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<<   作成日時 : 2008/11/30 01:24   >>

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 未熟児の出生率はバーモントで最も低く、ミシシッピで最も高い。喫煙、妊婦管理の不足、早期の帝王切開が未熟児出生に影響している。
 2010年の目標には遠く及ばず、国への評価は「D」となる。
 米国では50万以上の新生児−出生8人に1人−が未熟児出生で、ここ20年間着実に増加している。連邦政府の目標は妊娠37週前の出生率を7.6%以下にすることである。原因は複雑で全てが説明できるわけではない。
 しかし、水曜日に出されたレポートは、極めて大きな地域差が見られることが目立っている。
 バーモント州では、2005年に未熟児は9%であった。オレゴンとコネチカットは10.5%。南部は悪く、ウェストバージニアで14.4%、ケンタッキーとサウスカロライナは15%、アラバマとルイジアナは16%、ミシシッピは最高の18.8%である。
 各州に対して3つの要因を強調した。
 健康保険の欠如は、妊娠中の検診の不足や遅れにつながる。未熟児が高率の州では、妊娠適齢期の女性の5人に1人は無保険である。
 喫煙は、未熟産、低出生体重、先天障害のリスクが増大する。政府の統計では妊娠中に17%の女性が喫煙していると推計されている。ルイジアナとウェストバージニアでは約3分の1が喫煙しているが、ユタでは9.3%、カリフォルニアでは11%である。
 そしてややこしい問題として、米国における未熟児の増加の大きな原因でもある34-37週の未熟児の問題がある。更に早期に生まれた未熟児ほどではないが、学習障害や行動障害といった問題が出る可能性がある。最近の研究では満期前の帝王切開や在胎週数の間違いによるものがある。
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未熟児の急速な増加/英国医療事情
http://kurie.at.webry.info/200811/article_14.html
帝王切開による未熟児が増加/米国医療事情
http://kurie.at.webry.info/200805/article_59.html
帝王切開後の高額な健康保険料
http://kurie.at.webry.info/200806/article_3.html
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November 12, 2008 -- Updated 1806 GMT (0206 HKT)
U.S. gets 'D' on premature birth report card
http://edition.cnn.com/2008/HEALTH/family/11/12/premature.birth.rate.ap/index.html
* Story Highlights
* More than half a million U.S. babies, one in eight, are born prematurely each year
* Causes of prematurity are not wholly understood, but certain factors play a role
* Federal goal of lowering preterm births by 2010 not very likely
* Study conducted by March of Dimes
WASHINGTON (AP) -- The odds of having a premature baby are lowest in Vermont and highest in Mississippi.
Smoking, lack of prenatal care and early C-sections are factors affecting preterm birth rates.

Smoking, lack of prenatal care and early C-sections are factors affecting preterm birth rates.

The March of Dimes mapped the stark state-by-state disparities in what it called a "report card" on prematurity Wednesday -- to track progress toward meeting a federal goal of lowering preterm births.

There's not much chance of meeting that goal by the original 2010 deadline, if the "D" grade the charity bestowed on the nation is any indication.

More than half a million U.S. babies -- one in every eight -- are born prematurely each year, a toll that's risen steadily for two decades. The government's goal: No more than 7.6 percent of babies born before completion of the 37th week of pregnancy.

Preterm birth can affect any mother-to-be, stressed a recent U.S. Surgeon General's meeting on the problem. Scientists don't understand all the complex causes.

But Wednesday's report highlights big geographic differences that March of Dimes president Dr. Jennifer Howse called "a dash of cold water."

In Vermont, 9 percent of babies were preemies in 2005, the latest available data. In Oregon and Connecticut, just under 10.5 percent of babies were premature.

Travel south, and prematurity steadily worsens: In West Virginia, 14.4 percent of babies were preemies; more than 15 percent in Kentucky and South Carolina; more than 16 percent in Alabama and Louisiana; and a high of 18.8 percent in Mississippi. March of Dimes: See full chart

The report urges states to address three factors that play a role:

• Lack of insurance, which translates into missed or late prenatal care. In states with the highest prematurity rates, at least one in five women of childbearing age are uninsured. Early prenatal care can identify risks for preterm labor and sometimes lower them.

• Smoking increases the risks of prematurity, low birthweight and birth defects. Government figures suggest 17 percent of women smoke during pregnancy. The new report urged targeting smoking by all women of childbearing age. About a third of those women smoke in Louisiana and West Virginia, the report says, compared with 9.3 percent and 11 percent in Utah and California, respectively.

• Then there's the trickier issue of so-called late preemies, babies born between 34 and 37 weeks. They're fueling the nation's prematurity rise. While not as devastating as a baby born months early, being even a few weeks early can cause learning or behavioral delays and other problems. And recent research suggests at least some near-term babies are due to Caesarean sections scheduled before full-term, either deliberately or because of confusion about the fetus's exact age.

Howse urged hospitals to double-check that women given an early C-section truly need one for a medical problem, as current health guidelines recommend.

Copyright 2008 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

All About March of Dimes Birth Defects Foundation • Pregnancy and Childbirth • Smoking

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U.S. gets low marks for rise in premature birth rate
By Valerie Ulene December 1, 2008
http://www.latimes.com/features/health/la-he-themd1-2008dec01,0,5179666.story

画像Premature births
Ken Hively / Los Angeles Times
Consequences of premature birth can be serious. They include a higher risk of the infant dying within the first year; breaking and feeding problems and, later on, learning and behavioral difficulties.
March of Dimes score is a D. Fueling the rise could be later motherhood, more multiple births and an increase in C-sections.

Last month, the U.S. received a set of grades from the March of Dimes, the nation's leading organization committed to preventing preterm births, that were nothing short of horrible.

The report card on premature births compared preterm birth rates with national objectives. Overall, the nation received a D. Not a single state merited an A, and only one, Vermont, earned a B. Eighteen states and Puerto Rico and Washington, D.C., received an F, and California squeaked by with a C.

Given recent trends, it's unlikely that these grades will improve any time soon. Rates of preterm birth in the U.S. have been steadily increasing for years. In 2000, 11.6% of infants were born prematurely. In 2005, the most recent year for which statistics are available, this figure had grown to 12.7%.

The consequences of premature birth can be serious. Premature infants are at greater risk of dying during their first year of life than full-term infants. They often suffer from breathing and feeding problems and are at risk for intracranial hemorrhage (bleeding in the brain) and potentially life-threatening gastrointestinal problems. Their immature immune systems leave them susceptible to serious infections such as pneumonia and meningitis.

There are long-term problems associated with prematurity as well, such as cerebral palsy and vision and hearing loss. Children born prematurely also frequently suffer from learning and behavioral difficulties.

Experts in maternal and fetal health are working to identify the underlying causes of this increase in premature births. It appears that a variety of factors are at play.

Births between 34 and 36 weeks of gestation, or the late-preterm period, have increased most dramatically (a full-term birth takes place at 40 weeks). Late-preterm births now constitute 72% of all preterm births, according to the federal Centers for Disease Control and Prevention.

The fact that women are having babies at an older age is thought to contribute to this increase. "When they do get pregnant, women who are well into their 30s are more likely to incur all of the problems associated with pregnancy -- including prematurity," says Dr. Alan Fleischman, medical director for the March of Dimes.

The use of in vitro fertilization and other types of assisted reproductive technology also plays a role. More than half of all pregnancies conceived with assisted reproductive technology result in multiple births, dramatically increasing the risk of prematurity. Roughly half of all twin pregnancies deliver before 37 weeks and only 1 in 10 triplet pregnancies progress to term.

Perhaps the most significant factor contributing to the rise in late-preterm births, however, is an escalation in the rates of cesarean delivery. About 1 in 3 infants in the U.S. is born by cesarean section. Though rates vary substantially among states, ranging from 21.6% in Utah to 36.8% in Louisiana, they are almost universally higher than those of most European countries. "There's been a change in the way we practice obstetrics," Fleischman says.

That change, ironically, is partly due to lifesaving technologies developed to save preterm infants, Fleischman says. These have made many obstetricians feel that they've succeeded if a woman doesn't deliver before 34 weeks and that babies are more or less out of the woods by that point in the pregnancy.

This belief has lowered doctors' trigger points for performing an elective induction and cesarean delivery before a fetus has reached full term. If a pregnant woman is experiencing minor difficulties (or sometimes if she is simply feeling uncomfortable), some doctors will deliver the baby prematurely thinking that it is better for the baby to be in the neonatal intensive care unit than the womb.

"The problem is, they haven't taken into account that even late-preterm infants often have bad outcomes," Fleischman says. These babies suffer some of the same immediate problems that more premature infants experience, and often struggle with subtle developmental problems later.

"Getting to term should be the goal," he adds. "We don't want to stop one medically needed early delivery. But many elective inductions and cesarean sections would benefit from more careful consideration."

A host of other factors including infections, genetics and poor prenatal care likely play a role in premature births that occur earlier than 34 weeks. Fleischman also suggests the importance of a less tangible factor -- stress. He believes that many kinds of stress including financial strains and abusive relationships put women at risk of delivering preterm.

He points out that in many developed countries where rates of prematurity are much lower, extensive social supports are extended to pregnant women.

"We talk a lot about being supportive of our women and children, but we don't behave in a way that is truly supportive," he says.

The country hasn't seen the last of these grades: The March of Dimes plans to issue a new report card annually. Despite the recent discouraging trends in preterm births, I'm optimistic we can improve them -- if we really want to. In my mind, this year's Ds and Fs don't reflect insurmountable difficulties but rather a lack of attention and effort to the problem at hand.

Ulene is a board-certified specialist in preventive medicine.

health@latimes.com

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http://www.marchofdimes.com/padpetition/index.aspx?a=1&z=1&c=1&l=en
The March of Dimes has graded states by comparing each state's rate of premature birth to the nation's objective of 7.6 percent or less. Help us make progress for preemies by signing the petition and finding out more about what you can do.
Click below to see each state's report card.
(some browsers may need popup blockers disabled)

Petition for Preemies
1. 1. We urge the federal government to increase support for prematurity-related research and data collection as recommended by the Institute of Medicine and the Surgeon General’s Conference on the Prevention of Preterm Birth, to:
* (a) identify the causes of premature birth;
* (b) test strategies for prevention;
* (c) improve the care, treatment and outcomes of preterm infants;
* (d) and better define and track the problem of premature birth.
2. 2. We urge federal and state policymakers to expand access to health coverage for women of childbearing age and to support smoking cessation programs as part of maternity care.
3. 3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines*.
4. 4. We call on businesses to create workplaces that support maternal and infant health. View our 14 recommendations. (workplacecriteria.pdf, 90kb)

The American College of Obstetrics and Gynecology recommends that, unless medically indicated, scheduled deliveries should be after 39 weeks. This is because biological variations and uncertainties in estimating the beginning of a pregnancy introduces inaccuracies when assigning the due date. Preterm birth rates can be reduced by performing scheduled deliveries after 39 weeks.

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