The United States has a dismal distinction in international health rankings: 9.6 percent of babies are born preterm, a higher rate than in Turkey, Afghanistan, Thailand and dozens of other third world countries.
The problem is huge, but one California program, called Glow! (as in that pregnant cast) is taking a fairly local approach to preventing premature births. Just a few weeks ago in Fresno, a group of women, all in their third month of pregnancy, and most women of color, met for their third time since October. They exchanged stories and tips about pregnancy and parenting, but the meeting extended well beyond social connections by including mother and baby checkups supervised by a nurse practitioner.
Glow! is an initiative of the University of California San Francisco’s Preterm Birth Initiative (PTBI), a ten year project aimed at reducing the preterm birth rates in California and eventually across the nation.
Premature births are the leading cause of death for children under five, according to the March of Dimes. Being born too soon poses a host of health problems because babies often can’t thrive that young outside the womb. They are more likely than full term babies to be born with birth defects and to face developmental delays.
California fares somewhat better than the nation as a while, with 8.5 percent of babies born preterm, but Fresno County has the most preterm births in the state, with 9.5 percent of babies born three weeks or more before their due date. Among Black mothers in California, that number soars even higher, with nearly 12 percent of all babies born preterm.
PTBI was launched in 2015, when philanthropist Marc Benioff reached out to PTBI director Larry Rand, a perinatologist who is also director of Perinatal Services at the UCSF Fetal Treatment Center. Benioff wanted to better understand “how it could be that the needle on preterm births hadn’t moved despite decades of research,” Rand recalled, adding that Benioff challenged him “to shift the paradigm if necessary, and bring bright new minds and new ideas to the table.”
In response, Rand assembled an interdisciplinary team that included not just gynecology, pediatric and prematurity experts but also thought leaders in public health, health policy and epidemiology, among others disciplines. The team’s $100 million in funding comes from Benioff and the Gates Foundation. (PTBI also has an African arm working to reduce preterm births in several East African countries.)
The groups’ initial analysis, conducted in 2015, “made it strikingly clear that prematurity (along with other adverse pregnancy outcomes) epitomizes the health disparities we see in California and the U.S,” Rand said. Other key takeaways from the project’s analysis:
- Place matters: the highest rates of premature birth corresponded to neighborhoods of people with the lowest socioeconomic status.
- Toxic or chronic stress—what people feel when they are overwhelmed by situations over which they have no control—is a major contributor to preterm birth. Living with increased exposure to violence and economic uncertainty cause toxic levels of stress.
- The combined effort of patients, health providers, community members and advocates is essential to reducing rates of preterm birth.
Since its start three years ago, PTBI has initiated and collaborated on dozens of studies and projects in California, said Claire De Leon, PTBI’s communications managing director. Recent research projects have ranged from looking at local immigration enforcement exposure and its impact on preterm birth to the impact on early births of air pollution from local gas and oil power plants.
One finding from interviews with hundreds of families who had babies born prematurely was that better access to prenatal care might have prevented some premature births. Childcare and transportation challenges hampered mothers’ access to prenatal appointments, as did long waits for prenatal appointments. Some Interviewees also felt uncomfortable with racist overtones in their interactions with their providers, such as seeming disinterest in their pregnancy progression and a lack of respect for cultural concerns and customs.
Glow!, the maternity program in Fresno, is a collaboration among First 5 Fresno County, the Fresno State Central Valley Health Policy Institute and local health providers that is funded by PTBI. Glow! is a demonstration project, so if it proves successful, the program can serve as a model for the rest of the state and the United States.
Glow! participants get their care through group prenatal visits, and are provided with healthy food during each session, along with childcare and transportation assistance for the visits, as well as peer support. Group prenatal visits have been shown to help prevent preterm births, Rand said. A 2007 study in the journal Obstetrics and Gynecology showed a a 33 percent reduction in preterm births for mothers who get their care through group visits.
Erica Martinez, 37, of Sanger, California in Fresno County, has preterm birth experience expectant mothers are anxious to hear. Martinez has five children, 14, 13, 11 and two and a half year old twin girls who had surgery in utero to break physical links that were preventing one twin from thriving, were born four weeks early and spent ten days in a neonatal intensive care unit.
Martinez heard Rand speak at an event and wanted to get involved, so she contacted the PTBI staff in Fresno. “They took me seriously and I participated in a Glow! planning meeting.” Martinez was recently tapped to lead a Glow! prenatal group for Spanish speakers, together with a nurse practitioner.
The idea behind Glow! is to help expectant mothers identify potential problems with their pregnancy. Women in the program take their own blood pressure readings, weigh themselves and even test their own urine. A nurse practitioner is part of the process to answer questions, listen to the babies’ heartbeat and measure moms’ bellies.
The most common question by the mothers is about what’s normal for blood pressure and the baby’s heartbeat, and knowing what the numbers mean has made them made them very engaged in their baby’s progress, said Martinez.
“If you all you do is treat chest pains when someone has a heart attack, you won’t get anywhere in reducing the incidence of the problem,” said Rand. “It’s the same for premature birth, we have to deal with this way back before the problem begins.”