Deprivation and premature birth

Premature birth is the single biggest cause of death in babies. Women from deprived areas seem to be at increased risk of giving birth very prematurely, but no-one knows why. Researchers are searching for answers, with the ultimate aim of helping disadvantaged women have healthier babies.

What's the problem and who does it affect?

Premature babies are at risk of death and serious illness

Some 13,000 babies are born very prematurely, before 32 weeks of pregnancy, each year in the UK.(1) Sadly, around 10% of them die before reaching their first birthday.(2) Even if they survive, they are more likely to suffer brain damage, lifelong disabilities and other severe health problems.

Reducing the risk of premature birth is vital. But very little is actually known about why some babies are born so early. Pregnant women have few guidelines on how to avoid going into labour too soon.

The role of deprivation

Studies suggest a link between deprivation and premature birth. Indeed, researchers working on this project have recently discovered that women from the most deprived 10% of areas are twice as likely to give birth very prematurely as women from the most affluent 10% of areas.(3)

Life can be very tough for disadvantaged mothers who give birth early. Many premature babies spend months in intensive care, battling for life, many miles from home. Even just visiting the baby is difficult if you’ve got no car and there are other small children to look after.

What is the project trying to achieve?

What factors link deprivation with premature birth?

The researchers working on this project have already collected extensive data on over 13,000 very preterm births in the former Trent NHS region between 1994 and 2005.

In this project, they will perform sophisticated statistical analyses of their data to explore factors that might explain the link between deprivation and premature birth.

Previous studies suggest infection might trigger very premature labour. Researchers are therefore trying to find out whether the higher rate of preterm birth in disadvantaged women is due to higher rates of infection Other factors they will study include the mother’s age, birth weight, ethnicity, cigarette smoking, alcohol use, stress, occupation and education.

Researchers also hope to find out whether the general level of deprivation in a particular neighbourhood can be used to identify which women are at high risk of giving birth very prematurely.

What are the researchers' credentials?

Professor David Field, Consultant Neonatologist, and Dr Elizabeth Draper, Senior Research Fellow in Perinatal Epidemiology, lead The Infant Mortality and Morbidity Group, which investigates the causes, consequences and management of death and illness in unborn babies, infants and children. They’ve published extensively on this topic and they’re collaborating with a number of experts from around the world.

The group has been gathering detailed information about preterm birth in a population of about 4.5 million people in the East Midlands since 1990. The data they’ve collected is unique within the UK and, as far as they can tell, also in the world in terms of its degree of sophistication and completeness.

Who stands to benefit from this research and how?

Helping clinicians find ways to prevent premature birth...

Researchers hope their analyses will help explain why women living in disadvantaged areas are more likely to give birth very prematurely than women from affluent areas. They estimate deprivation is responsible for 30 to 40% of all preterm births.(3)

This important research is in its early stages. The first people to benefit will in fact be healthcare professionals, such as midwives, obstetricians and neonatologists. The results of this study will help them estimate service needs, monitor inequalities and, perhaps most importantly, design large-scale clinical trials of interventions that might help stop our most disadvantaged women from giving birth too soon.

... so more babies grow up healthy

The ultimate aim of these future trials will be to eliminate the rich-poor divide in the risk of premature birth, so bringing major improvements in the health and well being of newborns. This would produce substantial cost savings for the NHS and spare more parents from the heartbreak of having a premature baby.

References

1. Tucker J and McGuire W. Epidemiology of preterm birth. BMJ 2004;329(7467): 675-8.
2. Draper ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births by weight and gestational age: retrospective population based study. BMJ 1999;319:1093-7.
3. Smith LK, Draper ES, Manktelow BN, Dorling JS, Field DJ. Socio-economic inequalities in very pre-term birth rates. Archives of Disease in Childhood, Fetal and Neonatal edition (In press).