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Women giving birth

March of Dimes Gives Colorado a ‘C’ Grade on Preterm Birth Rate

Rebecca Cohen, MD, MPH, a family-planning expert and OB-GYN doctor, explores what the report means for infant and maternal health.

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Written by Mark Harden on December 14, 2023

A new “report card” on maternal and infant health from the March of Dimes gives Colorado a “C” grade for its rate of preterm births. And while that’s a slightly higher mark than the “D+” grade the national nonprofit group gives to the nation as a whole, the Colorado report is studded with concerning data points about the state.

The report says 10% of all births in Colorado in 2022 were preterm, defined as less than 37 weeks into pregnancy, versus 10.4% nationwide. It says preterm birth and low birth weight are believed to be the cause of 16% of infant deaths.

To help us better understand the report, we turned to Rebecca Cohen, MD, MPH, associate professor in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine. Cohen is chief of the CU Division of Family Planning.

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Much of this report deals with preterm births. What are some of the dangers and risks of a baby being born prematurely?

The best place for a baby to develop is inside of a healthy mom, but sometimes that is not possible. There are two kinds of preterm birth. One is spontaneous, where someone goes into labor far too early, and the other is induced or indicated, where we're having someone give birth several weeks before their due date because they have a health problem or there's a problem with the pregnancy.

Many preterm babies are very fragile. They may need additional help from a neonatal intensive care unit, and they may have lifelong health problems. They may grow up with difficulties feeding, difficulties walking, sometimes even stroke risk, because the brain tissue is fragile.

The March of Dimes report card says Colorado’s preterm birthrate of 10% is up from 8.4% in 2014. Why has the rate been increasing?

The 10% rate comes from 2022 data, and at that time a lot of things were being heavily impacted by COVID, including prenatal care. When we see people for regular prenatal care, we can treat infections and medical conditions to help maintain a pregnancy longer and lower the rate of preterm births.

We also know that, in general, people are having babies at older ages than they used to, which raises the chance of them having a chronic health condition like high blood pressure or diabetes that might lead to giving birth earlier because of complications to the pregnancy.

The report says Black babies in Colorado are 1.4 times more likely to be preterm than the overall rate, and the rate among Native Americans is almost as high. What are some factors that could cause those disparities?

The classic answers have always been things like rates of access to prenatal care, rates of poverty, rates of chronic illnesses that affect people of different racial and ethnic groups differently. But over the past few years, we’ve been thinking more about the role of racism in terms of prenatal health and social health.

There are both medical and social factors that affect people differently and determine who sees which health care providers, who goes to which hospitals, who has access to specialty care, who's able to have support during birth.

March of Dimes says almost two out of three multiple pregnancies in Colorado result in preterm births. Certain infertility treatments, such as ovulation-stimulating drugs, can trigger multiple pregnancy. Does that mean that women should avoid such treatments?

Spontaneous preterm births are more likely with twins or triplets. Essentially, the uterus reaches its capacity and is ready to have babies because it’s big enough even though those babies are early. And people with multiple pregnancies are also more likely to develop health problems in pregnancy, like high blood pressure, that might make us recommend that you have your babies early to protect your health.

For those reasons, in the field of reproductive endocrinology and assisted reproductive technology, there has been a big shift away from implanting multiple embryos. Our goal for people is to have them have a healthy pregnancy and a healthy birth. And that is more likely with a single pregnancy than with multiples.

What are some things that we might do as a state and a nation to improve on preterm birth and infant mortality rates?

One of the big truths in our field is that a healthy pregnancy starts before pregnancy. So that means ensuring that people have access to preconception care. That means if someone is considering a pregnancy, talking to a health care provider about managing diabetes or getting to a healthy weight or making sure that they have access to a high blood pressure medication that is safe for pregnancy.

If there's anything that looks like good news in this report, it's that the rate of maternal mortality in Colorado is 15.2 per 100,000 births, well below the national rate of 23.5. Any thoughts on why Colorado's rate is lower?

There are a lot of things we do well here in Colorado. Overall, there is good access to prenatal care. We do have rural areas where it can be harder to get in with an OB or a midwife, but once someone is coordinated into that care, as a state we do a good job of getting people the care that they need.

We have great infrastructure for telehealth, and relatively speaking, we’ve done a good job of providing people with medical coverage during pregnancy or with coordinated networks of care for people without health insurance. The report also talks about Colorado now having paid access to parental leave, which is huge for support.

Here at the CU School of Medicine we have specialty teams, whether that’s for people with high-risk cardiac conditions or for people with placenta accreta spectrum. We specialize in anticipation and treatment of things that can be life threatening for people. We also are working on health equity to decrease those disparities between people of different races and ethnicities.

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Rebecca Cohen, MD, MPH