Dr. Peter Earl, an obstetrician and gynecologist with Wellmont Medical Associates Women’s Health, says that the vast majority of women don’t get enough folic acid. Contributed photo.
Tennessee continues to lower its preterm birth rate, giving more babies a healthy start in life and joining a national trend of states who are making newborn health a priority.
Although the state has reduced its preterm birth rate steadily during the last several years, last year’s 12.5 percent earned a C on the March of Dimes 2013 Premature Birth Report Card. The March of Dimes is leading the Prematurity Campaign to reduce the nation’s preterm birth rate to 9.6 percent or less by 2020. The Premature Birth Report Card measures progress by comparing each state’s rate to the goal of 9.6 percent.
“Partnerships with local hospitals, Tennessee Department of Health & the Tennessee Hospital Association have helped us make newborn health a priority and lowered our preterm birth rate, making a difference in babies’ lives,” said Valencia Nelson, Tennessee director of program services. “We will continue to work to give all babies a healthy start in life because too many still are born too soon, before their lungs, brains or other organs are fully developed.”
Premature birth — considered to be birth before 37 completed weeks of pregnancy — is a serious health problem that costs the United States more than $26 billion annually, according to the Institute of Medicine. It is the leading cause of newborn death, and babies who survive an early birth often face the risk of lifetime health challenges, such as breathing problems, cerebral palsy, intellectual disabilities and others. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants. At least 39 weeks of pregnancy are important to a baby’s health because many important organs, including the brain and lungs, are not completely developed until then.
In 2006, the state’s preterm birth rate was 14.8 percent. Each year since then, that rate has declined: 14.2 percent in 2007; 13.5 percent in 2008; 13 percent in 2009; 12.9 percent in 2010; and 12.8 percent in 2011.
In Tennessee, the rate of late preterm births (live births between 34 and 36 weeks gestation) is 8.8 percent, down from 9.1 percent, and the rate of uninsured women is 17.1 percent, down from 18.1 percent. These factors, which earned stars on the report card, contribute to improved infant health in Tennessee. The percentage of women of childbearing age who smoke rose from 23.7 percent to 25.2 percent, indicating that the state is moving in the wrong direction.
“We will continue to improve access to health care, help women quit smoking, and through our Healthy Babies Are Worth the Wait consumer education campaign, encourage women and health-care providers to avoid scheduling a delivery before 39 weeks of pregnancy unless medically necessary,” Nelson said.
The United States overall again received a C on the March of Dimes Report Card. Six states — Oregon, California, Alaska, Maine, Vermont and New Hampshire — earned A’s, while Louisiana, Mississippi, Alabama and Puerto Rico received a failing grade.
Health-care providers are using the first full week in January — Folic Acid Awareness Week — to stress the importance of folic acid to pregnancies and healthy babies. Getting enough folic acid before and during pregnancy can prevent major birth defects of a baby’s brain or spine.
“Folic acid is a vitamin, and it plays a role in a lot of different things. As far as pregnancy-related concerns, the biggest thing is the vast majority of women don’t get enough, either naturally or through vitamins,” said Dr. Peter Earl, an obstetrician and gynecologist with Wellmont Medical Associates Women’s Health.
Folic acid is a B vitamin that helps the body make healthy new cells. The Centers for Disease Control urges women to take 400 micrograms (mcg) of folic acid every day, starting at least one month before getting pregnant, to help prevent major birth defects of the baby’s brain and spine.
“It’s related to neural tube defects in babies born. Spina bifida is the most widely known neural tube defect,” Earl said. “Ninety-five percent of neural tube defects happen in women who have no so-called risk factors, like family history, no indicator that they might be at increased risk. Only about 15 percent of theoretically preventable neural tube defects are actually prevented by folic acid. There’s a huge room for improvement for that. Neural tube defects like spina bifida are the second most common so-called congenital anomaly. The most common is heart problems.”
Neural tube defects (NTDs) are rare, Earl said, occurring in about one in every 1,000 life births, but if it happens, it can be devastating.
Spina bifida, the most common permanently disabling birth defect in the United States, means “split spine.” The neural tube is the embryonic structure that eventually develops into the baby’s brain and spinal cord and the tissues that enclose them. Normally, the neural tube forms early in the pregnancy and closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the backbone.
“The best way to prevent it is to take some folic acid,” Earl said. “Most authorities recommend at least 400 micrograms a day. The other wrinkle is most pregnancies in this country are unintended, unplanned, whoopsies. It’s the unintended ones that are problems. The recommendation now is if you want to become pregnant, start supplementing a month before, and supplement through a couple of months into the pregnancy. By six weeks along, the time frame has passed.”
Folic acid is very easy to get, Earl said, but it’s difficult to get the recommended amount solely through food — leafy, green vegetables; fruits; dried beans, peas and nuts; enriched breads, cereals and other grain products.
“Most multivitamins have it. You can also purchase it as a separate vitamin as plain folic acid ... but if you take a regular multivitamin every day, most of them will have 400 micrograms of folic acid,” he said. “It’s a pretty easy thing to do. It’s just remembering, thinking about it.”
Courtesy of Wellmont Health System