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Congress must face the preemie crisis

The number of preterm births in the U.S. has hit alarming numbers. It’s time for Congress to act

The Capitol at dusk on Oct. 12. (Bill Clark/CQ Roll Call)
The Capitol at dusk on Oct. 12. (Bill Clark/CQ Roll Call)

The U.S. preterm birth rate has hit a 15-year high, a startling increase of over 10 percent. This outsized leap is not an anomaly — rather, it is the culmination of a decade-long trend, one that has been particularly dangerous here in the U.S.

Today, more than one in every 10 babies are born too early, the second leading cause of infant death (35.8 percent) after birth defects. Additionally, babies born before 37 weeks frequently endure long-term impacts including intellectual and developmental delays, behavioral problems, neurological disorders, visual and hearing impairments, cerebral palsy and respiratory or intestinal complications.

It is important to underscore the deep racial divide when it comes to preterm births. Black and Native American women are 62 percent more likely to give birth prematurely, and their babies are twice as likely to die, when compared to those born to white women.

November marks Prematurity Awareness Month, an opportunity to honor the many moms and babies who experience the adversities of preterm birth. To cite just one example, Baltimore mom Hannah Baldwin gave birth to twin micro preemies at 23 weeks and five days, with a 25 percent chance of survival. Following their precarious births, both twins underwent multiple surgeries to fix conditions impacting their hearts, lungs, and eyes. The babies stayed in the hospital NICU for 136 days and 137 days, respectively, while their parents sang to them, read to them, prayed over them. The two miracle girls came home without any medical equipment, taking full bottle feeds, something these parents were told would not happen.

It goes without saying that not every preemie story enjoys such a happy ending, and with the numbers we are seeing, the prospect of struggling through such a trauma would alarm anyone. So just what factors have ignited this preterm birth crisis?

Pregnancy can be impacted by a myriad of causes including individual behaviors and chronic health conditions, psychosocial factors, community and neighborhood characteristics, job stresses, environment exposures, assisted reproductive treatments, support networks, genetics and other biological factors. Unfortunately, our research and current methods for diagnosis and treatment have been unable to identify the causes of preterm birth — we simply do not know enough about why it occurs or to prevent it. No less than two-thirds of preterm births occur without any evident risk factor — and when you consider the many non-medical causes that have only recently become a focus for research, finding the root source becomes even more complicated.

All this is reflected in the fact that there is currently no approved treatment to prevent preterm birth. At most, existing treatments focus on inhibiting contractions, which only delays delivery long enough to care for a mother already in the hospital. Beyond this, all medical practitioners can do is advise mothers on the lifestyle choices that minimize those risk factors that may impact their pregnancy and potentially cause a preterm birth.

With all of the above in mind, it is easy to see why it’s so urgent to fund vital research and prevention programs — babies’ lives are at stake. The prevalence of preterm births is motivating many, including our own organizations, to get proactive about seeking solutions. First and foremost, we need to ensure that the PREEMIE Act remains in place.

First passed in 2006, the original PREEMIE Act expanded research and developed a public-private agenda aimed at reducing preterm birth and its consequences. Since then, the PREEMIE Act has supported federal research, promoting known interventions and community initiatives such as identifying gaps in public health programs that address preterm birth.

However, the PREEMIE Act is in danger — programs and research funding would lose authorization if Congress does not take action. In fact, unless the PREEMIE Act is reauthorized by Congress in 2023, all major efforts to improve our understanding of and prevent preterm births will be in jeopardy.

More than 100 organizations have joined us to ask Congress to pass the PREEMIE Reauthorization Act this year. Additionally, on Sept. 28, March of Dimes, Nemours Children’s Health and Ann & Robert H. Lurie Children’s Hospital co-hosted an annual advocacy day in support of critical maternal and infant health legislation – featuring the PREEMIE reauthorization bill. Aside from reauthorizing Centers for Disease Control and Prevention’s research and programs on preterm birth, the legislation would establish an entity in the Department of Health and Human Services to coordinate all federal activities and programs related to preterm birth and authorize a study on the costs, impact of non-medical factors and gaps in public health programs that lead to prematurity. The bill also calls for HHS to make recommendations to prevent preterm birth.

Congress, we call on you to act without any further delay. We urge you to continue in the footsteps of your predecessors and the organizations supporting the PREEMIE Act by protecting our moms and babies.

Elizabeth Cherot, MD, MBA, FACOG is president and CEO of March of Dimes, the national nonprofit fighting for the health of all moms and babies, and a practicing OB-GYN for more than twenty-five years.

R. Lawrence Moss, MD, FACS, FAAP is president and CEO of Nemours Children’s Health, one of the largest integrated pediatric health systems in the country, and an accomplished pediatric surgeon and researcher.