Premature birth is a growing public health issue, affecting 12.5% of births in the USA and leading to increased mortality and long-term cognitive, behavioral, and academic challenges for late preterm infants. African American infants experience disproportionately higher rates of preterm birth and mortality, influenced by socio-economic factors and environmental stressors. The trend of rising preterm births, especially late preterm deliveries, raises concerns about the societal, medical, and educational implications for affected children.

1. Effects of Premature Birth on Neurocognitive Development and Academic
Performance: Longitudinal IEP Review of PT and SGA Student
Alamy, 2015; Beery, Buktenic , 2011; Woodcock-Johnson III Normative Update (NU) Complete, 1Ozella Brundidge 4/1/2017

2. Epidemiology of Preterm Birth
“Preterm birth is the most frequent cause of infant mortality, as well as the leading
cause of long term neurologic disabilities in children, including cerebral palsy and
developmental delays” (Shapiro-Mendoza & Lackritz, 2012, p. 120).
2

3. Preterm birth is an increasing public health problem in developed countries.2,5,6
3
Preterm Birth is an Increasing Public Health
Problem in the United States and
Developed Countries.
Cserjesi, Van Braeckel, Butcher, Kerstjens, Reijneveld, Bouma, Geuze, 2012; Goldenberg, Culhane, Iams, Romero,
2008 in 2012; Kramer, Demissie, Yang, Platt, Sauvé, Liston, 2000 in 2012; van Baar, Vermaas, Knots, de Kleine,
Soons, 2009 in 2012; Shapiro-Mendoza & Lackritz, 2012)
(Harrison-Dunn, 2016)
Preterm Birth Affects 12.5% of all Births in the USA

4. Preterm birth is an increasing public health problem in developed countries.2,5,6
4
Preterm Birth is an Increasing Public Health
Problem in the United States and
Developed Countries.
Cserjesi, Van Braeckel, Butcher, Kerstjens, Reijneveld, Bouma, Geuze, 2012; Goldenberg, Culhane, Iams, Romero,
2008 in 2012; Kramer, Demissie, Yang, Platt, Sauvé, Liston, 2000 in 2012; van Baar, Vermaas, Knots, de Kleine,
Soons, 2009 in 2012; Shapiro-Mendoza & Lackritz, 2012)
(Harrison-Dunn, 2016)
Preterm Birth Affects 12.5% of all Births in the USA

5. Preterm Infants are being Delivered at an Increasingly Early Gestational Age
5
Reasons for the Increase in Preterm Deliveries Include:
 An increase in elective deliveries for medical indications
 Increased use of caesarean section
(Kerr-Wilson, Mackay, Smith, & Pell, 2011 Meta-analysis citations: Howson, Merialdi, Lawn, et al., 2009; Noman, Morris,
& Chalmers, 2009; Goldenberg, Culhane, Iams, et al., 2008)

6. Precise Causes for the Increasing Preterm Birth
Trend are Unclear
6
Possible Etiologies
Include
Maternal Age
Artificial
Reproductive
Technologies
Multiple Births
(Cheong & Doyle, 2012; Kerr-Wilson, Mackay, Smith, & Pell, 2011
Meta-analysis citations: Howson, Merialdi, Lawn, et al., 2009; Noman,
Morris, & Chalmers, 2009; Goldenberg, Culhane, Iams, et al., 2008)

7. late preterm children not only have increased mortality and in-hospital morbidity including respiratory difficulties, but also
long-term cognitive, school performance, behaviour and psychiatric problems.
7(Cheong & Doyle, 2012)
Compared to Term,
Late Preterm
Children
have
Mortality
In-Hospital
Morbidity
Long-Term
Cognitive
Problems
School
Performance
Psychiatric
Problems
Behaviour
Problems
more
more
moreincreased
increased
poorer

8. The Practice of Delivering Infants Early when they Can be Delivered at Full-Term may Represent a
Larger Societal Burden than Previously Recognized
8(Lipkind, et al., 2012; Bastek, Sammel, Srinivas, Posencheg, & Elovitz, 2008 in 2012)
Evidence suggest that infants born late preterm have similar risks of adverse neonatal
morbidities as preterm infants delivered at 32-33+6 weeks’gestation.
The Practice of Delivering Infants Early when they
Can be Delivered at Full-Term may Represent a
Larger Societal Burden than Previously Recognized
(Montgomery, n.d.)

9. A Full 40-Week Gestation can help Prevent
Future Academic Difficulties
9
Late Preterm (LPT) Born Children are Not Reaching their
Full Academic Potential, and Require Additional Educational
Services that Might have been Avoided.
(Aeby, Van Bogaert, David, Baleriaux, Vermeylen, Metens, & De Tiege, 2012; Lipkind, et al., 2012; Bastek,
Sammel, Srinivas, Posencheg, & Elovitz, 2008 in 2012)
Evidence suggest that infants born late preterm (34-36+6 weeks’gestation) have similar
risks of adverse neonatal morbidities as moderate preterm infants delivered at 32-33+6
weeks’gestation.

10. The rising incidence and the possibility of long-term developmental impairments have triggered
growing concerns about the economic consequences of moderate prematurity for society.7,8
10
The increasing cases of moderate preterm (32-33 GA)
children with long-term developmental impairments have
triggered growing concerns about the medical, education,
and economic consequences for society.
(Jain, 2008; Stephens & Vohr, 2009)
(Kerstjens, et al., 2011; Mangham, Petrou, Doyle, Draper, Marlow, 2009 in 2011; Jain, 2008 in 2011)
(Brankin, n.d.)

11. A Normal Gestation Lasts 40 Weeks. Each year, Nearly 15 Million Infants are Born Premature
Worldwide.
11
A Normal Gestation Lasts 40 Weeks.
Each Year, Nearly 15 Million Infants
are Born Premature Worldwide.
(Barde, Yeatman, Lee, Glover, & Feldman, 2012; Noort-van der Speek, M.C. Franken, N.Weisglas-Kuperus, 2012 in
Ribeiro, C. D, Atramindes, D. V., Fuertes, M. G., dos Santos, P. N., Lamonica, D. A. (2016)
Meredith Woman's Corporation (2017)

12. the early interruption of the typical course of
pregnancy can lead to structural and anatomic
changes of the central nervous system
12
(Ribeiro, Abramides, Fuertes, Santos, Lamonica, 2016; Maria-Mengel & Linhares, 2007 in 2016; Reidy, et al., 2013 in
2016; Wohr, 2013 in 2016; Samra, et al., 2011 in 2016; Ballot, et al., 2012 in 2016; Ortiz-Mantilla, et al., 2008 in 2016)
Prematurity is Considered a Biological Risk Factor for
Atypical Developmental Trajectories
(123rf.com, 2017)
Early Interruption of the Typical
9.5 Month Course of Pregnancy can
Lead to Structural, Anatomic, &
Biological Changes in the Neonate’s
Central Nervous Center
(Study.com, 2017)

13. The Impact of Stress, Race, Poverty, and
Related Environmental Factors on Fetal Development
• Experience disproportionately high rates
of preterm delivery and low birth weight
• Are more than twice as likely to die during
their 1st year of life than White American
infants.
(Giscombé & Lobel, 2005; Myhre & Myhre, 2011)
13
African American Infants

14. Factors Associated with Ethnic Differences in
Adverse Birth Outcomes
• Ethnicity, socioeconomic status (SES), and health behaviors
• Higher levels of stress in African American women
• Greater vulnerability to stress in African Americans
• The impact of racism as a contributor to stress or as a
factor that exacerbates stress effects
• Ethnic differences in stress-related neuroendocrine,
vascular, and immunological processes.
14
(Giscombé & Lobel, 2005)
(Etsy, Inc., 2017)

15. Infants of African American
Mothers are Disproportionately
Affected by Premature Deliveries
• 1.5 times the risk of preterm birth
• 3.4 times the risk of preterm-related
mortality
15
(Shapiro-Mendoza & Lackritz, 2012; ClipartFest, 2016)

16. Late Preterm Infants (34-36 weeks gestation) Account for up to 75%
of Preterm Births and make up a significant proportion of all
neonatal admissions.
16
Neonatal Intensive Care Unit (NICU) Admission by
Race 2009-2010

17. Late Preterm Infants (34-36 weeks gestation) Account for up to 75%
of Preterm Births and make up a significant proportion of all
neonatal admissions.
17(Davidoff, Dias, Damus, et al., 2006 in McGowan, et al., 2012
Late Preterm Infants (34-36 𝟔
𝟕 weeks)
make up a Significant Proportion of all
Neonatal Intensive Care Admissions.

18. Over 400,000 Infants were Born Premature in the United States in 2013
The percentage of preterm births in the United States by race and Hispanic origin in 2013 (CDC, 2015).
According to the
Center for Disease
Control and
Prevention (CDC),
16.3% of all African
American Infants
were Born Preterm in
2013 (CDC, 2015).
18

19. Absence of Prospective Data on Late Preterm Outcomes
• Late preterm (LPT) infants have been ignored in follow-up, because
they were thought to be at low risk for permanent impairments.
• Since LPTs are prone to having temporary clinical problems, this may
have led to a less rigorous approach to their perinatal and postnatal
management, and to the absence of prospective data sets that track
outcomes.
19
Jain, 2008

20. Decreasing Gestational Age is Associated with
Neuropsychological Deficits
20(Bhutta, Cleves, Casey, Cradock, Anand, 2002 in Cserjesi, et al., 2012)
• The mean cognitive scores of preterm-born cases and term-born controls
were directly proportional to their birth weight (R2 = 0.51; P<.001) and
gestational age (R2 = 0.49; P<.001).
• Preterm-born children also showed increases in externalizing and
internalizing behaviors in 81% of studies, and had more than twice the
relative risks for developing ADHD (pooled RR, 2.64; 95% CI, 1.85-3.78).
Bhutta and colleagues’ (2002) previous study findings:

21. Moderately preterm infants born at ≥32 weeks’ gestational age (GA) currently
make up over 80% of all preterm births in developed countries
21(Stichting Perinatale Registratie Nederland, 2008 in Cserjesi, et al., 2012; Agarwal & Jain, Oct 19, 2013)
Moderately Preterm Infants Born at ≥32 weeks’
Gestational Age (GA) made up over 80% of all
preterm births in developed countries in 2006

22. Preterm Birth Effects 12.5% of all Births in the USA
22(Shapiro-Mendoza & Lack, 2012)
The preterm birth rate has increased by 33% in the last 25 years,
primarily due to the rise in late preterm births (34-36 weeks' gestation).
Infants of African American Mothers are Disproportionately Affected
 1.5 times the risk of preterm birth
 3.4 times the risk of preterm-related mortality

23. The Potential Risk for Preterm Birth as a Result of Exposure to Environmental Pollutants is
Poorly Understood
23
Environmental chemical pollutants, such as the
neurotoxin lead, tobacco smoke, and air pollutants are
suspects to contributing higher rates of preterm births
among African Americans living in inner cities or near
toxic waste sites.
The Potential Risk for Preterm Birth as a Result of Exposure
to Environmental Pollutants is Poorly Understood
(Behrman & Butler, 2007; thegirlwiththeblog, 2013 March 12; Fresh Water Systems.com,2017)

24. End of
Epidemiology of Preterm Birth
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