Nunatsiaq News
NEWS: Nunavut January 09, 2004 - 1:32 pm

Baffin pre-term birth rate three times national average

Early deliveries increase death rate, health problems, medical costs

JANE GEORGE

More babies in the Baffin region are at risk of dying or developing serious health problems, because pregnant women here are more likely to bear premature babies than women elsewhere in Canada.

Baffin women deliver premature, or pre-term, babies at three times the Canadian rate, and they’re giving birth to highly pre-term babies at twice the national rate, according to Dr. Elizabeth Muggah.

These babies are more likely to die or develop serious health problems than those who are born after the normal term.

“Pre-term delivery is the leading cause of death and disability among infants in the industrialized world,” said Muggah, who reported on her research findings at the International Circumpolar Health Congress in Nuuk.

Muggah, who is now with the Department of Community Health in Geneva, Switzerland, started looking at prematurity in the Baffin region while she was a University of Ottawa family medicine resident working at the Baffin Regional Hospital in Iqaluit.

Her study involved 938 births in the Baffin region from 1998 to 2000. Of these births, 95 per cent involved Inuit women.

Overall, Muggah found the women involved in the study had a pre-term delivery rate of 18.2 per cent - that is, more than 160 women delivered at least three weeks early.

More than 20 women, or 2.4 per cent, delivered at least eight weeks early. All of these women were Inuit.

Babies born before their full-term of 40 weeks can develop a variety of problems. Pre-term birth is responsible for 75 to 85 per cent of infant deaths in Canada. Later in life it can cause lung and eye problems as well as developmental delays in children.

“Babies born early do not have fully developed organs or organ systems, in particular, the respiratory, cardiac and neurological systems,” Muggah said. “Up until 40 weeks of gestational age, a baby’s heart rate, respiration, temperature control and other physiologic functions are supposed to be controlled by the mother. A pre-term baby is not able to cope with these demands placed on it out of the uterus.”

Until Muggah’s study, little was known about pre-term delivery among Inuit.

“Some of the recognized risk factors include genital tract infections, such as sexually transmitted diseases, multiple births like twins, triplets, etc., cigarette smoking, pre-eclampsia, that is, high blood pressure in pregnancy, incompetent cervix or prior pre-term birth. Psychological factors, such as stress, anxiety and depression may also affect the risk of pre-term birth,” Muggah said.

Muggah found the Inuit women in her study were overwhelmingly young, single, had less weight gain and had poor to fair nutrition. Some 87 per cent smoked. Those who smoked had lower birth-weight babies.

Inuit women had higher rates of urinary tract infections during pregnancy as well.

The women who delivered eight weeks early or more had a trend toward higher rates of chlamydia and other STDs.

Muggah also found that premature babies fared worse health-wise. Fewer were breastfed.

Medevacs for these babies were more common, as were hospitalizations and re-hospitalization. Among those infants treated in hospital in the Baffin, 24 per cent were born ahead of schedule. The number of premature babies under three months who had to be rehospitalized at the Baffin Regional Hospital was three times greater than the rate for full-term babies.

There’s also a cost to prematurity, said Muggah, as hospitalization is expensive and every medevac costs an average of $18,000.

Studies show educating women and caregivers about premature delivery can reduce the pre-term birth rate, although Muggah said studies also show targeting only high-risk women with special prevention programs doesn’t necessarily cut the number of premature births.

“Women need to be informed about the problem of pre-term delivery and how to recognize the signs and symptoms, so that they seek help and there is a chance to prevent delivery from happening,” Muggah said.

She suggested there should be better testing of pregnant women to check for causes of urinary and genital tract infections, including STDs, as well as more diagnostic tools to see which women may be at risk of pre-term delivery. These pregnant women could be treated or sent on before delivery to hospitals that specialize in high-risk deliveries.

“There is some evidence that infants transported while still in the womb may have a better outcome when compared to those infants transported as newborns,” Muggah said.

Muggah said further research studies should see if any communities are particularly at risk and whether economic factors, stress and the presence of a support system have an influence on pre-term delivery.

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