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About 12 percent of U.S. births are preterm, about the same as Wednesday’s report estimates in Thailand, Turkey and Somalia. In contrast, just 5.9 percent of births in Japan and Sweden are premature.

Experts can’t fully explain why the U.S. preemie rate is so much worse than similar high-income countries. But part of the reason must be poorer access to prenatal care for uninsured U.S. women, especially minority mothers-to-be, said March of Dimes epidemiologist Christopher Howson. African-American women are nearly twice as likely as white women to receive late or no prenatal care, and they have higher rates of preterm birth as well, he said.

More disturbing, the report ranks the U.S. with a worse preterm birth rate than 58 of the 65 countries that best track the problem, including much of Latin America. Add dozens of poor countries where the counts are less certain, and the report estimates that 127 other nations may have lower rates.

Whatever the precise numbers, “we have a shared problem among all countries and we need a shared solution,” Howson said.

One key: Not just early prenatal care but more preconception care, he said. Given that in the U.S. alone, nearly half of pregnancies are unplanned, health providers should use any encounter with a woman of childbearing age to check for factors that could imperil a pregnancy.

“Ensure that mom goes into her pregnancy as healthy as possible,” Howson said.

Scientists don’t know what causes all preterm birth, and having one preemie greatly increases the risk for another. But among the risk factors:

_Diabetes, high blood pressure, infections and smoking.

_Being underweight or overweight, and spacing pregnancies less than two years apart.

_Pregnancy before age 17 or over 40.

_Carrying twins or more.

_In wealthier countries, early elective inductions and C-sections.

“A healthy baby is worth the wait,” Howson said, noting that being even a few weeks early can increase the risk of respiratory problems, jaundice, even death.

The WHO defines a preterm birth as before completion of the 37th week of pregnancy. Most preemies fall in the “late preterm” category, born between 32 and 37 weeks. Extreme preemies are born before 28 weeks. So-called “very preterm” babies fall in between.

Lawn’s biggest frustration is how often later preemies die in low-income countries because even the health providers may not know simple steps that might save them _ and the fatalism around those deaths.

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