Preventing Preterm Birth: Is It Possible?

Despite medical advancements, preterm birth remains a significant issue affecting hundreds of thousands of families yearly. The FDA recently pulled its approval of Makena, leaving no drugs to prevent it. So what options remain for those looking to prevent premature births? Let's explore the alternatives now.

Key takeaways:

Around one in ten babies in the United States is born premature, leading to significant health problems and half of infant deaths. Recently, the FDA acted on a recommendation to pull Makena, a synthetic form of progesterone and the only drug available to prevent preterm birth, from the market. Makena was approved by an accelerated process after promising results in an initial trial, only to fail in a second trial. The confirmation study called the PROLONG trial, showed that the drug did not decrease preterm births.

Causes of preterm birth

Some preterm births you can’t prevent, but some happen for reasons you can do something about. The causes of preterm birth are:

50%Preterm labor-contractions that change your cervix before your baby is full term.
25%Preterm rupture of membranes — water breaking.
25%Medical reasons — when it is more dangerous to you or your baby’s health to continue the pregnancy than to deliver your baby.

There are many reasons for preterm labor, and doctors do not always know why it happens. Some things that make it more likely to happen include:

  • Getting pregnant via in-vitro fertilization or medicines to increase ovulation
  • Having a problem with the placenta causing bleeding
  • Past procedures or surgeries on your uterus or cervix
  • Being pregnant with more than one baby
  • Having a preterm baby in the past
  • Not getting enough nutrition
  • Smoking during pregnancy
  • Drug use during pregnancy
  • Having a short cervix
  • Infections
  • Injuries

Preterm rupture of membranes sometimes leads to labor contractions and sometimes does not. If your water breaks without contractions, your doctor may delay labor and give you antibiotics to give your baby time to develop. There are many causes of preterm rupture of membranes, but the most common is an infection.

Can preterm birth be prevented?

While no drugs are available to prevent preterm birth, there are still medical treatments to help your cervix stay closed and medicines that can delay labor once it starts.

Treatments

If you have cervical insufficiency — a weak cervix that becomes short or starts opening early — your doctor may recommend:

  • Cervical cerclage. A stitch is placed in your cervix temporarily to stop it from opening early.
  • Pessary. A device is inserted into the vagina to support the uterus and cervix.

Medication

When contractions start, your doctor may be able to stop them with medicines called tocolytics. Usually, once labor starts, these medicines can only delay it for 2-7 days. They can buy your medical team some time to give you medicines called corticosteroids. Steroids stimulate your baby’s lungs to make a substance called surfactant, which allows the air sacs to slide against each other when moving. Giving corticosteroids is the most important thing doctors can do to help your preterm baby if you are at risk of imminent delivery.

Some common tocolytics are:

  • Beta 2 agonists. Terbutaline is a commonly used medicine of this type. A nurse gives it to you by injection into a muscle. It is not labeled for preterm labor treatment and is only used in urgent situations.
  • Calcium channel blockers. Nifedipine is a commonly given medicine. It is an oral pill you may continue to take at home to prevent contractions from returning if acute labor stops.
  • Nonsteroidal anti-inflammatory drugs (NSAID). Indomethacin is a commonly given medicine. You can take it as an oral pill, or a nurse can give it through an intravenous line.
  • Myosin light chain inhibitor. Magnesium sulfate is the medication of this type used for stopping labor. You will receive it through an intravenous line in a continuous infusion for up to 48 hours. It has many side effects.

What about bed rest?

Experts no longer recommend bed rest to prevent preterm labor. Studies have not shown that it makes a difference, and it can cause other health risks. For some people at risk of preterm labor, strenuous activity and sex should be avoided. Talk to your doctor about your situation.

Things you can do to decrease your risk

To decrease your risk of preterm birth, avoid the causes that you can prevent, such as:

  • Smoking. Quit smoking if you smoke, and avoid tobacco, vaping, and second-hand smoke.
  • Alcohol. Don’t drink alcohol, and do not use street drugs. Check prescription medicine with your OB doctor, and don’t take more than your doctor prescribes.
  • Watch your health conditions. If you have diabetes or high blood pressure, work with your doctor to get them under control.
  • Weight. Ask your doctor what amount of weight gain is right for you.
  • Infections. Watch out for signs of urinary tract or vaginal infections, and get them treated immediately.
  • Inflammation. Studies show inflammation of the cervix can lead to softening and make it more likely to dilate early. Avoid inflammatory foods like processed meats, sodas, sugar, refined grains, and fried foods.
  • Be safe. Avoid situations where you could have an injury or impact on your abdomen, like risky sports or dangerous driving.
  • Get help if you are not safe at home. If your partner is violent toward you, do not stay in an unsafe situation where you risk injury.

Natural remedies

Caring for your body and health is the best natural way to protect yourself from preterm labor. Ensure you get the correct nutrition to support your pregnancy by eating a balanced diet full of vegetables with plenty of protein. Take a prenatal vitamin with folic acid and iron. Hydration is also vitally important. The uterus is a muscle that can contract when irritated due to dehydration. Drink at least 64 ounces of non-caffeinated fluid a day. Avoiding soda and diet soda when meeting those fluid goals is best.

Treat herbal remedies with caution. Studies support the safety of some herbal remedies in pregnancy, but others are unsafe or have not been studied. Experts do not recommend any herbs to treat preterm labor. Still, some herbs may help support your nutrition and overall health. Some herbs can cause preterm labor. Consult your doctor if you are thinking of trying herbal supplements.

What if I have had a preterm birth before?

If you have had a baby preterm, the chances of having another with a following pregnancy are about 31%. This percentage is influenced by how preterm your first birth was. You are more likely to have a second preterm birth if your first was earlier. The odds go up for every week preterm your first delivery was.

Your doctor will recommend seeing a high-risk doctor, a Maternal-Fetal Medicine specialist, if you have had a previous preterm birth. They will help monitor you for signs of having preterm labor again by:

  • Measuring your cervix and doing a cerclage if needed
  • Monitoring with ultrasound
  • Monitoring your baby’s growth
  • Monitoring your health conditions
  • Measuring lab tests

Preterm birth is a complex condition with many causes. Some can be prevented, and others can't be changed. Work closely with your medical team to make your risk as low as possible.



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