Preterm births are on the increase across the United States compared to other developed nations. The Centers for Disease Control and Prevention (2019) acknowledge the rise, adding that one in ten infants undergo preterm birth, with 17% infant deaths recorded in 2017. Preterm, or premature births, have significant effects on the infant and the mother. In essence, pregnancies take 37 weeks, and babies born less than this period develop several complications, including breathing and feeding difficulties, vision, and hearing challenges, among others (CDC, 2019). Understanding the intricacies of preterm births is essential to reducing its numbers, risks, and other implications. Indeed, infants undergo developmental changes throughout the 37 weeks of pregnancy. If born earlier than the stipulated time, certain developmental growths may not be complete, leading to complications after birth. This paper analyzes Healthy People 2020's preterm births and the state's efforts to reduce its rate through several interventions and health promotion.
According to WHO (2018), an estimated 15 million infants are born prematurely every year, with approximately one million dying from preterm birth-related complications. As earlier noted, those who survive to develop lifetime disabilities that impair their cognitive and behavioral functionalities. Globally, deaths resulting from preterm births are on the rise, raising questions on the effectiveness of preterm interventions currently in place. WHO (2018) notes that low socio-economic settings record high deaths from preterm births, citing inequalities in providing quality and cost-effective care necessary for the infants` survival. Additionally, preterm births are also associated with the early teen or older women pregnancies, with Africa and Asia recording higher prevalence rates of preterm births globally (WHO, 2018). Families, more so those from low-income regions, experience the highest rates of preterm births and associated deaths due to inadequate health systems and infrastructure.
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Several causes are linked to preterm births. Understanding these causes and other risk factors associated with preterm births is critical to developing cost-effective solutions. While preterm births can be spontaneous, much is attributed to early induced labor. Moreover, multiple pregnancies and chronic illnesses, such as diabetes and hypertension, are other common causes of preterm births. The survival of preterm babies is dependent on the availability of critical care services to the affected families. Preterm babies born in low-income families have a low survival rate compared to those from high-income settings. Healthy People 2020 has made it one of its mission to reduce preterm births, monitor and form new guidelines for managing and preventing preterm births.
The Healthy People 2020 national goal to reduce total preterm births was slated to 9.4% from 10.4% back in 2007 (HealthyPeople.gov, n.d.). The decrease is targeted at a 10% improvement rate that would involve interdisciplinary collaborations from the national and state governments. With the country's healthcare system moving towards a prevention mechanism rather than a treatment-focused system, health promotion remains a major hurdle to achieving the national goal. Further, Kenner et al. (2018) note that the current quality of healthcare service in the country has played a significant role in increased preterm births. Maternal care practices are doing little to improve the infant mortality rate at a critical pace to vulnerable women. The same challenges also translate to the mothers who have to battle with delicate care provisions for their children. In collaboration with the national government, the state's goal is shifting its focus towards providing sufficient resources for both the mothers and preterm babies.
The U.S has a resourced healthcare system that, despite implementing several policies and guidelines to reduce preterm births, is not effective. According to Kenner et al. (2018), previous preterm birth prevention programs implemented in the 20th century relied on identifying preterm labor early on to reduce cases of premature births. Pregnant women who were determined to be at risk of preterm labor were treated appropriately and educated on preventing the occurrence of preterm births. While these prevention programs' goals were precise and valid, identifying and treating women under such pregnancy conditions was ineffective. The interventions did not depend on health population metrics, nor did they target the most vulnerable populations (Kenner et al., 2018). Undoubtedly, seeking prenatal care is a practical approach, but service delivery leaves a lot to be desired with the deteriorating healthcare system. Disparities in health access compound the already increasing preterm birth rates.
Kenner et al. (2018) were critical of the country's healthcare funding and its impact on reducing total preterm births. Since the implementation of early prevention initiatives on preterm births, Medicaid has been of significant help. The insurance cover has provided support for pregnant women across the U.S. There have been significant achievements through this program in improving premature birth rates through financial support. Moreover, more coordination and implementation of initiatives to assist pregnant women and children have been channeled through these Medicaid programs. As such, changes in Medicaid programs' funding will impact the effectiveness and delivery of preterm interventions to vulnerable women (Kenner et al., 2018). Attempts to cap the Medicaid funding would have further increased the rate of preterm births. Nevertheless, slow progress is being made to manage preterm births and reduce premature births' infant mortality rate.
Through advanced nursing research and the use of emerging technologies in the clinical setting, there is sufficient evidence on the suitability of several interventions to help reduce the total preterm births. Remarkably, current nursing practices are creating new opportunities, especially in high-resource settings, to develop feasible and cost-effective strategies for preterm birth prevention. These strategies promise high success rates and are ready to be implemented in various clinical settings worldwide. With 2020 coming to a close, immediate evidence-based strategies are critical to helping the country achieve its national goal of reducing preterm births. According to Cheung et al. (2020), progesterone supplementation, cervical cerclage, and cigarette smoking prevention are three evidence-based interventions currently being implemented to help reduce preterm births. These approaches have shown significant changes to preterm births, and their effectiveness depends on their implementation, support structures, and the quality of healthcare services available.
Over the past several years, the potential use of progesterone supplementation has generated interest from researchers, and Cheung et al. (2020) have provided evidence-based results on the significance of using the supplements in reducing preterm births. A recent study by Cheung et al. (2020) on the use of universal progesterone supplementation early on has shown significant outcomes in preventing preterm births among women with small cervices. These supplements counteract the inflammatory process that occurs during labor. As such, natural progesterone is most preferred as it can be found locally (Kenner et al., 2018). However, other studies have shown that using supplements to reduce preterm births is not practical for all preterm births (Cheung et al., 2020). Ultimately, applying one intervention alone does not guarantee the reduction of preterm births. More interventions need to be exploited to achieve significant reduction levels.
In their study, Houlihan et al. (2016) ascertain the effectiveness of cervical cerclage in preventing preterm births among women with multiple pregnancies. In essence, a tape or suture is placed on the cervix to avoid dilatation or preterm birth. In comparison, Houlihan et al. (2016) show its simplicity in achieving the desired outcomes; Kenner et al. (2018) question its implications on pregnant women. The authors note that women who have opted for this method experience cervical bleeding, discharge, and an increased likelihood of Cesarean section delivery. As a result, health professionals in maternal care emphasize balancing the clinical procedure's benefits against its potential risks. A comparison between cervical cerclage and progesterone supplementation yielded no significant differences regarding their superiority (Kenner et al., 2018). Regardless, both approaches have promising outcomes in reducing preterm births.
Lastly, cigarette smoking in pregnant women leads to preterm births and issues in birthweight. According to Kenner et al. (2018), nicotine in cigarettes impacts passive and active smoking pregnant women, and prevention strategies geared to reducing preterm births are dependent on the woman's decision-making process. As such, reducing the risk of cigarette smoking in pregnant women should be made a priority. Indeed, all these interventions are critical to reducing preterm births, even at a small magnitude. Their effectiveness depends on women's willingness to adhere to the procedures. Nonetheless, health promotion on reducing preterm births and identifying vulnerable women with high preterm labor risks is a necessary recommendation. Since the healthcare system is moving towards a prevention-focused approach, health promotion and prevention strategies will significantly reduce the number of preterm babies dying or pregnant women undergoing preterm labor.
In conclusion, preterm birth remains a global issue impacting millions of pregnant women and babies, whereas vulnerable women, especially those from low-income settings, are more prone to premature births. With the U.S healthcare system undergoing significant reforms, current maternal care practice trends promise a reduction in preterm births. Prevention approaches are critical to achieving the Healthy People 2020 goal of a 9.4% reduction in preterm births. Through evidence-based practice and health promotion, much needs to be done to achieve this vision. Ultimately, the above information on preterm births will be critical in educating all patients in the risks and implications of preterm births, both for the mothers and babes. Indeed, with more emerging technologies and research on the way, high rates of preterm births will be an issue of the past.
References
CDC. (2019). Preterm birth . Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
Cheung, K. W., Seto, M. T., & Ng, E. H. (2020). Early universal use of oral progesterone for prevention of preterm births in Singleton pregnancy (SINPRO study): Protocol of a multicenter, randomized, double-blind, placebo-controlled trial. Trials , 21 (1). https://doi.org/10.1186/s13063-020-4067-z
HealthyPeople.gov. (n.d.). MICH-9.1 data details | Healthy people 2020 . Healthy People 2030 | health.gov. https://www.healthypeople.gov/node/4906/data_details
Houlihan, C., Poon, L. C., Ciarlo, M., Kim, E., Guzman, E. R., & Nicolaides, K. H. (2016). Cervical cerclage for preterm birth prevention in twin gestation with short cervix: A retrospective cohort study. Ultrasound in Obstetrics & Gynecology , 48 (6), 752-756. https://doi.org/10.1002/uog.15918
Kenner, C., Ashford, K., Badr, L. K., Black, B., Bloch, J., Mainous, R., McGrath, J., Premji, S., Sinclair, S., Terhaar, M., Verklan, M. T., Walden, M., Walker, D. S., White-Traut, R., Yeo, S., Zekas, L. B., Kostas-Polston, E. A., Greenberg, C. S., & Boykova, M. (2018). American Academy of nursing on policy: Reducing preterm births in the United States: Maternal infant health, child, adolescent and family, and women's health expert panels. Nursing Outlook , 66 (5), 499-504. https://doi.org/10.1016/j.outlook.2018.08.007
WHO. (2018). Preterm birth . WHO | World Health Organization. https://www.who.int/news-room/fact-sheets/detail/preterm-birth
