A successful pregnancy completes at least 37, but ideally 40, weeks of gestation before a full-term baby is born. Yet each year, nearly 15 million babies, or one in ten, is born prematurely. This can lead to a lifetime of serious health complications, disability, and unfortunately for almost 1 million of these babies, preterm birth complications will result in death. In fact, preterm death is the leading cause of newborn deaths globally, and has now reached the second leading cause of death in children under five, surpassed only by pneumonia.
Women of African descent face the highest risk of preterm labor. Some other risk factors include:
- being underweight before pregnancy
- failing to gain adequate weight during pregnancy
- receiving late prenatal care, or none at all
- living in a low income area
- having little to no education
With so many preterm labor risk factors in the developing world, it should come as no surprise that over 60 percent of preterm births occur in Africa and south Asia. In the poorest countries, around 12 percent of babies are born too soon, compared to around 9 percent in higher-income countries.
The following list reflects the countries with the highest rates of preterm birth per 100 live births:
- Malawi, 18.1 preterm births per 100 live births
- Comoros, 16.7 per 100
- Congo, 16.7 per 100
- Zimbabwe, 16.6 per 100
- Equatorial Guinea, 16.5 per 100
- Mozambique, 16.4 per 100
- Gabon, 16.3 per 100
- Pakistan, 15.8 per 100
- Indonesia, 15.5 per 100
- Mauritania, 15.4 per 100
Not only are preterm births more prevalent in low-income countries, but there is a dramatic difference in survival rates when compared to higher-income countries. Over 90 percent of extremely preterm babies (less than 28 weeks gestation) born in low-income countries die within their first few days of life. Yet in high-income countries, less than 10 percent of extremely preterm babies die.
There are two relatively simple tests that can cost-effectively monitor biochemical markers of preterm delivery in women who are considered high-risk, or are showing signs of preterm labor. In essence, these tests can predict when preterm labor is likely to occur.
The Fetal Fibronectin (fFN) test
Fetal fibronectin is a protein the body makes during pregnancy, which holds the membranes (the bag of waters) to the uterus. The fFN test, similar to a Pap smear examination, checks the levels of fetal fibronectin inside a mother’s body. When her water breaks, fibronectin is released into her vaginal secretions. If the results of the fFN test are negative, delivery is likely still at least two weeks away.
In studies, less than 10 percent of women with a negative result delivered before 35 weeks of pregnancy, which makes the fFN test extremely helpful in predicting preterm delivery. However, a positive test is not as reliable an indicator; seven out of ten women who received a positive result will remain pregnant past 35 weeks. So, in actuality, a negative fFN test result is a fairly solid indication that a mother will not deliver prematurely, while a positive result indicates that the risk is there, but by no means imminent.
The Salivary Estriol test
Estriol is a form of estrogen produced by the placenta. About three to five weeks prior to the onset of labor, estriol levels increase dramatically. It can then be detected in a number of the mother’s bodily fluids, including saliva. Measuring the amount of estriol in a pregnant woman’s saliva should, in theory, help predict when labor will begin. According to studies, the Salivary Estriol test is not as reliable as the fFN test, so it is not widely used outside of research purposes, and typically not covered by most insurance companies.
Both of these tests would be relatively inexpensive ways to predict preterm birth in the developing world. Once high risk mothers are identified, precautions can be taken to reduce their risk, whether through bed rest, supplements, or a cerclage (a stitch in a pregnant woman’s cervix to prevent dilation).
Education, empowerment, and improved access to family planning for women (especially adolescents) before and during pregnancies can prevent preterm births. But sometimes, even if the risk is identified, there is no guarantee that preterm labor can be prevented. In such cases, there are ways to reduce the number of deaths associated with the condition.
Some countries, such as Turkey, Ecuador and Oman, have significantly reduced deaths due to preterm birth by ensuring health workers are skilled in the care of premature babies and by improving medical equipment supplies.
Many premature babies could be saved with interventions as simple as steroid injections (given to pregnant women at risk of preterm labor to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding), antiseptic cream for the umbilical cord, and antibiotics to treat newborn infections.
All of these tests and treatment options, although relatively inexpensive, are rarely available in the developing world.