Premature Birth 1

Causes of Premature Birth

Brigid Burdette, Sara Ciletti, Alexa Gaetano, & Ashley Veneroso

Nursing Research

Youngstown State University

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Abstract

The goal of our research paper is to compare the causes of premature birth of babies

placed in the NICU. The causes of premature birth we have selected and will further discuss are

types of medications, illegal drugs, kinds of infections, and factors of nutrition. Among the four

nursing research students in our group, we have delegated each student to one topic with four

sources. For each cause of premature birth, we will look at what it is, how it causes the baby to

be born early, how it affects the baby, and lastly, if and how it can be prevented. We predict

illegal drug use during pregnancy will give the baby the worst outcome based on what we know

about drug addiction already.

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Wondering what is causing newborn’s to be placed in a parent's worst nightmare, the

Neonatal Intensive Care Unit (NICU). Often the most common reason a newborn is placed in the

NICU is because of premature labor. A normal pregnancy lasts around 40 weeks, but a baby born

before 37 weeks is considered to be a premature baby. Premature babies are not fully developed

and need to be closely monitored as well as well-nourished to bring them to a healthy size. There

are many potential factors that could cause a baby to be born premature, such as alcohol,

caffeine, medications, tobacco, or illegal drug use while pregnant. There are several possible

nutritional issues a woman may experience during pregnancy such as insufficient nutrition,

obesity, also decreased vitamin and mineral levels. Infection can also be at the huge issue

causing preterm labor such as STD’s, HIV, hepatitis and certain illnesses. We will dive a little bit

further to find the answer as to how and why these scary and uncertain situations occur.

Many people are prescribed medications and among those people are pregnant women. It

is important to check with your doctor to determine which medications are safe to take while

pregnant. Some prescription medications can cause preterm labor when not taken as directed.

Depression is common during pregnancy. “Reportedly, 10% to 16% of women suffer

from depression during pregnancy (kallen & Olausson, 2006: Williams & Wooltorton, 2005),

and anxiety may be more common than depression among women (22%) (Heron et al., 2004)”

(as cited in Furukawa, Ogawa, Takeshima, 2018). Benzodiazepines are a common sedative-

hypnotic drug. They are considered a schedule IV drug that has a sedative effect and causes

drowsiness. Schedule IV drugs have a low potential for substance abuse and dependence.
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Benzodiazepines have many therapeutic uses but is most commonly used for anxiety and

insomnia. A case-control study using a claims database supplied by Japan Medical Data Center

(JMDC) was done to determine if any exposure to benzodiazepines and antidepressants while

pregnant, resulted in preterm labor and low birth weights. Since January 2005, the JPMDC

database has collected monthly claims from institutions and pharmacies from those who are

insured. The women are linked with their babies through an encrypted personal identifier. The

JPMD database encrypted personal identifier shows the researchers their age, gender, diagnoses,

and prescriptions which in turn helped the researchers collect data on what prescription

medications were being taken during pregnancy. The researches only considered women who

were given benzodiazepines 5 to 8 months after the assumed conception date and excluded

women who were dependent on nicotine and alcohol. Furukawa at el., (2018) concluded the

maternal use of Benzodiazepines was associated with an increased risk of preterm birth but not

necessarily low birth weights.

There are many different medications that can be prescribed to treat depression and

anxiety. Talking with a healthcare professional about which drugs are safe to take while pregnant

will help prevent preterm labor.

Maternal drug use is another reason that could not only cause preterm labor but would

admit a newborn to the neonatal intensive care unit. Often used that would cause preterm labor

would be alcohol, tobacco, marijuana, and opioids. We will touch on the maternal use of tobacco

and opioids because of the prevalence of use. Although these are all considered to be extremely

harmful to a fetus and thus causing negative effects to the newborn. A newborn premature is at a
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high risk of low birth weight, developing diseases, death, and withdrawal symptoms. Smoking

tobacco is an addictive habit for some mothers and often very hard to stop even when pregnant.

Although mothers are warned of the negative side effects it can cause on their newborn, some are

unable to stop. A study was done to show the association between smoking and decreased birth

weight as well as how it affects the sex of the baby. The study showed that “Out of 11,583

infants only 1.9% of mothers quit smoking within the first months of pregnancy” (Powell &

Tayie, 2012). This then in turn caused “4.5% of newborns to have low birth weight and 12.8%

received NICU care” (Powell & Tayie, 2012). The association between the sex of the baby and

smoking resulted in newborn girls to have lower birthweights than boys. Smoking can be

prevented and should be stopped once pregnant. Yet another common addictive substance that

mothers abuse while pregnant are opioids. Opioids being extremely dangerous to a newborn can

cause neonatal abstinence syndrome which then in turn will cause a longer stay in the neonatal

intensive care unit. Neonatal abstinence syndrome is a combination of conditions a newborn will

face as a result of opioid exposure. A newborn exposed to opioids will thus have withdrawal

symptoms and need to be treated accordingly to the drug they were exposed to. A study was

done on forty-one infants to determine the duration of admission for an infant with NAS with the

“median duration being 29 days” (Greenough, 2003). The conclusion of the study was that

maternal drug abuse affected the treatment and length of stay for infants in neonatal intensive

care.

More than twelve percent of infants born in the United States are born prematurely. Forty

percent of those births are related to infections. If a pregnant woman is exposed to infectious
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agents during pregnancy, the consequences to the fetus can be serious and even life-threatening.

There are many different types of infections and how they can spread to the fetus can happen in

different ways as well. It is important to learn about all the different types of infections that

pregnant women are at risk for, how to prevent getting any of them, and to know the symptoms.

The first infection to be discussed is called an intrauterine infection. This is when there is

a bacterial infection that has spread to the membranes that surround the growing fetus, the

amniotic fluid, and/or the umbilical cord. Intrauterine infections can happen if bacteria move up

through the vagina, into the uterus, then possibly affecting the fetus. The bacteria that may cause

this is usually natural, harmless bacteria that many women carry on their skin, but it becomes an

issue when it has traveled to parts of the body where it’s not supposed to be. If the infection

reaches the membranes surrounding the baby it may be referred to as chorioamnionitis and if the

umbilical cord is affected, it may be called funisitis. Intrauterine infections can cause preterm

contractions, the mother's water to break early, premature labor, and it can even stop the

exchange of nutrients between the mother and fetus. All of these can possibly cause the baby to

be put into the NICU after he/she is born. To prevent a more serious infection from arising, the

doctor may deliver the baby early. If the infection is not treated correctly and becomes more

serious, it can cause the fetus to develop lifelong disabilities such as cerebral palsy, hypoxic-

ischemic encephalopathy, respiratory problems, neonatal sepsis, and meningitis. Some symptoms

to look out for that may be related to an intrauterine infection are abdominal pain, a high fever,

rapid heart rate, and a foul-smelling vaginal discharge. Intrauterine infections are very common

and typically do not harm the mother or fetus if it is being treated correctly. Doctors can prevent
Premature Birth 7

permanent harm by providing antibiotics to the mother, delivering the baby early, and possibly

via a C-section to be even safer.

Another common infection that can affect a fetus is a urinary tract infection (UTI). A UTI

is an infection in any part of the urinary system, the kidneys, bladder, or urethra. UTI's can

happen in both males and females and usually are not anything too serious to worry about, but

they could cause some issues if you are pregnant. Pregnant women have a greater chance of

getting a UTI because the growing fetus can put pressure on the bladder which can trap bacteria

or cause urine to leak. If a UTI is not treated correctly it can travel up into the kidneys, causing

pyelonephritis. Pyelonephritis is a kidney infection that can cause premature labor and low birth

weight which will cause the baby to be placed into the NICU after birth. Common symptoms to

be aware of are pain/burning sensations while peeing, the urge to pee but not being able to, pain

in the lower back, blood in urine, cloudy urine, or foul-smelling urine. UTI's are extremely

common and as long as they are taken seriously and treated correctly then both the mother and

baby should not develop any complications. Oral antibiotics are most used to treat UTI's, but

parenteral antibiotic therapy may be required if it has progressed into pyelonephritis. Some easy

ways to help prevent getting a UTI is staying hydrated, voiding frequently, and avoiding any

harsh soaps, perfumes, or sprays in the genital area.

There are endless amounts of infections that someone can develop while being pregnant.

If someone is pregnant and expecting, doing research and educating themselves about infections

is important. Many people may not experience the symptoms that an infection is occurring in
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their bodies, so it is important to learn how to prevent developing one. Everyone needs to wash

their hands, do their research, and keep themselves and their baby safe.

Another important and vital thing to monitor and maintain during pregnancy is a person's

nutrition and remaining a healthy lifestyle. Mothers want to be extra sure that her baby is

receiving all the nutrients and vitamins it needs to develop properly.

As time continues, we are getting to see more and more obese people. Not only does

being obese pose several risks on the individual itself, but even more if that person is pregnant.

A study done on obese pregnant women showed increased rates of: congenital anomalies such as

congenital heart defects, stillbirth due to placental dysfunction or changes in metabolism,

preeclampsia which can impair kidney and liver function, preterm birth which places the baby in

Neonatal Intensive Care Unit, gestational diabetes which can put the baby at risk for breathing

problems, fetal growth restriction which causes a low birth weight and has many potential risks,

and macrosomia which is classified as a birthweight of 8 pounds 14 ounces or more.

Furthermore, as obese pregnant women lose weight during pregnancy, the occurrences of

gestational hypertension, macrosomia, LGA, and emergency cesarean delivery all decreased

(Lockwood, 2015).

On the contrary, insufficient nutrition is just as bad as obesity. An underweight mother is

prone to fetal growth restriction which means she could give birth to a baby with lower birth

weight, lower fat and lean masses, a shorter length, and a smaller head circumference. More

serious than that, an undernourished fetus could be at risk for a still birth, perinatal mortality,

birth defects such as a deformed spinal cord, and underdeveloped organs. (Johnston, 1990).
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It is so important that moms-to-be watch what they eat while pregnant. What they eat

directly affects the fetus. One thing the moms really need to be on the lookout for is caffeine.

Caffeine contains many components that may reduce dementia, insulin resistance, type 2

diabetes mellitus, Parkinson disease, cirrhosis, and advanced hepatic fibrosis; however, excess

intake is not recommended; especially during pregnancy (Alamneh, 2020). According to a study

performed 2008-2014, premature babies of moms who drank copious amounts of caffeine while

pregnant where more likely to develop necrotizing enterocolitis and spontaneous intestinal

perforation with acute kidney injury. The most common outcomes of drinking caffeine during

pregnancy are spontaneous miscarriage or low birth weight (Aviles, 2019). Caffeine can cross

the placenta into the amniotic fluid and fetus and results in adverse pregnancy outcomes. The

American Pregnancy Association and March of Dimes recommends that a pregnant woman

should not take more than 200mg caffeine per day, which is around 355 milliliters coffee

(Alamneh, 2020).

All of the adverse pregnancy outcomes listed above could be prevented by maintaining a

healthy weight and avoiding caffeine throughout all three trimesters in order to give the baby the

best possible chance for a healthy baby with an on-time delivery.

After looking at all of these possible causes of premature birth that can put the infant’s

life at risk and spending their first few days to weeks in the world in an intensive care unit, it is

clear to see that these are all preventable in one way or another. Being informed about what can

cause preterm labor is important to know when being pregnant. It can help prevent many

complications that may be caused due to lack of knowledge.

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