Millions of premature births could be linked to air pollution, study finds

Air pollution could be a contributing factor in millions of premature births around the world each year, a new report has found.

Nearly 15 million babies are born annually before reaching 37 weeks gestation. Premature birth is the leading cause of death among children younger than five years old, and can cause lifelong learning disabilities, visual and hearing problems, the World Health Organization (WHO) reports.

Researchers for the Stockholm Environment Institute (SEI), the London School of Hygiene and Tropical Medicine and the University of Colorado, have concluded that as many as 3.4 million premature births across 183 countries could be associated with fine particulate matter, a common air pollutant, with sub-Saharan Africa, north Africa and south and east Asia most impacted by the issue.

“Preterm birth and associated conditions are one of the biggest killers of children in the US and worldwide,” said Dr Paul Jarris, chief medical officer at the March of Dimes, a US-based nonprofit focused on maternal and baby health. “Yet, there’s a lot of things we don’t know about what causes preterm birth, so every bit of information we can get is helpful.”

“We have known for a long time that air pollution contributes to asthma and heart disease in adults,” said Jarris. “What I think people fail to recognise is that so many of these risk factors impact babies before they are even born.”

Previous studies have looked at how effects of air pollution in utero might negatively impact babies’ birth weight, or the likelihood that they will be born early. SEI’s study, which examined data from 2010, attempted to calculate how those factors might influence the global rate of premature births.

“By showing in our study that 18% of preterm births are associated with air pollution, we are quantifying the health impacts of fine particulate matter on babies before they are born,” said Chris Malley, a researcher in SEI’s York Centre, at the University of York and lead author on the study.

Each year, around one in every 10 babies worldwide are born prematurely, according to the WHO. Africa and south Asia bear a disproportionate burden of premature births, accounting for 60% of all premature births globally. That region also dominated SEI’s report of premature birth associated with air pollution.

South Asia had the most preterm births associated with air pollution. Photograph: Harish Tyagi/EPA

SEI’s new report provides an estimate of potential birth impacts associated with air pollution, but the authors acknowledged that the study had considerable caveats because of a lack of research in some of the most affected areas.

This is one more reason why we need to be good stewards of the environment

Dr Paul Jarris

Still, two experts who reviewed the study called estimates “conservative”.

A number of factors have been identified in playing a part on premature birth, including poverty, infection, smoking and substance use, physical activity and maternal education. However, even with the report’s limitations, it is still one of the first to argue that reducing air pollution could also be effective in reducing premature births across the world.

Because of a lack of research in regions such as south and east Asia and Africa, researchers used studies conducted in the US and Europe to estimate global outdoor air pollution exposure.

Indoor cooking fires could play a larger role than the study allows for. “The exposure in Asia, and in part in say, China and India, to outdoor air pollution is significantly higher than outdoor air pollution in the US,” said Malley. “So that’s the other part of the uncertainty, that at these higher levels of exposure we don’t know whether this same relationship holds.”

The report focused on one kind of air pollution considered especially harmful to human health: fine particulate matter. This pollution is made up of tiny particles from a variety of emissions, such as diesel emissions and agricultural fires.

The particles, smaller than 2.5 micrometres in diameter, are considered harmful because they can lodge deep in the lungs, affecting the pulmonary and cardiovascular systems. Past studies have looked at these factors as ways that air pollution may impact preterm birth and low birth weight in babies.

South Asia had the most preterm births associated with particulate matter pollution – as many as 1.6 million associated births. Notably, even though China has a relatively low rate of preterm births, researchers found that as many as 521,000 preterm births could be associated with air pollution because of high concentrations of particulate matter.

A similar study conducted in the US found that air pollution had a costly impact on unborn children, estimating that the economic impacts cost $ 4.33bn in 2010.

Researchers said the estimates support their conclusion that “reduction of maternal [air pollution] exposure through emission reduction strategies should be considered alongside mitigation of other risk factors associated with preterm births.”

“This is one more reason why we need to be good stewards of the environment,” said Jarris. “The most vulnerable among us – unborn children – are affected, and really in a way that impacts families’ lives for generations.”

Guardian Cities is dedicating a week to exploring one of the worst preventable causes of death around the world: air pollution. Explore our coverage here and follow Guardian Cities on Twitter and Facebook to join the discussion

Millions of premature births could be linked to air pollution, study finds

Births led by midwives rather than doctors linked to greater risks – NZ study

The health outcomes for babies born in New Zealand where primary care is led by midwives are significantly worse when compared with care led by doctors, a major new study has found.

New Zealand and the Netherlands are the only two western countries to operate under a midwife-led birthing system. Midwives are the dominant care-giver for four out of five births in New Zealand – from pregnancy through to delivery and post-natal care.

However a new study released today by The University of Otago has found health outcomes for babies cared for by a midwife rather than a GP or obstetrician are significantly worse. The ministry of health said in a statement the results of the study were “unexpected” and required further investigation.

The study examined 244,000 births in New Zealand between the years 2008 to 2012, and found an “unexplained excess of adverse events in midwife-led deliveries in New Zealand where midwives practice autonomously”.

The study found that mothers who had medical-led care had a 55% less chance of the baby suffering oxygen deprivation during the delivery, a 39% less chance of neonatal encephalopath (a condition that can result in brain injury) and a 48% lower chance of having a low Apgar score, which is a measure of infant wellbeing immediately post-delivery, with a low score being indicative of an unwell baby.

Lead researcher Ellie Wernham – a former midwife who is studying to be a doctor – said further study into the reasons for the discrepancies needed to be conducted immediately, and a detailed review should be led by the ministry of health.

“Contributing factors could include high-risk mothers receiving midwife care inappropriately, staffing issues, collaboration issues, the level of training midwives receive and delays in mothers being referred to a medical professional,” she said.

Sweeping health reforms in the early 1990s transitioned New Zealand mothers from medical-led births to midwife-led births. Wernham said the changes were designed to empower women and give them greater autonomy and be subject to less frequent medical intervention, but the “significant changes” had yet to be analytically studied, and a review was overdue.

However, Karen Guilliland, chief executive of The New Zealand College of Midwives, criticised the study, saying it lacked “high evidence” and did not take into account the added challenges midwives often faced with their patients.

“Essentially the study has compared midwife care with obstetrician care. And studies have found midwives are more likely to look after poorer, sicker patients, who may register later, smoke or are Maori or Pacific. If you can afford to have an obstetrician you are not in that demographic.” said Guilliland.

“Most of our maternity hospitals are understaffed and often struggle to provide immediate response when midwives request medical input. This means that often women in labour have to wait to see a specialist causing unacceptable delays for them and their babies. None of our main maternity hospitals have an obstetric consultant on site after hours or weekends which are when the majority of births occur.”

The ministry of health said in a statement that adverse outcomes for births in New Zealand are low, and comparable to countries like Australia and Britain. The statement said the ministry had referred the study to the national maternity monitoring group for advice.

It also said the study did not explore the reasons why higher adverse outcomes were recorder for midwife-led births, but contributing factors could include that women under the care of midwives were more likely to be “younger, overweight, non-European, to have higher deprivation and to smoke”.

Births led by midwives rather than doctors linked to greater risks – NZ study

Quick ladies a lot more most likely to have short pregnanices and premature births

Shorter women have shorter pregnancies and smaller babies, in accordance to new research.

And the examine suggests they are also at higher danger of offering birth prematurely.

Researchers studied three,485 Nordic females and their infants, and found that maternal height, which is established by genetic variables, influenced the length of pregnancy and frequency of prematurity. But birth length and birth bodyweight are mainly influenced by transmitted genes.

Babies who survive an early birth face severe and lifelong health problems, like breathing troubles, jaundice, vision reduction, cerebral palsy and intellectual delays.

Medical doctor Joe Leigh Simpson, senior vice president for analysis at the March of Dimes Prematurity Investigation Centre in the US, explained: “A key objective of the nationwide network of March of Dimes prematurity research centres is identifying genes that govern foetal growth and length of pregnancy.

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“That a woman’s height influences gestational length, independent of the genes she passes on that decide foetal size, is a key discovering by our investigation networks, and the 1st of what we assume to be numerous genetic contributions.”

Doctor Jennifer Howse, president of the March of Dimes, stated: “The revolutionary, group-based model of our prematurity study centers is vital to knowing the unknown brings about or preterm birth.

“This new obtaining adds a single tiny piece towards solving the considerably greater puzzle of preterm birth.”

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Doctor Louis Muglia, the major investigator and co-director of the Perinatal Institute at Cincinnati Children’s Hospital Health care Centre, additional: “Our finding demonstrates that a mother’s height has a direct impact on how long her pregnancy lasts.

“The explanation for why this happens is unclear but could rely not only on unknown genes but also on woman’s lifetime of nutrition and her surroundings.”

Quick ladies a lot more most likely to have short pregnanices and premature births

Pregnant women flocking to courses on self-hypnosis births

It is the different birth technique that midwives predict will be normal antenatal practice inside a decade. Hospitals about the nation are reporting a steep rise in the demand for courses in hypnobirthing, which focuses on relaxation and self-hypnosis in the course of the birth procedure..

When Colchester Hospital University NHS Trust in Essex began giving hypnobirthing courses in 2012, it was running a single class a month, educating about 48 females a year. Soon after regular increases in 2013 and 2014, the trust made the determination to supply the course for cost-free. They now run ten hypnobirthing courses a month and predict they will instruct in between 720 and 960 women in hypnobirthing in 2015.

Almost 25% of girls who give birth at the hospital and birthing units in the Colchester trust took a hypnobirthing course prior to delivery and practically one in 6 of the trust’s midwives are qualified hypnobirthing instructors.

“It appears like the entire planet desires to hypnobirth,” stated Teri Gavin-Jones, a midwife and hypnobirth trainer at the trust. “Hypnobirthing is the place water-birthing was twenty years ago. Back then it was deemed a bit weird and there was a whole lot of scepticism from the medical community. But now every single believe in in the country does water births. Give it 10 years and hypnobirthing will be standard antenatal practice. It’ll be mainstream.”

At Royal Wolverhampton Hospitals NHS Trust the numbers are significantly less dramatic, with about five% of mothers making use of hypnobirthing, but the trust has observed a threefold increase in the amount of girls taking classes in the past five many years.

Couples at hypnobirthing lessons, which are subsidised by some NHS trusts and expense about £300 for 5 sessions from a private instructor, are taught visualisation, deep rest and breathing methods, as nicely as self-hypnosis.

Rachel Chilver, 35, 1st encountered hypnobirthing although carrying out research when pregnant with her very first little one and despite getting “quite sceptical” made the decision to consider the program at Colchester hospital.

Chilver, a executing arts lecturer from the town, said hypnobirthing produced the method of providing birth to her daughter, Winnie, now 6 months previous, “absolutely amazing”.

“There was a sensation, but I wouldn’t say it was soreness. It was strain, I essential to use a breathing method to deal with it, but I did not ever go: ‘Ooh, pain.’” For a brief time period during labour she stopped feeling contractions altogether – “It have to be the slightly hypnotic state I’d place myself into” – and while it acquired “intense” towards the finish, she gave birth inside of two hours of arriving at hospital with no the support of any soreness-relief drugs. Most importantly for her, Chilver said that at the finish of the approach, she felt “really proud and empowered”.

Some ladies have reported feeling no pain at all.

Katharine Graves, the founder of KG Hypnobirthing and writer of The Hypnobirthing Guide, explained she has encountered several ladies – such as her personal daughter-in-law – who had ache-free births.

“Hypnobirthing works on the premise that it’s unnatural to have pain [in labour] in the first spot. The root of the problem is fear because everyone ‘knows’ that birth is unpleasant so people have a poor experience and they pass it round. If you’re in my planet you usually get reviews of females saying birth was the most empowering and great knowledge and no medicines had been necessary,” said Graves.

She calls the development in hypnobirthing in the Uk a revolution and mentioned it has grown so quickly mainly simply because of Britain’s “strong, independent midwifery profession” and word-of-mouth promoting.

Scientific evidence is inconclusive about hypnobirthing’s impact on ache. Some NHS trusts have begun collecting data, with Wolverhampton Trust reporting that 80% of hypnobirthing mothers have normal births with no analgesic treatment options, compared with 60% of the basic population who have a typical birth. A small-scale 2006 examine in Australia discovered that ladies who have been taught antenatal self-hypnosis tactics reported fewer epidurals (36%) than the management group (53%) and lower use of other types of pain relief.

Even so, the biggest examine into the topic, a randomised trial of 680 pregnant women in the United kingdom identified as the SHIP trial, reported that self-hypnosis manufactured no distinction to both the strategy of birth – regular, instrumental or caesarian – or to the use of analgesic treatment in between the group who had been taught self-hypnosis techniques and the control group, however the hypnosis group did report a reduction in anxiety about birth.

Gail Johnson, training adviser at the Royal College of Midwives, mentioned ladies ought to not be spooked by the approach. “It’s not ‘one, two, 3, go into a trance and wake up with a baby’. The hypnobirthing approach is not necessarily about hypnosis, it’s frequently about focusing on some thing other than the discomfort of labour and that’s not something that is specifically new.

“It’s usually important that females are assured the folks working the programs are competent and they seek out out reliable trainers, but we believe something which delivers women a wider choice in their ache relief is great. We’re not saying it is proper for all girls, it’s portion of a wider spectrum of support and care for women.”

Pregnant women flocking to courses on self-hypnosis births

Fears new guidance on births will improve infant deaths

Nevertheless the advice also explained a lady need to be in a position to pick exactly where to give birth, which includes in hospital with medical professionals present and that her selection ought to be respected.

Issues have been raised that the guidance would be utilised to deny females hospital births with doctors for the cheaper possibilities of home birth and midwife-led care.

Any women who desires epidural pain relief or who requirements instruments or a caesarean section would have to be transferred into hospital.

The Birthplace Review, conducted by a group at Oxford University, was the basis for the revised Nice advice and found that almost half of low chance very first time mothers providing birth at residence had been transferred into hospital along with 1 in three first time mothers giving birth in midwife-led units.

Maureen Treadwell, research officer at the Birth Trauma Association, explained: “Selection depends on good information and it is not real that there is excellent evidence that free of charge standing midwife units are as safe for very first time mothers.

“Several females might merely not want to decide on to give birth in which there are no doctors or epidurals and in which they will need to have to be transferred mid labour in an emergency. It is quite easy for ‘encourage’ to become persuade.

“The Department of Well being was a commissioner of the new research and it needs to centralise maternity care for large chance women in massive superunits and to downgrade numerous regional obstetric units to midwife led. It are not able to do this with out ‘selling’ these units as protected.

“There is no robust evidence they are, indeed a recent Netherlands examine located low chance women in midwife care had the exact same risks as higher chance ladies in obstetric care.”

The authors of the Netherlands study said their findings should imply that the pattern of maternity services in that country need to be re-evaluated.

They concluded: “Infants of pregnant females at low risk whose labour started in main care below the supervision of a midwife in the Netherlands had a increased threat of delivery related perinatal death and the exact same chance of admission to the neonatal intensive care unit in contrast with infants of pregnant females at substantial risk whose labour commenced in secondary care under the supervision of an obstetrician.

“The findings are sudden and the obstetric care system of the Netherlands wants further evaluation.”

Dr Jennifer Hollowell, co-author of the Birthplace research, told the Telegraph that the Netherlands review cannot be utilized to the Uk due to the fact of different populations and patterns of care.

She mentioned: “In the Birthplace research there was totally no hint of a big difference in security in midwife-led units compared with hospital units.

“Given that we published Birthplace there has been an boost in the number of midwife-led units alongside obstetric ones.”

She mentioned it was appropriate that girls be informed the dangers of obtaining to transfer into hospital when creating their selection but additional that increasing use of midwife-led units would reduce the ‘escalating rate’ of caesarean sections in the United kingdom.

She added that the death fee amongst babies in the Dutch research was a lot increased than in the whole group in her Birthplace research.

She added: “Offered that these mortality data recommend that there might be essential distinctions amongst the counties in the way that labour and birth is managed, we truly feel that Good took the correct decision to base their recommendations on planned area of birth in the NHS on evidence from Birthplace which relates to outcomes of maternity care in England.”

At the moment a single in 4 births are via caesarean part.

Dr Antony Falconer, then president of the Royal University of Obstetricians and Gynaecologists and colleagues wrote to the British Health-related Journal, which published the Birthplace examine, to stage out problems with the analysis such as, how 20 out of the 32 deaths of infants occurred to lower threat women offering birth at residence or in cost-free-standing midwife-led units.

A spokesman for The Royal School of Obstetricians and Gynaecologists (RCOG) said: “We welcome the publication of this draft advice on intrapartum care from Great, bearing in thoughts that this is only in draft and subject to alter pending consultation.

“The RCOG supports selection for minimal-danger females who have had profitable earlier births to give birth at residence supplied transport arrangements are in area for hospital transfer in the occasion of an emergency or should there be a request for ache relief.

“Based mostly on the findings from investigation, there are issues about the risk assessment of pregnant females and the RCOG is in favour of alongside midwifery units (AMUs) for girls who could need multidisciplinary care in the course of delivery.”

Christine Carson, clinical guideline programme director for Wonderful stated: “Since we published our unique guidance, much more evidence has come to light about the positive aspects and dangers connected with offering birth at house, in an independent or hospital-based mostly midwife-led unit and on a classic labour ward.

“We now know that these units are as risk-free as conventional labour wards for all minimal chance pregnant females and are more probably to consequence in a greater birth experience with less medical intervention.

“The proof also highlights that residence births are just as secure as other settings for lower threat pregnant ladies who presently have at least one particular little one, but not for women expecting their first child.

“Nevertheless, each girl need to in the end have the freedom to pick where she desires to give birth and be supported in her option.

“We’re pleased we are now able to propose more definite guidance to aid pregnant girls pick the best option for them. We now want to hear what other folks believe so that we can make certain the last, up to date advice will promote the safest feasible care for girls and their infants.”

Cathy Warwick, chief executive of the Royal College of Midwives, mentioned: “We certainly welcome the modify in guidance.

“The proof displays that for lower danger girls providing birth in a midwife-led unit or at property is secure, indeed, may possibly be safer than hospital.

“Ladies also have a tendency to have higher satisfaction prices and a greater birth experience when giving birth in these environments.”

A Division of Wellness spokesman stated: “We often fund research.

“To suggest this study was done as element of a plan to downgrade units is totally incorrect. Good has come to an independent view and is recommending women continue to have a selection about how and the place they give birth, and supplies midwives and medical doctors with far more advice to aid girls make safe choices. This is excellent news.”

The guidance is open for consultation till June 24 and last guidance will be issued later on in the 12 months.

Fears new guidance on births will improve infant deaths

Smoking bans cut premature births

Banning smoking in public locations has helped to reduce premature births by ten%, according to new study from the United States and Europe.

A research in the Lancet health care journal found that whilst the effect of anti-smoking laws varied in between countries, the general impact on little one health around the globe had been positive.

“Our study exhibits that smoking bans are an effective way to protect the health of our kids,” said Jasper Been of the University of Edinburgh’s Centre for Population Well being Sciences, who led the review. He mentioned the findings must support to accelerate the introduction of anti-smoking legislation in cities, nations and districts that have yet to do so.

Laws banning smoking in public areas this kind of as bars, dining establishments, offices and other workplaces have currently been verified in previous studies to shield grownups from the overall health threats connected with passive smoking.

In accordance to the Planet Overall health Organisation (WHO) tobacco kills around six million individuals a yr throughout the world, which includes a lot more than 600,000 non-smokers who die from exposure to secondhand smoke. By 2030 if present trends continue it predicts tobacco’s death toll could be eight million a yr.

Only 16% of the world’s population is covered by comprehensive smoke-cost-free laws and forty% of youngsters worldwide are regularly exposed to secondhand smoke, the WHO says.

Public well being experts hope that as more and more nations in Europe and close to the planet adopt stricter legislation on smoking in public areas, the health positive aspects will swiftly start off to grow to be evident.

The investigation in the Lancet analysed information on more than two.five million births and virtually 250,000 hospital attendances for asthma attacks. It was the first comprehensive research to seem at how anti-smoking laws affect children’s wellness.

With final results from 5 North American studies of nearby bans and six European research on national bans, it found costs of each pre-term births and hospital attendance for asthma fell by 10% inside a year of smoke-free laws coming into effect.

“Together with the known overall health positive aspects in adults our examine gives clear evidence that smoking bans have significant public wellness rewards for perinatal and little one overall health,” said Been.

He explained it also supplied “robust assistance for WHO recommendations to create smoke-free of charge public environments on a nationwide level”.

Smoking bans cut premature births