A good head start

The Star Malaysia - Star2 - - YOUR HEALTH -

AC­CORD­ING to World Health Or­ga­ni­za­tion sta­tis­tics, there were 12.3 preterm births per 100 live births in Malaysia in 2011. This num­ber is still about the same today.

Preterm is when a baby is born alive be­fore the 37 weeks of preg­nancy is com­pleted.

“Very lit­tle is known about the un­der­ly­ing causes of preterm births,” says Dr Loo Hui Min, res­i­dent pae­di­atric and neona­tol­ogy con­sul­tant at Mahkota Med­i­cal Cen­tre.

Mea­sures can be taken both pre­con­cep­tion and peri­con­cep­tion ( af­ter con­ceiv­ing) to re­duce the risks of preterm labour.

One way to re­duce the risk of preterm birth pre­con­cep­tion is plan­ning your preg­nan­cies to en­sure they are ad­e­quately spaced out; ide­ally, preg­nan­cies should be 18 to 24 months apart.

Other risk- re­duc­ing mea­sures in­clude en­sur­ing the mother’s preg­nancy weight is op­ti­mised – avoid a body mass index lower than 18.5kg/ m or more than 25kg/ m and main­tain a healthy and nu­tri­tious diet sup­ple­mented with folic acid and ap­pro­pri­ate vi­ta­mins.

All this can im­prove the over­all health of the mother and baby.

Pre­con­cep­tion med­i­cal check- ups for med­i­cal con­di­tions such as di­a­betes or hy­per­ten­sion and sex­u­ally trans­mit­ted dis­eases should also be car­ried out so that treat­ment and man­age­ment can com­mence im­me­di­ately.

Peri­con­cep­tion care in­cludes check- ups to screen for con­di­tions such as ges­ta­tional di­a­betes and hy­per­ten­sion, and main­tain­ing a healthy diet with folic acid and iron sup­ple­men­ta­tion.

“Women with a pre­vi­ous his­tory of preterm birth should get them­selves screened to en­sure their cervix is not struc­turally weak,” ad­vises Dr Loo, ex­plain­ing that the weight of the baby may cause a struc­turally weak cervix to open be­fore the baby is ready to be born.

In this case, your doc­tor may sug­gest a place­ment of cir­cum­fer­en­tial stitches to strengthen the cervix.

Mul­ti­ple ges­ta­tion preg­nan­cies ( more than one baby at a time) should also be closely mon­i­tored, as these types of births are of­ten preterm due to there ba­si­cally not be­ing enough space in the uterus for all the ba­bies to grow to full term.

Women who have early signs of labour should im­me­di­ately seek med­i­cal at­ten­tion. “It is pos­si­ble for the ob­ste­tri­cian to pro­long the preg­nancy and slow down labour with med­i­ca­tions,” ex­plains Dr Loo.

Ba­bies born pre­ma­ture are at risk from myr­iad com­pli­ca­tions that mainly arise due to in­com­plete devel­op­ment.

For ex­am­ple, im­ma­ture lungs may lead to dif­fi­cul­ties in breath­ing, an im­ma­ture liver may lead to the baby be­ing jaun­diced or an im­ma­ture im­mune sys­tem may leave the baby highly sus­cep­ti­ble to in­fec­tion.

Moth­ers are of­ten given an­te­na­tal cor­ti­cos­teroids at least 24 hours be­fore giv­ing birth to re­duce mor­bid­ity and mor­tal­ity in the preterm baby.

These med­i­ca­tions are known to re­duce the risk of res­pi­ra­tory dis­tress syn­drome ( a con­di­tion caused by lung im­ma­tu­rity that re­sults in the lungs col­laps­ing) and in­tra­ven­tric­u­lar haem­or­rhage ( bleed­ing into the brain) in preterm ba­bies, among oth­ers.

Dr Loo ex­plains that one of the most com­mon prob­lems pre­ma­ture in­fants face is suck­ing, swal­low­ing and breath­ing in­co­or­di­na­tion.

Preterm ba­bies of­ten need help to feed and are more likely to as­pi­rate ( get food in their lungs).

These in­fants should also be mon­i­tored for necro­tis­ing en­te­ro­col­i­tis, a rare con­di­tion that af­fects the in­testi­nal wall of very pre­ma­ture ba­bies.

“Pre­ma­ture ba­bies also have very lit­tle body fat and need good ther­mal care and so are of­ten placed in in­cu­ba­tors,” says Dr Loo.

“The sever­ity of the risks these ba­bies face de­pends on how pre­ma­ture they are. All these ba­bies re­quire spe­cialised care by trained pro­fes­sion­als.

“There­fore, it is im­por­tant to en­sure you de­liver your preterm baby in a cen­tre that is able to han­dle the mother and baby care ef­fec­tively,” says Dr Loo.

She ad­vises prospec­tive par­ents not to be dis­cour­aged by the risks of pre­ma­ture births.

“Good ma­ter­nal health­care from pre­con­cep­tion to birth sig­nif­i­cantly de­creases the risks of preterm labour and birth. Par­ents should ed­u­cate them­selves about these good prac­tices and be aware of all pos­si­bil­i­ties,” she says.

“Fur­ther, mod­ern ad­vances in neona­tal care means that the out­come for preterm ba­bies is gen­er­ally favourable.”

For more in­for­ma­tion, call 06- 285 2999.

Dr Loo Hui Min.

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