High premature birth rates linked to obesity, care access
March of Dimes aims to lower number in city
Houston has one of the highest rates of premature births in the nation, a problem experts say could reflect a lack of access to care and high levels of obesity.
According to a new report from the March of Dimes, 10.8 percent of the births in Houston in 2013 occurred before the 37th week of gestation, more than a percentage point above the national average of 9.6 percent. The March of Dimes has set a goal of bringing the preterm birth rate down to 8.8 percent by 2020.
Texas had a 10.3 percent preterm birth rate, the
10th-highest rate in the nation.
Researchers from Baylor College of Medicine and Harris Health recently drilled into the factors contributing to the region’s high rate of early births. Using state data on more than 366,000 births, they identified links to chronic conditions such as diabetes, hypertension and obesity.
“When we started looking at the data, it was pretty clear that most of the risk factors are preventable,” said Dr. Luis Rustveld, assistant professor of family and community medicine at Baylor College of Medicine, who worked on the project. “Those kinds of things we can affect by emphasizing health lifestyle recommendations into well-woman visits.”
The researchers also found a strong correlation with the number of prenatal visits. In areas of Harris County with the lowest rate of preterm births, under 5 percent, women average more than 14 prenatal visits. But in areas with the highest premature birth rates, above 9.7 percent, women averaged 10 prenatal visits.
“It’s clear that the more prenatal care, the less likely they are to have a preterm birth,” Rustveld said. “And if they don’t initiate prenatal care in the first trimester, they’re at risk.”
Risk factors
Although women can qualify for Medicaid once they become pregnant, many still face significant barriers to access.
“About 4.5 percent of all births in Harris County are to mothers less than 17 years old,” said Dr. Sean Blackwell, chair of the Department of Obstetrics at UTHealth Medical School and an obstetrician at Children’s Memorial Hermann Hospital. “That is a risk factor for preterm birth, but what goes along with that is a real challenge of access to care.”
More than half of expectant mothers who are African-American or Hispanic are not getting in for their first prenatal visit until the second or third trimester, Blackwell said.
“That’s another risk factor,” Blackwell said.
Houston also has a high rate of couples going through infertility treatments. That can lead to higher numbers of multiple births, which often aren’t carried to full term. Women seeking infertility treatments are more likely to be in their late 30s or early 40s, another risk factor for early birth.
Blackwell is involved in a joint project with Community Health Choice, a nonprofit that administers Medicaid managed care plans, and physicians from the University of Texas Medical School in Houston and the UT Medical Branch in Galveston. The initiative creates a fixed payment for pregnancy care from the first prenatal visits through 60 days after delivery, and for all the care delivered to newborns up to 30 days after they leave the hospital. Doctors can share in the savings if they can keep costs down by avoiding unnecessary cesarean sections, elective inductions and premature births.
Costs of a premature birth in Harris County average nearly $40,000, about 12 times the rate for a fullterm birth. Babies born prematurely often incur lifelong health issues that also raise costs.
“There’s definitely a significant return on investment” in early and frequent prenatal care, Blackwell said. “If pregnant women have early access to care, particularly if they have high-risk pregnancies … those things will have a big return.”
Problems down the road
Premature birth is the leading cause of infant death. Even those who survive an early birth can face lifelong health problems, including jaundice, breathing problems, vision loss, cerebral palsy and developmental delays.
Rustveld’s group also found that once a mother delivered prematurely, she was at risk for a second premature birth. A pair of bills that were introduced but failed to pass in the last state legislative session were aimed at addressing the issue of repeat preterm births by extending coverage under Medicaid to six months past delivery. That would allow doctors to address issues like postpartum depression and to treat the chronic conditions linked to premature births.
There is some sign of local progress. According to the Department of State Health Services, preterm birth rates in Harris County had been above 13 percent since 2005 but began to drop in 2012, reaching 10.9 percent in 2013.
According to the March of Dimes report, premature birth rates were highest in Southern states, particularly in Louisiana, Mississippi and Alabama, states that also have some of the highest obesity rates in the nation. Rates were lowest in New England and the Pacific Northwest.
Texas scored better on ethnic disparities in premature birth rates, a measure of differences among different ethnic group. Texas has the fourth-lowest disparity in the nation.
Portland, Ore., (7.2 percent) had the lowest rate among the 100 cities with the greatest number of births, while Shreveport, La., (18.8 percent) came in last.