Hotline discusses prematurity risks

The woman had two normal pregnancies and delivered healthy babies. But in her third pregnancy, she started labor much too soon and the baby didn't survive. Now pregnant again, she's worried and wants to do everything she can to have a healthy baby and deliver it at full term.

Saturday, she called the Deseret News/Intermountain Healthcare Hotline to talk to maternal-fetal specialist Dr. Sean Esplin, associate professor in the Division of Maternal-Fetal Medicine at the University of Utah who also practices at Intermountain Medical Center, and Katrina Jensen, a registered nurse who is case manager with SelectHealth's Healthy Beginnings Program.

Women who have lost a baby or delivered too soon have a much greater risk of prematurity than others do. It's a risk factor in itself. So Jensen suggests that women make it a point to get a pre-conception examination to make sure that everything is all right and to get control of problems like high blood pressure or diabetes that increase risk but can be managed, if care is taken.

A pre-conception appointment is a good idea for any woman considering or trying to become pregnant, Jensen said, not just those at high risk of delivering too early.

There are other things that contribute to prematurity that are within an individual's control, such as smoking. That increases the risk of prematurity and complications. Being too heavy or not weighing enough both increase the risk, as well, Esplin said.

Women who have risk factors need to be carefully managed throughout the pregnancy, and there are tools like progesterone injections that can head off delivery. That's a weekly injection from the 20th week to the 36th week.

If a baby is determined to be born early and it's possible to give steroids, that makes a huge difference to lung development, Esplin said. Ideally, the two-injection series should be given 48 hours before delivery.

The two also noted that there are some conditions, like pre-eclampsia, that can only be resolved by delivering the baby, in spite of the prematurity.

The Deseret News and Intermountain Healthcare tackle a different topic the second Saturday of each month.

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E-mail: lois@desnews.com