What is a premature birth? Can it be avoided? What are the consequences?

Definition: When do we speak of premature birth?

A normal pregnancy lasts around 40 weeks. A premature birth (ICD-10 code: P07.3) is when a baby is born before the end of the 37th week of pregnancy - i.e. more than three weeks before the expected date of birth. The birth weight can also be a decisive factor: If a baby weighs less than 2,500 grams, even though it was born on schedule, it is also referred to as a premature birth.

Two thirds of all premature births occur naturally: labour starts early or the amniotic sac breaks. In a third of premature births, the birth is induced artificially due to a pregnancy complication.

Late preterm birth (32 to 37 weeks' gestation)

Babies born between the 32nd and 37th week of pregnancy are also known as late preterm babies. They hardly differ from babies born at term, but are slightly smaller and lighter.

Early preterm birth (28 to 32 weeks' gestation)

The term "premature baby with a very low birth weight" is also commonly used when a baby weighs less than 1,500 grams at birth. As a rule, these premature babies are born before the 32nd week of pregnancy - i.e. in the eighth month of pregnancy.

Extremely premature birth (before 28 weeks' gestation)

Premature babies with an extremely low birth weight weigh less than 1,000 grams and are usually born before the 29th week of pregnancy - i.e. in the seventh or even sixth month of pregnancy.

Underweight term babies

If a baby is born on the due date but still weighs less than 2,500 grams, it is referred to as an "underweight term baby". According to the Maternity Protection Act, these babies are also categorised as premature babies.

When is it no longer a premature birth?

As soon as a baby has completed the 37th week of pregnancy and weighs more than 2,500 grams at birth, it is no longer a premature birth. 

When can a baby survive a premature birth?

The general rule is that the 23rd week of pregnancy must be completed for the baby to be viable. In Germany, therefore, all babies who have reached 24 weeks' gestation at birth receive intensive medical care.However, there are always success stories of babies who have survived after a premature birth in the 21st, 22nd or 23rd week of pregnancy andhavea particularly low birth weight of sometimes less than
500 grams However, this is not the norm. In Germany, the chance of survival for these particularly small premature babies is 20 to 30 per cent. 

The chance of survival depends heavily on the time of birth and weight.Premature babies born after 24 weeks of pregnancy have a statistical chance of survival of
60 per cent At 28 completed weeks of pregnancy, this is already 90 per cent.

Frequency: Statistics for premature births in Germany and Switzerland

The probability of a premature birth in Germany is around eight per cent.With around
800,000 births per year, this equates to around 64,500 premature births

The figures are similar in Switzerland: according to the Swiss Federal Statistical Office
7 out of every 100 newborns are born prematurely

Problems with premature birth

When a baby is born prematurely, it is usually not yet fully developed. Depending on how prematurely it was born, the baby may not yet be able to breathe, drink or maintain its body temperature independently. This is why premature babies often have to be ventilated and fed via a feeding tube. In an incubator, the conditions that the baby is familiar with from its mother's womb are simulated. 

The following complications can also occur after a premature birth:

• Electrolyte deficiency or excess due to underdevelopment of the kidneys
• Brain haemorrhages
• Infection with infectious diseases due to an underdeveloped immune system
• Digestive problems
• Hypoglycaemia
• Neonatal jaundice

Causes: Why does a premature birth occur?

There are various causes that can trigger a premature birth. Several factors often play together, meaning that no single cause can be held responsible. In addition to maternal causes such as previous illnesses or pregnancy complications, demographic factors such as age and even dental health can also increase the risk of a premature birth.

Periodontitis and premature birth

As many people are unaware of this cause of premature birth, we will mention it first: women who suffer from periodontitis have an increased risk of premature birth. What exactly does this mean? Periodontitis is an inflammation of the periodontium: the gums recede and form gum pockets. The necks of the teeth become visible. At an advanced stage, the jawbone also recedes so that the teeth become loose and, in the worst case, fall out. 

What sounds terrible in such a simplified description often starts off harmlessly - with inflammation of the gums. If we do not brush our teeth regularly and thoroughly with a toothbrush and interdental brush, plaque builds up on our teeth, which can harden into tartar and which we can no longer brush away with a toothbrush. 

This plaque is the ideal breeding ground for bacteria, which can settle and multiply undisturbed. These bacteria secrete metabolic products, acids and toxins that attack the gums. The junction between the tooth and gum is particularly susceptible to this. If the gums are inflamed, you can often recognise this by bleeding gums. Simple gum inflammation is not tragic. However, it becomes dangerous if it is not treated and can spread further - until it has developed into periodontitis. To prevent this, a special brush to care for the gum line, such as the CS 1006 Single from Curaprox, can be helpful.

And what does this have to do with premature birth? Numerous studies have shown that mothers with healthy teeth have a very low risk of miscarriage, while mothers who gave birth prematurely predominantly suffered from severe gum disease - the risk of premature birth is seven times higher for periodontitis patients than for women with healthy teeth. The reason for the frequent miscarriages with poor gum health may be an increased level of the body's own antibodies in the blood.

This realisation is particularly important, as many women suffer more frequently from gum inflammation during pregnancy due to hormonal changes and the loosening of the tissue. 

Infections and pregnancy complications

An ascending bacterial infection from the vagina or urinary tract can also trigger a premature birth. 

Other pregnancy complications can also lead to this. For example:

• Uterine malformations
• Premature detachment of the placenta
• Cervical weakness
• Malformation of the child

If you are wondering whether a symphysis loosening can trigger a premature birth , we can reassure you: During pregnancy, the cartilage that connects the right and left halves of the pelvis can expand by up to 4 millimetres. Although this leads to severe pain in the area of the pubic bone, it is not dangerous for the child's development. 

Diseases

The following diseases of the mother can favour a premature birth:

• High blood pressure
• Diabetes
• Kidney and liver diseases
• Heart diseases
• Functional disorders of the thyroid gland

Numerous studies have also found that the number of premature births has risen sharply due to corona . According to an Israeli study, women who become infected with coronavirus after the 34th week of pregnancy have a seven-fold increased risk of premature birth. 

Medical history 

If a woman has experienced a premature birth with her first child, there is a risk of recurrence for the second child. After a premature birth or miscarriage, doctors often classify a pregnancy as a high-risk pregnancy . In principle, this is no reason to panic and simply means that those affected should take good care of themselves and follow the recommendations of healthcare professionals. The term high-risk pregnancy is also used for the possible causes of premature birth mentioned above.

Multiple pregnancies

Premature births are particularly common in twin pregnancies. The average age at which twins are born is 36 weeks' gestation - for triplets it is 32 weeks' gestation and for quadruplets 31 weeks' gestation. If three or more babies have to share the mother's womb, premature birth is inevitable - there is simply not enough space for full development.

Lifestyle 

It is generally recognised that an unhealthy lifestyle has a negative impact on pregnancy. Smoking and the consumption of alcohol or drugs can not only impair the development of the child, but also increase the risk of premature birth. Women who are severely overweight or underweight and women who perform heavy physical labour during pregnancy also have a higher risk of premature birth. 

Interesting: A global study by the World Health Organisation from 2014 shows that smoking bans in public buildings (including workplaces) in the USA and Europe were able to significantly reduce the number of premature births.

Demographic factors

Age can also be a risk factor: Women under 18 or over 35 have an increased risk of premature birth.

Premature birth due to heat

Surprisingly, even the weather can influence the time of birth: A particularly large number of babies are born on particularly hot days - and also on the following day. Scientists came to this conclusion when they compared weather data and birth rates in the USA from 1969 to 1988. 

Premature birth due to stress

Severe stress can trigger premature labour and thus lead to a premature birth. It doesn't matter whether it is caused by conflicts in the private sphere, relationship problems, stress at work or financial worries. Many women also suffer from multiple stresses because they are trying to juggle family, household and career.

Is the risk of premature birth hereditary?

In fact, there appears to be a hereditary component to the risk of premature birth: Women who were either born prematurely themselves or have a sibling who was born prematurely have a 50 to 60 per cent higher risk of premature birth. The exact reason for this is not yet known. 

Can linseed oil cause premature birth?

Experts are not unanimous on this question. There are scientific studies that suggest that linseed oil could increase the risk of premature birth. However, this has not yet been proven. If you want to be on the safe side, you can avoid linseed oil during pregnancy as a precaution. It is best to seek advice on this from your gynaecologist.

Possible consequences of a premature birth

As important developmental time is lost in the womb during a premature birth, children of the same age can have a head start in development. Premature babies often need several years to catch up. At the age of three or five, for example, there are often still major differences between premature babies and full-term babies. By the age of eight, however, the level of physical development is usually similar - at least if there has not been a brain haemorrhage after birth. 

A simple principle applies to the late effects of premature birth: the later a child is born, the less likely it is to have serious late effects. Premature babies with an extremely low birth weight (less than 1000 grams) are therefore much more likely to develop a physical disability or cognitive impairment.
 25 per cent of extremely premature babies show signs of autism. Attention deficit hyperactivity disorder (ADHD) and learning disabilities such as dyslexia or dyscalculia are also common in extremely premature children. 

According to a US study, 50 per cent of children with a birth weight of less than 1000 grams suffer from a learning disability by the age of eight. Another study found that children born prematurely at the age of eight were twice as likely to suffer from asthma (21 per cent vs. 9 per cent in the control group), five times as likely to have motor disorders (47 per cent vs. 10 per cent) and 2.5 times as likely to have an intelligence quotient below 85 (38 per cent vs. 15 per cent). They may also have visual and hearing impairments, seizures and chronic lung problems.

Late effects of premature birth in adulthood

Long-term consequences can also be expected in adulthood: premature babies are more likely to need therapeutic treatment - for example physiotherapy, speech therapy or occupational therapy. Premature birth also has long-term social and psychological consequences: Children who weigh less than 1,500 grams at birth are more likely to be anxious and insecure as adults than their term-born peers and are also more likely to suffer from depression and anxiety disorders. They often shy away from social contact and challenges and have communication difficulties. This is also evident in their sex life: In a survey of
200 people aged 26 who were born prematurely, 25 per cent stated that they had not yet had any sexual experience - compared to less than one per cent of those born at term.

Psychological consequences for the parents

A premature birth is a huge burden for parents. Not only are they worried about the well-being of their little baby, but they often feel guilty and have the feeling that they have failed - even if they are not actually to blame for the premature birth. Added to this is the burden of caring for the premature baby - especially if there are other children who need to be looked after. Many parents also feel overwhelmed by a premature birth because they suddenly have no time and have not yet prepared for the birth. Due to these numerous stress factors, parents of premature babies are more likely to suffer from depression and anxiety disorders. Postnatal depression is also more common in mothers who have experienced a premature birth than in mothers who have had a normal pregnancy.

Warning signs: How can I recognise an imminent premature birth?

Many women are afraid of a premature birth. This makes it all the more important to recognise the first symptoms: The clearest sign of a premature birth is the early onset of labour. Pay attention to whether the contractions last longer than an hour, occur at intervals of five to ten minutes and last longer than 30 seconds. If this is the case, you should tell your midwife or doctor and go to hospital. 

Another sign of premature labour is premature rupture of the amniotic sac. If you feel that your waters are breaking - either in the form of droplets or a gush - you should also go to hospital. 

Bleeding can be a sign that the placenta is detaching prematurely. This should also be examined by a doctor immediately.

Examinations in the event of a threatened premature birth

In addition to a physical examination, the following examination methods can be used in hospital:

• Ultrasound examination to check the position, size and weight of the baby and to determine the amount of amniotic fluid and position of the placenta
• Swab for checking for germs
• Checking the baby's heartbeat and labour activity (cardiotocography)

Premature birth: treatment

If a premature birth is imminent, there are two scenarios: 

1. the birth is permitted because the amniotic fluid has already broken or the placenta has already been expelled or the baby generally has a good chance of survival. If labour has not yet started at this point and the cervix has not opened, the birth is induced.  

2. the baby is not yet ready for birth and the healthcare professionals are trying to delay the birth therapeutically. In this case, the expectant mother must remain on bed rest and may be given labour-inhibiting medication. Although these drugs cannot treat the cause of the contractions, they do give the expectant mother and baby some much-needed extra time. The mother can then be transferred to a perinatal centre that specialises in premature births. In addition, glucocorticoids are often administered in this situation to speed up the lung maturation process and reduce the risk of cerebral haemorrhage, respiratory distress syndrome and necrotising enterocolitis.

If the cervix has already opened and the cervix is already shortened, doctors can perform a cerclage up to 23 weeks' gestation and close the cervix artificially. 

Caesarean section or natural birth?

Around half of premature babies in Western countries are born by caesarean section. For a long time, it was assumed that this form of birth was gentler on the particularly small and weak babies. However, US researchers found the opposite to be true: premature babies born by caesarean section need assistance with breathing more often than babies who have "fought" their way through the vaginal birth canal. The reason for this could be that the airways are "squeezed free" by the narrowness of the birth canal.

Neuroprotection

In the case of a premature birth between the 24th and 32nd week of pregnancy, the expectant mother can receive magnesium sulphate in the form of an infusion a few hours before the birth. This measure is also known as neuroprotection. This is intended to reduce the risk of a malformation of the brain that causes movement disorders and muscle stiffness (cerebral palsy). 

Incubator

Many babies who are born prematurely must first spend some time in an incubator. The conditions in the mother's womb are simulated there and the organ functions are monitored and supported. Many premature babies are not yet able to regulate their body temperature and need support with breathing and feeding. The incubator provides the baby with a constant temperature and humidity as well as protection for the not yet sufficiently developed immune system. 

The kangaroo method

A premature birth is a traumatic experience for both the baby and the parents. In order to strengthen the emotional bond between parents and child and to give the baby a feeling of safety and security, premature babies are placed on the mother's or father's bare chest for several hours a day, dressed only in a nappy. This allows the baby to hear the familiar heartbeat and enjoy the physical contact. Kangarooing is not just a lovely cuddling session that has a positive psychological effect. It has also been proven to improve the premature baby's health and development.

Breast milk as early as possible

Breast milk from mothers who have had a premature birth contains a particularly high concentration of important nutrients and also provides the baby with antibodies. It is therefore important that the baby receives breast milk as early as possible. However, premature babies are often unable to feed themselves. Mothers then have to express the milk and the baby receives it via a feeding tube. If the baby is not yet able to digest breast milk, it is initially given a mixture of water and sugar. It is an important milestone when the premature baby can finally be fed directly from the mother's breast.

What support options are there for premature babies?

A premature birth is an incision that parents first have to come to terms with. This is why they are supported by paediatric, medical and obstetric specialists during their stay in hospital and receive guidance on everyday life with their premature baby. Parents can also apply to their health insurance company to have certain support costs covered. This includes, for example, home paediatric care and household help or the support of a childminder to look after other children during the hospital stay.

Premature birth is also taken into account in statutory benefits: In Germany, maternity protection and maternity benefit are extended from 14 to 18 weeks for a birth weight of less than 2,500 grams. The certificate of "medical premature birth" is issued by the clinic and must be submitted to the employer.

If the baby has to stay in hospital after the premature birth and it is medically necessary for both parents to be present, fathers can take unpaid special leave and apply to the health insurance fund for net replacement payments. Similar to a sick note, doctors issue a certificate that must be submitted to the health insurance company. The health insurance company then pays the lost net salary for this period.

There is also extended parental leave for premature births so that parents have more time for their child. Depending on how prematurely the baby was born, parents are entitled to one to four months of additional basic parental allowance, which can also be converted into Parental Allowance Plus. The following rules apply in Germany for calculating parental leave in the event of a premature birth:

• An additional month of basic parental allowance for a birth at least six weeks before the due date
• Two additional months of basic parental allowance for a birth at least eight weeks before the due date
• Three additional months of basic parental allowance for a birth at least twelve weeks before the due date
• Four additional months of basic parental allowance for a birth at least 16 weeks before the due date

5 tips for prevention: How can I prevent a premature birth?

As you already know, a premature birth can have a negative impact on the child's development. It is therefore particularly important to keep the risk of premature birth as low as possible and to minimise the risk factors that we can influence.

1. Undergo preventive medical check-ups and take protective measures

Make sure you attend the check-ups during your pregnancy. If you have a high-risk pregnancy, preventive measures can be taken to avoid a premature birth: For example, administering the hormone progesterone can reduce the risk of another premature birth if you have already had a premature birth. The cervix can be completely closed during a cervical closure operation. This prevents bacteria from entering the uterus and causing a premature birth. In this so-called cerclage, a band is placed around the cervix. 

A pessary can also reduce the risk of a premature birth - especially in the case of multiple pregnancies and cervical weakness. A gynaecologist inserts a ring-shaped medical device to stabilise the cervix. 

2. Abstain from alcohol, tobacco & co.

A healthy lifestyle is a prerequisite for a healthy pregnancy. Avoid alcohol, tobacco and other drugs during pregnancy so as not to negatively affect your child's development and unnecessarily increase the risk of premature birth.

3. Intimate area care

Infections in the genital area can be a cause of premature birth. It is therefore important that you prioritise good intimate hygiene. But be careful not to overdo it. The natural vaginal flora protects against pathogens. If you cleanse it with unsuitable aggressive care products, you will upset the balance and possibly cause damage. Use mild intimate care products and seek advice from your gynaecologist or midwife. Also important: Synthetic underwear can cause infections and provides an ideal breeding ground for bacteria and fungi. It is therefore better to use cotton or silk underwear.

4. Reduce stress and seek help

Stress is also a risk factor for a premature birth. Reducing stress is perhaps easier said than done, especially during pregnancy - after all, you have lots of appointments, are preparing for the baby's arrival, are trying to juggle work, family and friends and may also be struggling with physical complaints. However, you should really focus on your mental well-being during this time and allow yourself as much time off as possible. Ideally, your partner, family and friends will support you. Don't be afraid to ask for help if you feel overwhelmed. There are also social support programmes for pregnant women that you can use.

5. Pay attention to dental care

As you already know, periodontitis also increases the risk of premature birth. That's why you should make sure you take good care of your teeth and ideally rectify any existing problems with your teeth and gums before you become pregnant. If you are already pregnant and have not yet been to the dentist, you should make an appointment for a check-up as soon as possible. 

Professional teeth cleaning  is also a good idea during pregnancy. To protect your teeth and gums, you should brush your teeth twice a day for around three minutes. A soft toothbrush (such as the CS 5460 from Curaprox) is ideal to protect your gums, which are particularly sensitive during pregnancy. Using a fluoride toothpaste (such as 'Be you' toothpaste from Curaprox) not only protects your teeth from tooth decay, but also from the aggressive stomach acid that your teeth often come into contact with if you suffer from morning sickness and the associated vomiting.