Increasing Awareness of Late Preterm Birth

It is often said that good things come to those who wait. Research shows that this is especially true for infants—every week in the womb makes a big difference in a child's development and health. And members of the NICHD’s National Child and Maternal Health Education Program (NCMHEP) want all health care providers to know and understand this fact.

The NCMHEP recently launched a new CME/CE course, available through the Medscape Web site, entitled Raising Awareness: Late Preterm Birth and Non-Medically Indicated Inductions Prior to 39 Weeks (login required), to alert health care providers to the impact and effects of late preterm birth and of inducing delivery for non-medical reasons prior to 39 weeks in the womb.

This CME/CE is intended for obstetricians, neonatologists, pediatricians, nurses, nurse midwives, nurse practitioners, clinical nurse specialists, and any other provider who cares for pregnant women. The program features a "free flowing" roundtable discussion led by Catherine Spong, M.D., Chief of the NICHD Pregnancy and Perinatology Branch. Those who complete the course successfully receive 0.5 credits or contact hours from Medscape, from the American Medical Association, from the American Academy of Nurse Practitioners, or from the American Nurses Credentialing Center. The program will be on Medscape, a leading online venue for in-depth clinical information and training in more than 30 specialty areas, for one year, and the CME/CE credit is good for one year. Most of the time, childbirth happens on the its own schedule. But in certain cases, as the estimated due date approaches or passes, health care providers and mothers make decisions about inducing or causing labor to deliver the baby.

Research shows that more time in the womb—specifically 39 weeks or more—gives the best outcomes for mother and baby. Birth at or after 39 weeks allows infants to reach a stage of development that best equips them for life outside of the womb. Fewer weeks in the womb increases the chance of health problems and the severity of those problems.

For example, late preterm infants, born at 34 weeks to 36 weeks, have increased rates of illness and death compared to infants born later. Even infants born at 37 weeks’ to 38 weeks’ gestation are at greater risk for various health problems and challenges than infants born later. Fewer weeks in the womb mean a greater risk of health problems, including (but not limited to):

• Increased risk for sudden infant death syndrome and cerebral palsy;
• Respiratory Distress Syndrome and other breathing problems; and
• Problems with brain development and function, such as psychological, developmental, behavioral, and/or emotional problems, many of which may require special education as the child grows or later in life.

Waiting until 39 weeks is not always possible—complications for the mother or for the baby could mean that the benefits of an early delivery outweigh the risks associated with preterm birth. Some complications that could lead to immediate delivery of the baby can include gestational diabetes, preeclampsia, and a drop in fetal heart rate. In addition, many infants born before 39 weeks survive and thrive, living healthy lives.

The NCMHEP and its members aim to raise awareness among health care providers that, unless there are complications, birth at or after 39 weeks in the womb improves outcomes for both mothers and babies. The 39 week concept and the risks associated with birth before 39 weeks are the focus of the CME/CE.

In addition to Dr. Spong, the CME/CE features three faculty experts: Jane Lamp, C.N.S., member of the Association of Women’s Health, Obstetric, and Neonatal Nurses Late Preterm Infant Science Team; Karna Murthy, M.D., a neonatologist; and Anne Moore, N.P., a fellow with the American Academy of Nurse Practitioners.

The overall goal of the CME/CE is to improve outcomes for mothers and babies; the specific objectives of the CME/CE include:

• Identifying the factors that contribute to the rising rate of late preterm births and non-medically indicated inductions prior to 39 weeks
• Identifying the potential short- and long-term consequences of births occurring between 34 and 38 weeks gestation
• Integrating best practice evidence-based guidelines for delivery prior to 39 weeks

The CME/CE is the first major project for the NICHD’s NCMHEP, which provides a forum for reviewing, translating, and spreading new research in maternal and child health. The Program aims to raise awareness among health care providers, patients, and other audiences, such as policymakers, about the most important challenges in maternal and child health.

A coalition of the nation's most prominent health care provider associations, federal agencies, nonprofit maternal and child health organizations, and other partners not only work together on NCMHEP projects, but they also contributed to the design of and plan for the Program. The Program’s Web site provides a complete list of member organizations, an outline of how the Program operates, and other information.

Members have been working on the Program's first focus area—late preterm birth and elective term deliveries—since mid-2009. The CME/CE is the first of several outreach activities, in this case geared toward health care providers, about the 39 weeks target. Educating health care providers about the rising rates of late preterm birth and the associated health risks helps to set the stage for later outreach to mothers and families and to other audiences.

The NCMHEP Coordinating Committee met on January 28, 2011, to design and plan activities for remaining outreach on this focus area and to discuss possible future focus area topics. Updates on future activities will be posted on the NCMHEP Web site.

For additional information, select one of the links below:

• Raising Awareness: Late Preterm Birth and Non-Medically Indicated Inductions Prior to 39 Weeks (login required)
• Medscape Ob/Gyn and Women’s Health Education (no login required)
• NICHD National Child and Maternal Health Education Program Web Site
• NICHD A to Z Health and Human Development Topic: Preterm Labor and Birth
• NICHD Publication:
  • Prematurity Research at the NIH

Originally posted: February 18, 2011

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