San Diego Among Top 10 Cities For Preventing Preterm Births
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November 5, 2015 1:06 p.m.
San Diego Among Top 10 Cities For Preventing Preterm Births
Victoria Lombardo, associate state director of program services, March of Dimes
Dr. Anup Katheria, director, Sharp March Birch Neonatal Research Institute
Related Story: San Diego Gets High Marks For Preventing Premature Births
Our top story on midday edition, we are in the top 10, but that doesn't mean we couldn't do better. In national report card was issued today by the March of Dimes listing the right of premature births in 100 cities in America. San Diego was listed as having one of the lowest rates of premature births and that is very good news because premature birth is the biggest single cause of infant deaths and a leading cause of cerebral palsy. But, some other areas of California and the nation did not fare as well on the report card. Joining me are Vicki Lombardo, associate state director of program services for the March of Dimes. Vicki, welcome.
And Anup Katheria.
Thank you for having me.
There are many babies born before their expected due dates. What defines a birth is premature?
A normal pregnancy is 40 weeks one. Any BBB -- any baby born before the completion of the 37th week of pregnancy is considered preterm.
Okay and San Diego's weight of premature births is a .3% of all live births. That puts us in the top 10 best USA's, but we got a B. Why not and A?
You got a B, but the goal of March of Dimes is to achieve a .1% by the year 2020. So, we use a standard deviation math formula to determine how far away from that 8.1 goal you are and you are at the be level away from that.
Chula Vista also got a B, which is lower than Boston.
Yes, it is.
I think if you look down the rates of these cities, that's quite shocking. You could of Boston as a very -- a city with many resources and many, many ways to reach out to women who are pregnant and get them in for prenatal care.
That's correct. If you look at the United States, which is a highly industrialized country, we are a rich country. We are in the bottom 10% of countries with similar resources as the United States. So, the goal of the March of Dimes is to move the United States of into the top 10%. That will mean by the year 2020, reaching a goal of 5.5% preterm birthrate.
Is San Diego's rate lower than it used to be?
It is. It's going down and Redwing the right things, but we need to do more. On this report card, we are actually helping by allowing you to compare yourself to other cities of similar size and actually, the folks that are leading the initiative in San Diego can reach out to those cities and find out ways your preterm birthrate lower than ours? What are you doing right? So that we can look at those techniques. We are also, on the report card, looking at disparities. So, how are African-Americans, Asian-Pacific Islanders, native Americans and whites, how do their rates compare? And in the state of California, we see that it's actually our Asian moms that have the lowest preterm birthrate. Why is that? If we can achieve it with the Asian moms, why can we achieve it with everybody?
How to San Diego stack up against other cities in California comes to the preterm birthrate?
The preterm birthrate, San Diego actually has a preterm birthrate equal to the state of California, but Oxnard has a particularly low preterm birthrate. There is is the second lowest in the country when we look just at cities.
IC. And LA has a higher?
It does. It's a big, diverse county and we need to learn some lessons from some of our cities that are getting B because LA has a C.
Will you say are some of the reasons? I want to ask you both, but first Vicki, of seeing -- of San Diego's premature births going down?
Because it continues to go down? The reason -- a lot of the reasons are we are being more patient with pregnancies. We are teaching moms that those last five weeks are so very important and the amount of brain development and lung development that happens in those last five weeks is a significant. Rather than scheduling your C-section just a few weeks early for your induction just a few weeks early, we are getting better at winning and the moms are understanding why that's important. The hospitals in San Diego are all just a saying no when there is no medical reason for doing that elective delivery. That makes a big difference.
And, Doctor Anup Katheria, you are the director of the Mary Birch neonatal research Institute and I'm wondering, what you think might be some of the reasons that this rate of premature births continues to drop in San Diego
Sure. I think one of the biggest reasons is we have really improved access to care. For example, our hospital, our perinatologist, obstetricians that specialize in high-risk pregnancies have really wish out to the community. We have mothers of away from El Centro to -- that come down for high-risk pregnancies. Increasing access out some of those regional centers, while the talk about San Diego having a low preterm birthrate, but often times they are having this coming from other areas that don't have access to preterm care. Even racial disparities, we want to make sure some of those other communities are getting the same access we get here in San Diego.
What are the biggest metal concerns, Doctor, when a baby is born early?
There are number of organs that are not fully developed. The one we are most concerned about is the brain. And the rest alone, about 12,000 babies every year and of having brain injury from brain bleeding and as physicians, want -- one of the things we want to enable is preventing that from occurring. That often times happens in the first few minutes are weeks of life. So much of our research is aimed at improving brain injury and other organs fall in line. As you protect the brain, you are protecting the other spec
How delicate are these premature babies?
Very delicate. Many of the vessels in the brain are really prone to rupture or breaking just from the slightest change of blood flow to organs. The skin of a preterm baby is very fragile. In fact, they don't have the same amount of muscle and tissue to prevent temperature loss. They get very cold. We have to be careful and regimented from the first few seconds of birth.
I have read that you have been developing some innovative treatments for premature babies and involving keeping them connected to their moms afterbirth. Tell us about that.
At Sharp Mary Birch, we finished a study that took us about a year and a half, but we wanted to demo trade keeping babies connected to the mother's -- when I say connected, the placenta -- especially preterm babies born before 30 weeks are about 10 works -- 10 weeks earlier, leave about half the blood behind if you cut the umbilical cord. Because preterm babies often need help breathing, those universal or dish universal practices has been to cut the cord and provide them to another room with access to care, but what if you could keep the baby with the mother, getting that essential blood, stem cells, nutrients to help protect the baby, but then provide life-sustaining interventions like keeping them breathing. The other thing we have found just as an anecdote to the study as many mothers don't realize by having a preterm birth you are now separated from her baby. Because we have to take the babies to another room, that whole natural bonding experience it happens in it that first minute is lost. Many of our parents are thrilled for the fact that they are seeing their baby born, they can see and touch their baby for the first time. We talk about these unquantifiable benefits of maternal bonding that not only help the mother, but the baby. I think these are things that will change the way we practice.
Also, considering that there are so many medical concerns that might come along with having a premature baby, is there also a sense of fear that some parents have about the fact that they do have a premature baby and how to care for that baby and what's going to happen to that baby?
Absolutely. One of the big things we do is spend times before the babies are born talking to the mother's. I think most of our counseling or visit is to rear -- is to reassure the mother. Number one, what I think the March of Dimes has been aiming for, the mother is not to blame for that baby being born prematurely. 99% of the time it was a cause we just don't know. If he gets important to let the mother know it wasn't that extra class she took our running up the stairs or doing something in her diet. Most of these, we don't have a clear cause as to why these babies are born early. Not being said, once we talk about the interventions we have, the good outcomes, we take care of babies born up to four months early. This is a whole new opportunity for parents to really understand that their babies can be healthy, can survive and grow up to be productive members of society.
As we have been saying and how the Doctor has been explaining, it's quite something to take a child, an infant, a newborn is so delicate and has not really been fully formed and guided that child into a healthy infant, a healthy child. And what happens at great deal of the time is that the child is taken away from the family so there is this emotional component of not being able to bond, but there is also a financial cost isn't there?
There is. These babies are very expensive. The cost is $26 billion to the nation around preterm birth. So, it's not just the medical care of the mom and baby in the hospital, but it also goes on into their discharge. In need additional therapies for them to have the best quality of life they possibly can.
I want you to talk to us more, Vicki, about the racial disparities you're talking about before that increase the right of preterm births in some populations.
The biggest population where preterm birth happens consistently is in our African-American families. We don't have those reasons. We can compare an African-American mom with the same socioeconomic group -- status as a Caucasian mom and the risk of a preterm baby in the African-American mom is twice as high. We don't have those answers. The March of Dimes is funding 5 million -- five multiple in dollar research centers across the country that are interacting with each other called team science. They are looking for those answers, but we don't have them right now.
Of the reasons that we know, that might lead to a premature birth, what are those? Are they lack of prenatal care?
That's one of them. The most common cause of why a mother goes into preterm labor, which then leads to preterm birth is infection. We are very vigilant and aggressive trying to treat mothers as well as their babies for infection. Then, maternal causes. For instance, maternal diabetes, maternal obesity, maternal health has also been a big cause. Another one as high blood pressure. Particularly African-American mothers have high blood pressure, which then causes them to go into preeclampsia, a condition where the high blood pressure doesn't improve until the baby is born. Those are reasons we deliver the baby to help the mother. There are a number of causes, I think some of which we can control and some of which we have no control over.
So, considering there are these?'s about what causes premature birth and a lot of different areas and the fact that we do know some of the things that might lead to someone to be at risk for delivering a premature baby, what are some things San Diego can do to get to those numbers, that goal that the March of Dimes has? That 8.1% to 20?
Part of it is helping our moms be as healthy as they can before they get pregnant. So, that is enter conception care or preconception care. And rolling the moms in a health plan or cover California is one thing. Helping them stop smoking, all those issues the doctor talked about are really important. The other piece is adopting the new, proven practices. So, Doctor Anup Katheria mentioned preeclampsia. We now know taking low-dose aspirin during pregnancy can reduce the risk for three -- pre-Clancy a. As we become smarter and no these new things, adopting them and being aware of latest findings is really important. That's why the March of Dimes does a lot of professional education also.
Okay, well for people who are curious to see this, you can go to the March of Dimes website and see the report card.
I would have been speaking with Vicki Lombardo, state director of program services for the March of Dimes and Anup Katheria, director of the Sharp Mary Birch neonatal research Institute, soon to be a new father.
Thank you very much.