(RxWiki News) Sometimes it's not so good to be at the top. Though Asia and Africa dominate when it comes to premature births, the US ranks in the top ten countries - but the rate has been slowing.
A worldwide report of preemie births finds that one in every ten children worldwide is born early, and in nearly all the countries whose rates over time were studied, the rate is increasing.
"Attend all prenatal appointments with your OB/GYN or midwife."
Hannah Blencowe of the London School of Hygiene and Tropical Medicine and Joy Lawn, a pediatrician with Save the Children in Cape Town, South Africa, led the first known worldwide study into preterm birth rates across the world that included both estimates for each of the 183 countries as well as analysis of trends over time.
Their most important finding is that, in 2010, an estimated 14.9 million babies were born before they were due - which equates to about 11 percent of all births worldwide.
Preterm is considered birth before the 37th week of pregnancy, and it's the second leading cause of death among children under 5 years old.
"Our estimates highlight a fact that has received little attention," Dr. Lawn said. "Most European countries have about half the preterm birth rate of the USA, but whilst the US rate has leveled off, European rates, even in Scandinavian countries, are increasing."
They noted in their analysis the link between increased rates of cesarean sections and increases in preterm births.
"Distinguishing preterm births that are spontaneous from those that are provider-initiated is important to monitor trends associated with increased cesarean sections," they write.
Dr. Lawn and colleagues pulled from a range of data sources to gather their numbers. They used 563 national birth registries in 51 countries, 13 reproductive health surveys in eight countries, and 162 published and unpublished studies that provided data for 40 countries.
Another 55 countries submitted additional data to the World Health Organization, and the researchers estimated rates for 13 countries where data was inadequate.
The team could only analyze time trends for 65 countries, and as a group, the preterm birth rate has increased from 7.5 percent in 1990 to 8.6 percent in 2010.
The only three countries that saw a decrease in their preemie rates from 1990 to 2010 were Croatia, Ecuador and Estonia. In the US, the rate of increase, 0.7 percent, was lower than most European countries.
Those topping the list of higher increases in Europe are Cyprus, Slovenia, Belgium, Austria, Spain, Ireland, Portugal, Greece, France, the United Kingdom and Bosnia, ranging from 2.8 percent to 1.5 percent respectively.
"Urgent attention is needed to better understand and reduce these rates of preterm birth," the authors said.
According to an accompanying commentary by Nils-Halvdan Morken from the University of Bergen and Haukeland University Hospital in Norway, the costs of premature birth are not limited to the poor health outcomes of the babies themselves.
He quotes the US Institute of Medicine's estimate that preterm birth costs the US $26.2 billion a year and then notes that these babies, just 12 percent of all children born annually in the US, account for 60 percent of all spending on neonatal care.
"The expenses are clearly related to gestational age; an infant born at 38 weeks incurs a tenth of the expense of one born at 35 weeks ($441 vs $4733)," Morken writes. "Therefore, even a modest reduction in preterm birth would lead to substantially reduced costs."
Spending money on reversing the trend would therefore be well spent, Morken said. "Worldwide investment in maternal health and pregnancy will reduce suffering and probably save life-years at a scale never before seen in the history of public health," he said.
The study was published online June 7 in the Lancet. The research was funded by the Bill and Melinda Gates Foundation, the March of Dimes, the Partnership for Maternal Newborn and Childe Health, and the WHO's Department of Reproductive Health and Research. The authors declared no conflicts of interest.