January 17, 2007
Contact: Larry Parker
Phone: (973) 972-3000
RWJMS Faculty Study: Premature Birth Not Always A Bad Outcome
But Ananth/Vintzileos Research Cites Issues about Care
Disparities, Placental Disease
NEW BRUNSWICK — According to a professor at UMDNJ-Robert Wood Johnson Medical School, not all premature births are bad. In fact, Cande Ananth, Ph.D., M.P.H., director of the Division of Epidemiology and Biostatistics at RWJMS, says statistics demonstrate conclusively that many such births save babies from being stillborn.
His review of studies he performed over the last two years with Anthony Vintzileos, M.D., chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at RWJMS, published in the December 2006 issue of the Journal of Maternal-Fetal and Neonatal Medicine, contains numerous other interesting, and occasionally disconcerting, findings about the incidence of premature birth.
Dr. Ananth, a member of the RWJMS faculty for almost 12 years, examined the highly detailed database of all single births in the United States between 1989 and 2000 - more than 46 million babies in all. (Multiple births were excluded because of the overwhelmingly increased likelihood of medical complications in such cases.)
Dr. Ananth noted that any premature, or preterm, birth occurs in one of three ways - a pregnant woman’s membranes, euphemistically called her “water” or “afterbirth,” break early; a woman goes into labor prematurely; or, a doctor finds indications that the pregnancy is in serious trouble and orders induced labor or a Caesarean section.
He was intrigued to find that the data showed the rate of perinatal death (stillbirth or deaths within the first month after birth) declined more than 25% during the 1989 to 2000 period - even though the rate of premature births increased during the same period.
However, Dr. Ananth realized, the types of premature births had changed - preterm births from “water breaking” or early labor declined, while premature births due to medical intervention increased rapidly. This increasing willingness of doctors to induce labor or perform a Caesarean section when serious issues are discovered with the mother’s or fetus’ health, Dr. Ananth concluded, is saving babies’ lives.
“Why keep bashing preterm births if physicians are doing something good?” Dr. Ananth asks. “In terms of preventing death, it’s a success.”
Nevertheless, Dr. Ananth agrees with the overall goal of preventing premature births, which still have potential consequences for a child’s lifelong health.
When Dr. Ananth delved deeper into his huge database, he found several trends - including a disparity of care between African-American and white mothers; and, through joint research with Dr. Vintzileos, a common link in the causes of preterm birth.
At first, Dr. Ananth thought he had found a possibly encouraging trend. Though African-American women remain twice as likely as white women to have a preterm birth, African-American women’s rate of premature births has gone down slightly in recent years, shrinking the disparity in the rate of premature births compared to white women.
But Dr. Ananth then found that white women’s rate of premature births has actually gone up in recent years. Furthermore, he found that virtually the entire source of the rise in white premature births was “ good” preterm births when doctors intervened early to save mother and child. African-American women benefited 40% less from this trend compared to white women. “It has to be an access to care issue,” concluded Dr. Ananth.
Being frustrated by the slow but sure upward trend in the incidence in premature births over time, Dr. Ananth sought the vast clinical expertise of Dr. Vintzileos for an explanation. Dr. Vintzileos, with most other OB/GYNs today, considers the placenta - the tissue inside the uterus that provides a bridge between the mother and unborn baby, surrounding and nourishing the growing fetus - to be not a mere “afterbirth,” but instead the key to both a mother’s and baby’s health in any pregnancy.
“Most of our physical and intellectual health in life depends on genetics - which we can’t help - and environment. And no environment,” says Dr. Vintzileos, “is more important than the uterus.” In addition, since how healthy adults are can depend on their intrauterine environment when they themselves were fetuses, Dr. Vintzileos’ favorite saying is a simple but sometimes forgotten truth: “Children come from mothers.”
Dr. Ananth’s and Dr. Vintzileos’ more recent studies show that 54% of premature births where a doctor intervenes because of just four causes: preeclampsia, or very high blood pressure in the mother; small-for-gestational-age syndrome (SGA), when a fetus’ growth is severely stunted for that stage in the pregnancy; fetal distress, when a fetus’ heartbeat or movement suddenly weakens; and placental abruption, the separation of the placenta from the uterus.
All four of these causes, Dr. Ananth and Dr. Vintzileos realized, are directly related to a blockage of blood circulation between mother and fetus through the placenta. They have invented the term “ischemic placental disease” to cover the commonality of these four causes of premature birth that force medical intervention. Dr. Ananth said he and Dr. Vintzileos now believe that the causes of so-called “doctor indicated” premature births do not vary nearly as widely as previously thought.
Dr. Ananth, Dr. Vintzileos and their research team also found that if a woman gives birth to her first child prematurely, whether on her own or with medical intervention, she is likely to give birth to her second child prematurely as well. In fact, she is most likely to give birth within a week to 10 days (either way) in her second pregnancy compared to when her first child was born. The question of why this is will be a subject of future research by Dr. Ananth and Dr. Vintzileos.
For more information on Dr. Ananth’s and Dr. Vintzileos’ research, please contact Larry Parker of UMDNJ’s University News Service at (973) 972-7265 or at firstname.lastname@example.org.
UMDNJ is the nation's largest free-standing public health sciences university with more than 5,500 students attending the state's three medical schools, its only dental school, a graduate school of biomedical sciences, a school of health related professions, a school of nursing and its only school of public health, on five campuses. Last year, there were more than two million patient visits to UMDNJ facilities and faculty at campuses in Newark, New Brunswick/Piscataway, Scotch Plains, Camden and Stratford. UMDNJ operates The University Hospital (UH), a Level I Trauma Center in Newark, and University Behavioral HealthCare, a mental health and addiction services network.