The United States has a higher rate of babies born too early – and therefore at greater risk of death or health problems – than more than 125 other countries, including Rwanda, Uzbekistan, China and Latvia, according to a report out today.

About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks.

Click to view interactive map and charts

While nearly two thirds of all pre-term births worldwide occur in Sub-Saharan African and Asia, the U.S. rate shows that “this is not just a developing country issue,” says Chris Howson, vice president for global programs at the March of Dimes.

His organization, along with the World Health Organization, Save the Children and the Partnership for Maternal, Newborn & Child Health, produced the report. It says about one million pre-term babies worldwide die shortly after birth, while others can suffer lifelong health problems.

Born Too Soon is a joint effort of almost 50 organizations, including the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s.

“This report sounds the alarm that prematurity is an enormous global health problem that urgently demands more research and resources,” said Craig Rubens, MD, PhD, executive director of GAPPS and contributor to the report.

“Even if every known intervention was implemented around the world, we would still see 13.8 million preterm births each year; we could only prevent 8 percent,” he said.

Maternal risk factors include being under- or over-weight, having diabetes or high blood pressure, smoking, being younger than 17 or over age 40.

Rates within countries can vary widely. In the U.S., for example, the pre-term birth rate for white women in 2009 was 10.9 percent, compared with 17.5 percent for African American women, the report says.

In the U.S. and some other developed countries, pre-term births are also linked with a higher use of fertility drugs, which are associated with mothers carrying twins, triplets or more, increasing the chance of early labor. Some births in the U.S. are also induced early, either because the mother is having health problems or for the convenience of the doctor or mother.

Because pre-term births are costly and dangerous, physician groups, organizations like the March of Dimes and even some employers have ongoing efforts to discourage women and their doctors from scheduling births before 39 weeks, unless there is a health reason to do so. The Obama administration launched a $40 million program in February aimed at reducing the number of premature births, especially elective deliveries.

Those elective early births are also the subject of a March of Dimes education campaign, which says even though the absolute numbers are small, the risk of death for babies born just one to two weeks early is twice as high as for those born at 39 weeks.

Howson says the groups that signed on to the report have made a variety of suggestions for lowering the rate worldwide, ranging from inexpensive injections that can be given to mothers in preterm labor to help develop fetal lungs to encouraging women to have health exams before they get pregnant to check for risk factors.

“A preterm baby indicates a failure in the system,” he says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Blood, placenta tissue and other specimens will be saved.

A Seattle Children’s project to reduce premature births and still births opens a new facility today to store tissue from pregnant women that researchers from around the world can use to study both normal and abnormal pregnancies.

The biorepository will be run by the medical center’s Global Alliance to Prevent Prematurity and Stillbrith (GAPPS).

Specimens stored at the facility will include maternal blood and urine, cervical vaginal swabs, placenta tissue, and cord blood.

Samples will are collected from the first trimester through the postpartum period.

The specimens will be linked with information about the mothers’ preconception history, course of her current pregnancy, environmental exposures, medical and reproductive history, mental health, nutritional intake, and behaviors.

Participation is voluntary, and the identity of participating mothers is kept confidential with the specimens being identified only by number.

“While pregnancy specimen biobanks have been developed before, this is the first time that specimens paired with information about mothers and their pregnancies have been made widely accessible,” said Dr. Craig Rubens, executive director of GAPPS.

The repository currently has more than 8,000 individual specimens available to scientists, with 800-900 specimens being added each month.

The collection includes contributions from women representing a wide range of racial, ethnic, regional, and socioeconomic backgrounds.

Among the goasl of the GAPPS Repository project are to:

• Help researchers discover biomarkers and create screening tools to identify women and babies at risk for preterm birth and stillbirth

• Use those findings to develop diagnostic tests, treatments, and prevention strategies

• And to support research to identify the causes of poor birth outcomes and the fetal origin of adult diseases in the hope of developing cures.

“Many adult health problems can be traced to fetal development,” Dr. Rubens said. “With these specimens, researchers can begin to understand what causes adverse pregnancy outcomes, and develop novel interventions to prevent them.”

To learn more:

• Visit the GAPPS website: www.gapps.org.

• Go to the GAPPS Flickr page to see more photos of the repository.

The guidelines, which were published online this week by the  American Journal of Obstetrics & Gynecology, were written to help health-care providers counsel mothers-to-be on how to avoid such toxins as lead, mercury, and a class of chemicals called “endocrine disrupters” that resemble hormones and have been linked to a number health problems including reproductive tract and neurodevelopment abnormalities.

Although the guidelines were written for health-care providers, the guidelines contain helpful information for patients, too, says Dr. Sathyanarayana.

“There are simple ways to reduce exposures to lead, mercury, pesticides and endocrine-disrupting chemicals . . .  by following the guidelines we have outlined,” Dr. Sathyanarayana said.

“Women and their partners should be aware that pregnancy is an important time for development, that environmental chemicals can cause harm to a developing fetus, and that this topic is important to discuss with health care providers,” said Dr. Sathyanarayana.

A summary of the guidelines provided by Seattle Children’s Research Institute is below:

Environmental Exposures:  

Tips for Reproductive Health Care Providers, Preconception and Prenatal Women

Mercury

• Risk factors: Exposure can come from eating fish, contact with quicksilver, and use of skin-lightening creams.  Exposure during pregnancy can lead to adverse neurodevelopmental outcomes that include lower IQ, poor language and motor development
• Reducing exposure to mercury:  Pregnant, preconception and breastfeeding women should follow U.S. Environmental Protection Agencyand state-specific fish consumption guidelines.  Avoid shark, swordfish, king mackerel, tile fish and large tuna.
• Resources:  Fish Chart and mercury guide.

Lead

• Risk factors: Risk factors for exposure include recent immigration to the U.S., occupational exposure, imported cosmetics, and renovating or remodeling a home built before 1970.  Lead is neurotoxic to a developing fetus.
• Reducing exposure:  Never eat nonfood items (clay, soil, pottery or paint chips); avoid jobs or hobbies that may involve lead exposure; stay away from repair, repainting, renovation and remodeling work conducted in homes built before 1978; eat a balanced diet with adequate intakes of iron and calcium; avoid cosmetics, food additives and medicines imported from overseas; and remove shoes at the door to prevent tracking in lead and other pollutants.
• Resources: Lead in Pregnancy/CDC and Poison Center Locator.

Pesticides

• Risk factors: Exposure can come from eating some produce and from using pesticides in your home or on your pets.  Exposure to pesticides in pregnancy has been shown to increase risk of intrauterine growth retardation, congenital anomalies, leukemia and poor performance on neurodevelopmental testing.
• Reducing exposure:  Do not use chemical tick and flea collars or dips; avoid application of pesticides indoors and outdoors; consider buying organic produce when possible; wash all fruits and vegetables before eating; and remove shoes at the door.
• Resources:  http://www.ewg.org/foodnews (focus on the “Dirty Dozen,” a list of the 12 most contaminated products published by the Environmental Working Group.

Endocrine-disrupting chemicals

• Risk factors: Human prenatal phthalate exposure is associated with changes in male reproductive anatomy and behavioral changes primarily in young girls. Animal studies suggest prenatal exposure to BPA is associated with obesity, reproductive abnormalities and neurodevelopmental abnormalities in offspring. Endocrine-disrupting chemicals mimic or antagonize the effects of hormones in the endocrine system and can cause adverse health effects that can be passed on to future generations.
• Reducing exposure:  Decrease consumption of processed foods; increase fresh and/or frozen foods; reduce consumption of canned foods;  avoid use of plastics with recycled codes #3, #6 and #7; be careful when removing old carpet because padding may contain chemicals; and use a vacuum machine fitted with a HEPA filter to get rid of dust that may contain chemicals.
• Resources:  BPA, CDC, and EPA.

The changes, detected in white matter of the infants’  brains, were widespread and would likely have a profound effect on brain development, said Annette Estes, PhD, research associate professor of speech and hearing sciences at the UW and a co-author of the study.

The findings also suggest that autism does not develop suddenly but involves a long process that begins early in life, Estes said.

A tensor diffusion image showing the white matter tracts of the brain

Individuals with autism typically have difficulty with social interaction, interpersonal communication and may engage in repetitive behaviors. Symptoms can range from mild to severely disabling.

The U.S. Centers for Disease Control and Prevention estimates that 1 in 110 U.S. children is affected by the disorder. The condition is usually detected in the second year of life after a seemingly normal infancy.

Although the cause of autism is unknown, recent research suggests that abnormalities in the brain’s white matter are involved.

White matter: the brain’s wiring

White matter is made up of bundles of millions of nerve fibers that create the “wiring” through which nerve cells communicate with each other. These nerve fibers are sheathed in a fatty insulating material, called myelin, that gives these areas of the brain a whitish appearance.

It is thought that abnormalities in white matter not only disrupt communication within the brain but also impair normal brain development, Estes said.

In the study, the UW researchers, working with collaborators from across the country, studied the brains 92 infants with a technique called diffusion tensor imaging that allowed them to track the development of the infants’ white matter,

The infants all came from families that already had one child with autism, which meant the infants were at high-risk of developing the condition as well.

Each infant had diffusion tensor imaging study at six months followed by a behavioral assessment at the age of two. Most also had follow-up scans at at one and two years of age.

The  researchers found that at the age of two, 28, or 30 percent, of the children had symptoms of autism while 64, or 70 percent, did not.

Comparing the brain imaging studies of the two groups revealed significant differences in the development of 12 of the brain’s 15 major white matter tracts.

That so many white matter tracks are involved suggests that at this stage autism is a “a whole-brain phenomenon not isolated to any particular brain region at this early stage of development,” said said Dr. Stephen R. Dager, M.D., UW professor of radiology and principal investigator of the University of Washington team.

The study’s findings are preliminary and diffusion tensor imaging is not ready to be used to diagnose autism in infants, Estes said, but the technique should help researchers better understand the cause of the condition and hopefully develop better interventions.

Autism and childrearing

In the past, it was commonly held that autism was the result of the failure on the part of parents to be sufficiently nurturing to their infants,  but the findings of this study suggest autism involves abnormal brain development that begins very early in life, Estes said.

Many parents wrongly blame themselves when their child develops autism, Estes said, but these findings indicate they “did nothing wrong” to cause the condition.

Future research will include looking at changes in the white matter development in infants younger than six months of age and tracking those changes as children age, Estes said.

The study, published online by the American Journal of Psychiatry, was the result of a collaboration with the Infant Brain Imaging Study (IBIS) Network funded by the National Institutes of Health and headquartered at the University of North Carolina at Chapel Hill.

Dr. Joseph Piven, professor of psychiatry at University of North Carolina at Chapel Hill and director of UNC’s Carolina Institute for Developmental Disabilities, was the senior author of the study.

Other institutions that took part in the study include the University of Utah, Washington University in St. Louis, McGill University, Children’s Hospital of Philadelphia and the University of Alberta.

To learn more:

• Visit the Infant Brain Imaging Study (IBIS) website: www.ibisnetwork.org

• UW Autism Center’s IBIS page.

• Seattle Children’s Autism Center.

The Daily Beast: How Karen Handel’s Komen Resignation Boosts Her Political Prospects

Even if you put politics and ideology completely aside, Karen Handel had to resign from Susan G. Komen for the Cure. It’s hard to think of the last time an employee did so much damage to such a respected brand in so little time. … But while Komen will sustain long-term damage, Handel probably will be just fine. Yes, she’s lost her position as Komen’s vice president for public policy. But Handel has long had political aspirations, and she’s now a right-wing cause célèbre. When she ran for the Georgia Republican gubernatorial nomination two years ago, she was attacked for being insufficiently anti-abortion. That’s unlikely to happen again. “It’s kind of hard to criticize her now,” Joel McElhannon, a Georgia-based GOP strategist, told the Associated Press (Michelle Goldberg, 2/8).

TIME: New Criteria May Change Alzheimer’s Diagnosis

Recently revised guidelines for diagnosing Alzheimer’s disease would reclassify nearly all patients who are currently diagnosed with mild or very mild Alzheimer’s as having mild cognitive impairment (MCI), a new study finds. The change may be confusing for doctors and misleading for patients and their families, says Dr. John Morris, a neurologist at Washington University in St. Louis. Reporting in the journal Archives of Neurology, Morris finds that 99.8 percent of patients now diagnosed with very mild Alzheimer’s dementia would actually be considered to have MCI, according to the latest guidelines. Among patients with mild Alzheimer’s, 92.7 percent would be reclassified as having MCI (Alice Park, 2/8).

KHN summarized other news coverage on Alzheimer’s this week: Obama Administration Pledges $156 Million For Alzheimer’s Research And Care (2/8).

American Medical News: The Limits Of Treating Loved Ones

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped. So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again — this time from an emergency department. The doctors there said she had a heart attack. … Professional ethics policies have long warned about the perils of physicians treating themselves or family members. … Yet medical board officials say such rules are commonly violated by well-meaning physicians, either knowingly or unknowingly (Carolyne Krupa, 2/6).

Scientific American Mind: Thinking About Mortality Changes How We Act

The thought of shuffling off our mortal coil can make all of us a little squeamish. But avoiding the idea of death entirely means ignoring the role it can play in determining our actions. Consider the following scenario: … It’s the middle of the night when you are suddenly awakened from a deep sleep by the sound of screams and the choking smell of smoke. … [S]ome thoughts of death shore up our beliefs, and other types of reflection make us reexamine them. Which kind leads to a better life? For their experiment, Blackie and Cozzolino recruited volunteers aged 17 to 76 and primed them in different ways (Wray Herbert, 2/6).

The New Yorker: Out The Window

Today is January, midmonth, midday, and mid-New Hampshire, and the writer sits in his blue armchair looking out the window. He is eighty-three. He teeters when he walks, he no longer drives, he looks out the window and watches birds come to his feeder. … The cow barn forty yards away was built in 1865, and he gazes at it every day of the year. His mother turned ninety in the Connecticut house where she had lived for almost sixty years, and she spent her last decade looking out the window. She died in a nursing home one month short of ninety-one. A year later, Jane, the writer’s wife, at forty-seven, was dying of leukemia (Donald Hall, 1/23).

Newsweek/Chicago Tribune: Life With Trig: Raising A Special-Needs Child

Families of children with special needs are bonded by a shared experience of the joys, challenges, fears, and blessings of raising these beautiful children whom we see as perfect in this imperfect world. … When I discovered early in my pregnancy that my baby would be born with an extra chromosome, the diagnosis of Down syndrome frightened me so much that I dared not discuss my pregnancy for many months. All I could seem to muster was a calling out to God to prepare my heart for what was ahead. My prayers were answered beyond my shallow understanding of what true joy could be (Sarah Palin, 2/9).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.