Premature delivery: Causes, risk factors, signs to watch out for, complications

Global icon Priyanka Chopra Jonas and pop singer-husband Nick Jonas recently shared a family picture on Mother’s Day where they revealed that their baby girl, Malti Marie Chopra Jonas, was born 12 weeks prematurely and spent more than three months in the hospital getting intensive care. Health experts point out that there is an increase in the risks of preterm deliveries or premature birth, which is birth of a baby more than three weeks before the estimated due date. 

A premature baby is said to be born before the 37th week of pregnancy. Premature babies, especially those that are born very early, can have complicated medical problems which vary according to the duration or according to how premature the babies are born but in general, the earlier the baby is born, the higher the risk of complications. 

Depending on how early a baby’s born, we can classify preterm as:

i) Late preterm: Babies who are born between 34-36 completed weeks of pregnancy.

ii) Moderate preterm: Born before 28-32 weeks

iii) Extreme preterm: Before 28 weeks

Causes and risk factors:

In an interview with HT Lifestyle, Dr Shashidhar Vishwanath, Lead Consultant in Neonatology and Paediatrics at SPARSH Hospital for Women and Children listed the causes and risk factors of premature birth or preterm deliveries as:

1. Previous premature births can lead to subsequent premature birth

2. Pregnancy with twins, triplets and multiple babies

3. Conceiving through In vitro fertilization (IVF)

4. An issue with the mother’s uterus structure, cervix and placenta can lead to preterm deliveries

5. Infections in the amniotic fluid or an infection in the lower genital tract

6. If the mother has high blood pressure, uncontrolled diabetes or any other chronic health problems

7. If the baby itself is quite small, underweight and has blood flow problems, or even if the baby is quite big, the obstetrician might take a call to deliver the baby early

8. If the mother is overweight before pregnancy, there is a higher chance of premature delivery

9. Mental distress like death of a loved one or domestic violence can lead to early contractions

10. If the mother has had many miscarriage or abortions, or physical injury or trauma can cause preterm deliveries.

Adding to the list, Dr Vidya Bhat, Medical Director at RadhaKrishna Multispeciality Hospital, said, “There is an increase in the risks of preterm deliveries now mainly because of high risk pregnancy like diabetes, hypertension and infection, and factors related to lifestyle and stress.”

She shared, “Pregnant women are exposed to a lot of work and that leads to mental and physical stress and it can be considered as one of the causes for increase in incidence of preterm labour. Second reason being IVF and ART( Assisted reproductive techniques) techniques. IVF pregnancies can increase the incidence of preterm labour and if it is associated with complications with PIH (Pregnancy induced Hyper-tension) and diabetes, the chances of preterm labour is high.”

Signs to watch out for:

Dr Vidya Bhat revealed, “Uterine anomaly i.e cervical incompetence, which is if there is cervical incompetence, there is increase in the incidence of pre-term labour. Classical signs and symptoms are back and lower abdomen pain, thigh pain and water discharge. Contractions also can start and are sometimes associated with bleeding or excessive mucal discharge. So, these are the signs which you should look out for preterm labour.”

She added, “Also, routinely on a trans viginal ultra sound, if we are suspecting pre-term labour, a cervical length scan has to be done and if the cervical length goes less than 2.5cms, then there is increase in risks of pre-term labour or abortion in patients who are about 20-25 weeks of gestation. Infection is an important factor and chronic infections like UTI and chorioamnionitis (infection of the placenta and amniotic fluid) can lead to preterm labour. During Covid times, I have seen a lot of patients with pre-term labour and an increase in NICU admission. We have seen patients having premature contractions and water discharge.”

Complications:

According to Dr Shashidhar Vishwanath, not all premature babies undergo complications but being born early can cause short term and long term problems, particularly if they are born too early and the earlier the baby is born the higher the risk of complications but importantly, birth weight plays a vital role. She said that smaller the baby, the higher are the risks of complications and in the case of extreme premature babies, she listed some of the complications they are likely to face:

1. Respiratory distress syndrome – A condition where the newborn will struggle to breathe easily. Premature babies develop breathing problems and may have trouble breathing due to an immature respiratory system. Lungs have a special substance called ‘Surfactant’ which allows the lungs to expand easily. This is said to be almost absent in extremely premature babies. Without this, lungs cannot expand and contract normally because of the lack of surfactant.

2. Bronchopulmonary Dysplasia – A long term problem of the lung that develops when preterm babies are in a ventilator. Due to a weak respiratory system, preterm babies require oxygen support through a ventilator or breathing machines. Babies who end up being in a ventilator and needing oxygen, end up having lung issues. Some preterm babies can also have apnea/prolonged pauses in breathing. Apart from breathing issues, preterm babies can face heart related problems. 

3. Patent Ductus Arteriosus – PDA is a heart condition that preterm babies might have. PDA is an opening which is needed between the aorta (blood vessel carrying oxygen rich blood) and the pulmonary artery (carries blood to the lungs). This opening is needed only in fetal life but it should close once the baby is born. In preterm babies, the opening does not close and it can cause overloading of the lungs and difficulty breathing. Most of the PDAs close on their own but some of them might require medication and very rarely a surgery too.

4. Low blood pressure is another issue preterm babies might have

5. Brain related issues – Preterm babies may face problems related to the brain. The baby’s brain is still developing inside the mother’s womb. Premature babies are at a greater risk of having bleeding inside the brain because the covering of the brain structure from the internal side called the ‘germinal matrix’ is very fragile. If there are any changes in the blood pressure and circulation, it can lead to a condition called Intra ventricular haemorrhage. Most of these conditions are mild and can be resolved without too much impact.

5. Other issues – Premature babies do not have a fully mature temperature control system. They can lose heat through their body surfaces. If the temperature drops too low, other functions can be affected. That’s why it’s important for small babies to be kept under radiant heat or an incubator.

6. They can develop feeding problems-the ability to suck breast milk, and also indigestion – Extreme premature babies will have immature gut health and an immature gastrointestinal system. When they are given a feed that is not breast milk, they are unable to tolerate it and the lining of the intestine can rupture. This condition is called NEC (Necrotizing enterocolitis). This is a serious condition in which the cells lining the bowel wall can become injured and it can cause long term problems. Therefore, it’s important that we give only breast milk to the baby as much as possible because it reduces the risk of developing NEC.

7. Anaemia – It is a common condition where there are not enough blood cells in the system. So preterm babies end up needing transfusions.

8. Newborn jaundice is a yellow discoloration of baby skin and eyes, and it needs to be treated to prevent excessive tiredness.

9. In preterm babies, the immune system is underdeveloped. Therefore, there is a higher risk of infection. We need to treat any sort of infection, including minor infections, aggressively so that it doesn’t spread to the bloodstream.

10. Long term complications – The long term complications are when we have to follow up later on. There is certainly some degree of developmental problems in extreme premature babies. One of them is Cerebral palsy, a movement disorder in which the muscle tone and posture can be affected.

11. Impaired learning and vision problems are common in premature babies. They develop some blood vessels in the retina that cause hindrance in their vision. They may tend to develop hearing problems, dental problems, behavioural and psychological problems.

12. They may develop chronic health issues like Asthma too.

Thankfully, all these issues are less nowadays because of improved neonatal care and also the understanding of long term issues and how to prevent them by early intervention.