Experts gather in Seattle to tackle the rise in premature births

The health problems of rich and poor countries are often very different, but premature birth is a plague that strikes women around the world.

The rate of premature births is climbing in the United States, with Washington's rise among the steepest in the nation. Modern technology rescues many preemies, but more than 1 million die worldwide each year and an additional 3 million babies are stillborn, said experts gathered in Seattle this week to find ways to save those youngest lives.

"It happens to women in Seattle and Sri Lanka," said Dr. Craig Rubens, of Seattle Children's hospital and executive director of the Global Alliance to Prevent Prematurity and Stillbirth, or GAPPS. "It happens to women who go to every prenatal appointment, and it happens to women who simply cannot see a doctor while they are pregnant."

GAPPS was launched in 2007 by Rubens and his colleagues, who were concerned about the number of premature babies locally.

The Bill & Melinda Gates Foundation provided $1.5 million for the effort, which is also supported by UNICEF, Save the Children and other organizations.

Prematurity and stillbirth collectively claim more lives each year than malaria, tuberculosis or AIDS, yet get very little attention from researchers or the public, said Dr. Joy Lawn, of Save the Children. The Seattle meeting, which brings together 200 international experts, is the first global conference to address the problem, said Lawn — herself a premature baby.

Her mother went into early labor in the bush of northern Uganda. A health worker who had never performed a cesarean section brought the future pediatrician into the world at a clinic with no running water or electricity.

But many premature babies die at home, unnamed and uncounted, which is one reason the problem remains hidden, Lawn said.

In the wealthy world, the increase in premature births is linked to rising rates of diabetes and obesity, stress and other complications that require early delivery, often by C-section, Rubens said. Multiple births, sometimes as a result of fertility treatments, are a factor. Exposure to chemicals that mimic hormones also can disrupt pregnancy, said Dr. Michael Gravett, vice chairman of obstetrics and gynecology at the University of Washington School of Medicine.

In the U.S., about one in eight babies is born early. Washington's rate is about one in nine, but that has shot up nearly 30 percent in the past decade.

Few premature babies die in developed countries, thanks to $30,000 respirators and round-the-clock medical care. But many suffer lifelong health problems, including high blood pressure and diabetes.

"We have technology to improve survival," Rubens said. "We don't know how to prevent premature births."

But there are many simple steps that can be taken, particularly in poor countries, that have been shown to improve the survival of newborns and their mothers, said Dr. Mahmoud Fathalla, former dean of Egypt's Assiut University Medical School.

"We can't wait," he said. "We have to work with what we have now."

Protein and zinc supplements for women can slash stillbirths. Screening and treating pregnant women for syphilis protect babies from infection. Keeping mothers free from malaria and parasitic worms also leads to healthier newborns. Breast-feeding premature babies within the first hour of birth boosts their survival, as does skin-to-skin contact — part of what is called "kangaroo mother care," for the way marsupials are nestled and nursed in their mother's pouch.

The challenge is to reach more women in countries with few health workers and little money to spend on health care, participants said. Even in the United States, many hospitals fail to administer steroid shots to pregnant women, which can speed maturation of premature babies' respiratory systems, Rubens said.

"We need to raise awareness, and we need to create a sense of urgency."

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com