Top 10 Things You Can Do As a Health Care Provider to Make a Difference for Late Preterm Infants

1) Educate yourself about Late Preterm Birth and late preterm infants - understanding the problem will help you to figure out what you can do about it.

2) Identify patients (or friends or family members) who could benefit from learning more about preterm birth in general, but especially late preterm birth.  Knowledge is power, and the more your patients know, the more they can be proactive.

- OBGYNs                                                                                          
- Pediatricians                                                                     
- Family Physicians                                                                 >    All of us come into
- other Physicians                                                                                      contact with women of child-bearing age daily                    
- Nurses/Nurse Practitioners of any field                                      

3) Encourage your patients of child-bearing age to make a Reproductive Life Plan - that means planning ahead, knowing when you want to get pregnant and when you don't, and following appropriate measures to support either case.  See more information about this (as well as patient handouts) below.

4) Help your patients get healthy BEFORE they get pregnant - many cases of preterm labor can be caused by maternal complications that are best controlled before conception: hypertension, diabetes, obesity, healthy diet, including supplementation with at least 400 mcg folic acid daily.  Whether you are the woman's cardiologist, endocrinologist, OB/GYN, or the pediatrician for her children, a few words of guidance can get her on the path to being healthy - for healthy future pregnancies and healthy babies.

5) Encourage any pregnant patient to seek prenatal care - somewhere, anywhere - for the best outcomes for both Mom and baby.

6) Talk to all your patients about smoking cessation, but especially your pregnant patients.  Also encourage patients to stop drug or alcohol use while pregnant, or at least cut down on their use as much as possible (as some might tell you they "just can't quit", or at least are thinking it, but are willing to cut back quite a bit).  All of these substances can also cause preterm labor leading to a late preterm infant.  See more on smoking in pregnant women below.

7) Monitor all late preterm infants closely, and anticipate possible complications.  This requires a team effort: physicians, residents, nurses, medical students.  Educate yourself on the special issues of late preterm infants, and know what is appropriate for discharge.  For more information, see the AAP guidelines for "Recommended Minimum Criteria for Discharge of Late Preterm Infants" located on the "Physician Education" page.

8) Arrange for appropriate follow-up of any late preterm infant upon discharge, in order to prevent rehospitalization or delayed complications.  As we learn more about the long-term effects on late preterm infants, this may include closer developmental and behavioral evaluation at all well-child visits. 

9) Good parent education is key upon discharge from the hospital.  Parents should know what to watch for, what to be concerned about, and when to get help.  If the infant has a problem at home, the parents should know what to do and where to go.  Lots of great patient handouts are available for reinforcing what you talk about with them, on this topic as well as others, please see below.

10) Do some research - and publish it!  Many of the reports from the Surgeon General's office, Institute of Medicine, AAP, and many others repeatedly state "more research needs to be done" on the causes of late preterm birth, or on the long-term outcomes of these infants.  Add your own piece to our communal knowledge, and you could make a
BIG DIFFERENCE for late preterm infants.

Preventable Causes
of Late Preterm Birth, and What To Tell Your Patients

Although we don't know the exact cause in some cases of Late Preterm Birth, there are many factors that can cause late preterm birth that we do know about, and many of these can be prevented.  And with each preventable cause comes the opportunity for patient education.  Most of the known causes can be organized into two main groups:

1) Medical Interventions - Induction of Labor and C-Sections during the late preterm phase.  There are many reasons why a woman or her physician may choose to induce labor or perform a c-section before the infant is full term, some are emergent situations and some are not.  Of course, if early induction or c-section needs to be performed because of maternal or fetal compromise, the health care professional should follow their own judgment about what is needed for the best outcome.  But ACOG has published an official statement in April 2008, stating "Preterm delivery should occur only when an accepted maternal or fetal indication for delivery exists". 
[See "Physician Education" page for more information]. 

Here are some contributing factors for non-emergent preterm medical interventions, and what health care professionals can do to prevent them:

- Errors in dating of gestational age, so early induction is accidental [woman is thought to be 38 weeks but really only 36]
     - this can be prevented with correct dating of gestational age with early ultrasound in 1st trimester - encourage patient
        to seek prenatal care from the very beginning of the pregnancy

- Incorrect assumption that 34-36 weeks is "close enough" given our current technological advancements
     - this can be prevented with patient and physician education of the facts

- Growing culture of the "patient as customer", early inductions and c-sections mandated by patient request for
 non-medical reasons [physician preference, travel concerns, etc]
     - this can be prevented with patient education about the importance of continuing the pregnancy until full term is
        reached, even if it is inconvenient to the patient
     - this can also be improved with the collaborative action of obstetric physicians - be respectful of patients' concerns,
        but use your professional judgment: longer pregnancy has better maternal and fetal outcomes

2) Pre-term Labor: Spontaneous Premature Labor and PPROM.  There are also many reasons why a woman may go into premature labor, which may ultimately lead to the birth of a late preterm infant.  Sometimes the cause is unknown, but there are many known factors that contribute to premature labor, and many of these are preventable.  Here are some examples, and how they can be prevented:

- Smoking, alcohol, or drug use - this can be prevented with cessation during pregnancy

- Poorly controlled Diabetes, hypertension - this can be prevented with tight control of blood sugar and blood pressure, beginning before conception

- Maternal infection - this can be prevented with good prenatal care, and treatment of infections as soon as they arise

- Birth defects of the infant - this can be prevented with folic acid supplementation beginning before conception, proper immunization of Mom before conception, proper prenatal screening and fetal testing when indicated

- Prior history of preterm labor or history of giving birth to a preterm infant, either Mom's prior history or a family history of preterm labor - this can be prevented with good prenatal care, and medical or surgical interventions if needed

- Pregnancy with multiples increases risk of preterm birth, the more infants in one gestation, the higher the risk - this can be reduced with judicious use of assisted reproductive therapies (ART) and better efforts to limit the number of infants in one gestation

- Social causes of preterm labor - these can be prevented by decreasing maternal emotional and psychological stress, by ensuring appropriate birth spacing (which can contribute to physical stress on Mom), and by avoiding extremes of maternal age: <20 years or >40 years, as these have higher rates of preterm births

Late Preterm Infants - Patient Information

To help facilitate patient education, the organization AWHONN [Association of Women's Health, Obstetric and Neonatal Nurses] has produced a patient handout for parents of late preterm infants, and what they should know when they take their late preterm infant home from the hospital.  The first page is informational, and the second page has space for them to write down what you tell them in the hospital when discharging the infant.  The handout comes in both English and Spanish.  See the AWHONN website for more information.

Parent information - ENGLISH
File Size: 545 kb
File Type: pdf
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Parent Information - ESPANOL
File Size: 1136 kb
File Type: pdf
Download File

There is also a lot of patient information available through the March of Dimes.  You can get patient handouts through your local March of Dimes office, or refer your patients to their website.  See several of the links below for patient-friendly information.

Things to Know Before You Get Pregnant

General Information About Preterm Birth - Fact Sheet

Information Specifically for Women about Pregnancy and Premature Birth

Information About Preterm Labor and Birth in Espanol

A Section for NICU families

March of Dimes sponsored YouTube videos for patients on all kinds of topics related to pregnancy, newborn care, etc.

Even a section Just for Dads

For Patient Education Materials for Purchase, see the Product Catalog

And much, Much more!

Reproductive Life Plan

In 2006, the CDC published a statement calling for all men and women to formulate a Reproductive Life Plan as a way to promote overall reproductive health, to promote healthy pregnancies, and as a way to prevent many of the adverse health outcomes associated with unplanned pregnancies and unhealthy pregnancies [which can lead to complications and at-risk infants].  So what is a Reproductive Life Plan?  Basically, it means planning ahead.  It involves a set of goals, which can include a time line, about whether or not a person wants to have children, and if so how many, when, and in what context.  It helps with spacing between pregnancies, which has an impact on birth outcomes and maternal health (see below).  It includes what the person wants to do before getting pregnant ("preconception health", for example, getting health conditions under control, losing weight, or starting a healthy diet), or what method of birth control they plan to use if they don't want to have children (right now or ever).  It can include health decisions, financial decisions, social decisions, you get the idea.  Of course the plan can change over time as a person's life plans and priorities change, but the most important point is for everyone, both women and men, to plan ahead and make conscious decisions about their reproductive health.

Adolescents and young women are the most vulnerable to experience multiple unplanned pregnancies, and represent a population that may benefit the most from a reproductive life plan.  If you think the term sounds intimidating to your patients, you can simply encourage them to "be thinking ahead about if and when [they] want to have children, and make sure [they] are in the best health before [they] decide to get pregnant".  See the links and patient handouts below for more information.

Check out the CDC's recommendations for preconception health, or the March of Dimes site for What To Know Before You Get Pregnant.  For nurses interested in CME, check out the Preconception Curriculum through the UNC School of Medicine.  Check out the great patient handout below on a Reproductive Life Plan produced by the Utah Department of Health along with Utah March of Dimes chapter, including what it is, why it's important, and a step by step guide on how to make the plan.

Reproductive Life Plan - Patient Handout
File Size: 523 kb
File Type: pdf
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Ideal spacing between pregnancies, which is 2.5 to 3 years (with a minimum of 18 months to avoid increased risk of adverse perinatal outcomes), can also be achieved with a successful reproductive life plan.  See the journal articles below for more information about the importance of Birth Spacing, and the impact on maternal and fetal outcomes.  Also check out the patient handout on birth spacing.

JAMA article on Birth Spacing and Risk of Adverse Perinatal Outcomes

Article on Effect of interpregnancy interval on birth outcomes: findings from three recent US studies
File Size: 165 kb
File Type: pdf
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Article on Folate Depletion and the role of birth spacing
File Size: 167 kb
File Type: pdf
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Patient Handout - Birth Spacing
File Size: 74 kb
File Type: pdf
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Smoking Cessation During Pregnancy

Maternal smoking in pregnancy is associated with adverse pregnancy outcomes, including an increased risk for preterm birth, placental abruption, placenta previa, and low birth weight.  See these resources for more information about smoking and pregnancy, and ways to help your patients quit.

Visit this site for lots of online resources for smoking cessation during pregnancy put together by Dartmouth Medical Center.

ACOG publication on Maternal Smoking and Its Association With Birth Weight
File Size: 148 kb
File Type: pdf
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CDC Report on Smoking in Women of Reproductive Age
File Size: 41 kb
File Type: doc
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CDC Patient Handout on Smoking and Pregnancy
File Size: 546 kb
File Type: pdf
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March of Dimes presentation on Smoking, Alcohol, and Drug Use in Child-bearing Families
File Size: 753 kb
File Type: ppt
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Healthy Diet and Folate Supplementation

Eating a healthy diet and supplementation with at least 400 mcg of folic acid BEFORE conception are important steps for a healthy pregnancy.  See these resources for more information.

NEJM article on Reduction in Neural Tube Defects after Folic Acid Fortification 

March of Dimes Information on Folic Acid, including Government Recommendations, information for patients, etc.

Patient Handout on Taking Folic Acid from the Canadian Pediatric Society

March of Dimes YouTube Video for Patients on Healthy Diet During Pregnancy

March of Dimes YouTube Video for Patients on Folic Acid

Disclaimer:  This site is for educational purposes only, and does not constitute medical advice.  Always seek medical advice from your health care provider.  The information on this site reflects current scientific information at the time of its initial publication to the web.