Are Preterm Births on the Decline in the United States? Recent Data From the National Vital Statistics System

Abstract

• This marks the first 2-year decline in the preterm birth rate in nearly three decades. • Preterm birth rates declined from 2006 to 2008 for mothers of all age groups under age 40, for the three largest race and Hispanic origin groups and for most U.S. states. • The percentage of preterm births was down for all types of deliveries from 2006 to 2008, for cesareans and for induced and noninduced vaginal deliveries. The U.S. preterm birth rate (less than 37 weeks of gestation) rose by more than one-third from the early 1980s through 2006 (1). This rise has been a cause of great concern (2,3). Preterm infants are at increased risk of lifelong disability and early death compared with infants born later in pregnancy (2,4). Many reasons, such as changes in maternal demographics and increases in multiple births, have been suggested for the growth in preterm births (5). Another factor cited is the heightened use of obstetric interventions such as induction of labor and cesarean delivery earlier in pregnancy (5,6,7). Although it is not possible to know whether an infant would be born preterm if labor was not induced or delivered by cesarean, studies suggest that increased use of these procedures before 37 completed weeks of gestation may have influenced the upswing in preterm birth rates (6,7). Preliminary 2007 and 2008 birth certificate data reveal a shift in the long upward trend in preterm births (8,9). This report describes this change.

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“…Preterm delivery, or birth prior to 37 weeks, affects 12.3% of pregnancies in the United States (209). It remains one of the most prevalent and morbid perinatal complications.…”

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“…Preterm birth rates are increasing in many 25,26 but not all countries. 27 The contribution of planned preterm birth to prematurity has been described in South America, 28 the USA 29,30 and France. 31 Despite improvements in outcomes, even late preterm birth is associated with higher short term and long term morbidity and mortality.…”

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“…This good news is tempered by a continued black-white disparity in both neonatal and infant mortality rates, with black infants having twice the rates of neonatal and infant deaths as compared with white (Figure 2) (22). Sobering news is that the United States continues to have high rates of preterm birth, with continued racial disparity in risk of prematurity (Figure 3) (24).…”