of the problems of prematurity.
  2. Educate pregnant women and their families to recognize the signs of preterm labor and support parents of babies in neonatal intensive care units.
  3. Assist health care practitioners to improve prematurity risk detection and address risk-associated factors.
  4. Invest more public and private research dollars to identify causes of preterm labor and prematurity and to identify and test promising interventions.
  5. Expand access to health insurance in order to improve prenatal care and infant health outcomes.

The March of Dimes also has a major research portfolio where we provide $38 million annually for basic science research. Some of that funding goes to prematurity research, including initiatives such as looking at models of infection or other factors that influence prematurity from a basic science and medical model. We’ve just completed a five-year program called Perinatal Epidemiologic Research Initiative (PERI ), and we’re now receiving applications for a new research initiative focused specifically on prematurity.

Q. What can HMHB members and partners do to advance the March of Dimes’ work to save babies from being born too soon?

A. We invite groups to partner with the March of Dimes to help us reach out to women and health care providers and educate them about the broad range of issues that are part of achieving a healthy pregnancy. Each new partner helps us expand our reach.

Prematurity is a significant problem that costs our nation billions of dollars each year. The number of preterm births are rising—currently about 1,300 babies are born premature each day! We need more research and research dollars for solutions that will reduce preterm births. We also encourage organizations to join our efforts during Prematurity Day on November 16th. So please, go to our Web site and learn how you can help.