FACT SHEET FOR PATIENTS AND FAMILIES
Preterm Birth: 10 Steps to Help Prevent It
What is it — and why does it matter?
Preterm birth is a birth that happens too soon — before 37
weeks of pregnancy. (Your due date is set for 40 weeks
gestation, so a preterm birth is 3 or more weeks early.)
Preterm births fall into two groups:
•• A medically indicated preterm birth is a delivery that’s
recommended and initiated by the doctor. A doctor
will suggest an early delivery if either baby or mother
has a condition that makes continuing the pregnancy
dangerous. Common reasons for indicated preterm
birth include intrauterine growth restriction (IUGR, in
which the baby is grows poorly during the pregnancy),
preeclampsia, and placenta previa.
•• A spontaneous preterm birth happens when the woman
goes into preterm labor or when her water breaks too
early (premature rupture of membranes, or PROM).
Once preterm labor begins or the membranes have
ruptured, an early birth usually can’t be avoided.
Preterm babies are premature — their organs and systems
may not be completely mature or functional, not completely
ready for the outside world. Because of this, these
“preemies” face an increased health risk both immediately
after birth and in the long term. The earlier in pregnancy a
baby is born, the higher the risk.
Short-term problems. In the first few weeks of life,
a premature baby can have these problems:
•• Breathing problems. Premature babies often have
problems caused by underdeveloped lungs. Abnormal
pauses in breathing (apnea), difficult breathing (from
respiratory distress syndrome), and lung infections are
all common, particularly in babies born before 34 weeks.
•• Heart problems. A premature baby may have a heart
opening (patent ductus arteriosus, or PDA) that will require
surgery to correct. Low blood pressure is also common.
•• Brain problems. Premature babies, especially those born
before 28 weeks, have a higher chance of brain bleeds.
•• Problems feeding and digesting. A small baby, born
too early, may not have the stamina to feed well. Also,
premature babies are at risk for a serious problem in the
intestines, necrotizing enterocolitis (NEC). It can
develop 2 to 3 weeks after birth, causing feeding
problems, diarrhea, and a swollen belly.
•• Temperature control problems. Premature babies often
have trouble keeping their bodies warm. This can make
other problems worse, since the babies must use extra
energy to try to maintain a healthy temperature.
Long-term problems. Studies show that babies
born too early have a higher chance of having these
problems throughout life:
•• Learning and behavioral problems. Children who
were born prematurely may lag behind their peers in
school. They may have trouble with social skills,
attention, and speech.
•• Cerebral palsy. This lifelong condition can affect
movement, balance, and posture.
•• Vision and hearing loss.
•• Chronic conditions. Asthma and allergies are often seen in
children who were born prematurely. Depression is also
more common in teenagers who began life as preemies.
Not all premature babies have health problems. Many do
well right from the start — and continue to do well all
their lives. However, given the high risk of problems, a
preterm birth is never the best end to a pregnancy.
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What causes preterm birth?
Many cases of preterm birth have no known cause. Even
preeclampsia, a common reason for a medically indicated
preterm delivery, isn’t well understood. However, science
has shown that preterm birth (indicated or spontaneous)
is more common in women with certain risk factors.
Factors strongly associated with preterm birth include:
•• Prior preterm birth. You’ve delivered early before. This
is the strongest risk factor for recurrent preterm birth.
•• Short cervix. Your cervix — the neck-like opening to
the uterus — shortens in preparation for childbirth.
If an ultrasound shows that your cervix has shortened
too early in the pregnancy, you have an increased risk
of delivering early.
•• Pregnancies close together. You’ve become pregnant
within 18 months of your earlier pregnancy.
•• Multiple gestation. You’re carrying twins or triplets.
•• Infection. You have an untreated urine or
vaginal infection.
•• Smoking and substance use. You use tobacco,
prescription pain medication, or street drugs.
•• You have a chronic condition such as
insulin‑dependent diabetes, antiphospholipid
antibody syndrome (APS), chronic high blood
pressure (hypertension), or anemia.
•• Underweight, overweight, or poor nutrition.
•• Little or no prenatal care.
•• African American race.
•• Problems with the uterus or cervix (fibroids, scarring
from previous surgery, anomalies such as septate uterus
or bicornate uterus).
Keep in mind that while these factors increase your
likelihood of preterm birth, they probably don’t explain
the whole story. Most preterm deliveries happen in
women with no known factors.
What can I do to help prevent it?
Because preterm birth isn’t well understood, there are
few reliable ways to predict, prevent, or treat it. However,
studies have shown that there are ways to lower risks.
1 Plan your pregnancies — and space them at least 18
months apart. Family planning gives you a chance to
make sure you, your body, and your circumstances are
prepared for a new addition. It’s also important for
preventing preterm birth. A gap of at least 18 months
between pregnancies lowers your risk for delivering early.
2 Use highly effective contraception as soon as possible
after a birth. The best way to ensure an 18-month space
between pregnancies? Use highly effective
contraception. Some forms of contraception can be
started before you leave the hospital. See the chart at
right for a comparison of contraception choices.
3 Achieve or maintain a healthy weight. Underweight
and overweight women both have an increased risk of
preterm delivery. Ideally, your body mass index (BMI)
should be between 18.5 and 24.9 when you get pregnant.
If you’re outside of this target range, ask your doctor what
you can do to get there. Don’t get discouraged — and
keep the end in mind (a healthy baby). Even small
changes in weight reduce your risk.
BMI is calculated based on your height and weight.
You can learn your BMI by checking online here:
www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
4 Don’t smoke and don’t use substances that increase
the risk of preterm birth. Smoking is a major risk
factor for preterm birth. So is using prescription pain
medication (opioids) or other substances like cocaine
and methamphetamine (meth). The more you smoke or
use, the higher the risk of your baby being born early.
If you smoke or use substances, talk to your doctor.
Your doctor can give you support and information for
quitting. Don’t give up! Most people try to quit several
times before they’re successful — and there has never
been a better time to quit.
• For support to quit smoking, call
800-QUIT-NOW (1-800-784-8669) or visit
www.tobaccofreeutah.org/quitline.html
• To locate counseling or treatment for substance use,
visit Substance Abuse and Mental Health Services
Administration: 800-662-HELP (English, Spanish) or
www.findtreatment.samhsa.gov
To lower your chance of having a preterm birth —
and to protect your baby from potentially dangerous
complications — take the following steps:
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Comparing effectiveness of contraception methods
most effective
to make the method
more effective…
less than 1 pregnancy per 100 women in one year
highly effective contraception:
the methods in this row prevent pregnancy more than 99% of the time
implants
(Implanon, Nexplanon)
IUD
(Mirena, ParaGard)
female
sterilization
vasectomy
effective contraception:
the methods in this row prevent pregnancy more than 90% of the time
injectables
(Depo-Provera)
birth control pills
patch
diaphragm
spermicides
female condoms
periodic abstinence
(fertility awareness
method, rhythm method)
•• Injectables: Get repeat
injections on time.
•• Birth control pills:
Take a pill every day.
•• Patch, ring: Keep in
place, change on time.
vaginal ring
(NuvaRing)
less effective contraception:
the methods listed below prevent pregnancy 70% and 90% of the time
male condoms
•• Vasectomy
(male sterilization):
Use another method
for first 3 months.
•• Condoms, diaphragm:
Use correctly every time.
•• Periodic abstinence
methods: Use condoms
on fertile days (or
don’t have sex then).
Newer methods such as
Standard Days Method or
Two-Day Method may be
easier to use.
•• Spermicide: Use correctly
every time you have sex.
Combine it with another
method (e.g., condoms)
to increase effectiveness.
least effective
about 30 pregnancies per 100 women in one year
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5 Take a multivitamin with at least 400 mcg of folic acid.
Make this a habit! Experts recommend that every
woman of childbearing age take folic acid, even if she’s
not planning to become pregnant. Long-term
supplementation helps prevent certain birth defects —
and may lower your chance of delivering early.
6 Get good control of any chronic conditions.
Controlling your chronic condition can help you have
a healthy pregnancy — and a healthy, full-term baby.
Work with your doctor to achieve or maintain control
of these or any other conditions you may have:
–– Diabetes, type 1 or type 2
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If you’ve already had one preterm birth, get a
personal risk assessment. Previous preterm birth is
the strongest risk factor for another preterm birth.
Based on your unique situation, your doctor can
estimate your chance of recurring preterm birth.
Your chance will be expressed as a percentage.
A 50% chance of recurrence, for example, means
that you have a 1 in 2 chance of preterm birth in
your next pregnancy.
For your personal risk assessment, ask
your provider for Intermountain’s
Preterm Birth Risk Worksheet
–– High blood pressure (hypertension)
–– Autoimmune disease, such as rheumatoid arthritis,
lupus, or antiphospholipid antibody syndrome (APS)
7 If you’ve received treatment for infertility, talk to
your doctor about ways to lower the chance of
multiples (twins or triplets). Fertility treatment can
sometimes increase your risk of getting pregnant with
more than one baby — and unfortunately, these
multiple gestation pregnancies have a very high risk of
ending prematurely. However, there are strategies to
lower your chance of having twins. Talk to your doctor.
8 See your doctor before you start trying to get
pregnant — and see your doctor early and regularly
during your pregnancy. Seeing your doctor before
and during pregnancy can help you have a healthy
pregnancy. Studies show that women who receive good
prenatal care have a smaller chance of delivering early.
Why is this important to know? Knowing your risk
can help you and your doctor work together to treat
other risks and watch closely for early signs of preterm
labor or other complications.
10 If you’ve ever delivered early because of preterm
labor or because your water broke early (premature
rupture of membranes, or PROM), talk to your
doctor about taking 17P during your next
pregnancy. During pregnancy, injections of 17P, a
form of the natural hormone progesterone, can lower
the chance of preterm birth. In fact, 17P is one of the
most effective treatments available for women with a
prior preterm delivery — studies show that treatment
with progesterone lowers the risk of another preterm
birth by about one-third (30%). Even in pregnancies
that still end in preterm delivery, treatment seems to
add valuable days to the pregnancy — vital extra time
for babies’ growth and development in the womb.
17P is only appropriate for women with singleton
pregnancies (not twins or other multiples) who have
had preterm labor or PROM in a previous pregnancy.
17P is given by injection once a week between weeks
16 and 36 weeks of pregnancy.
For more information, ask your provider
for Intermountain’s fact sheet,
17P for Preventing Preterm Birth
© 2014 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it
should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. More health information is
available at intermountainhealthcare.org. Patient and Provider Publications 801-442-2963 FS370 - 03/14 Also available in Spanish.
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