14 Preterm Birth Risks You Should Never Ignore

One in nine moms-to-be will deliver early. Here's how you can lower your risk for preterm birth

While most babies are born healthy, about one in nine arrive earlier than expected, according to the Centers for Disease Control and Prevention. Preterm birth -- before 37 weeks -- can cause serious health complications from developmental delays to respiratory, heart, and intestinal problems (depending on just how early the baby is born). The good news is that while preterm labor can happen to anyone, there are steps you can take to help prevent it -- and that starts with knowing the risk factors. Here's how you can help protect your baby.

14 Preterm Birth Risk Factors

1. Risk Factor: Smoking, Drugs and Alcohol 
You probably know that smoking is dangerous for both you and your baby. "Tobacco and nicotine can cause a mother's blood vessels to become constricted and decrease blood flow to her fetus," explains Diane Ashton, M.D., MPH, deputy medical director for the March of Dimes. "This can increase the risk for a placental abruption -- when the placenta separates prematurely from the uterus -- which can cause catastrophic complications for both the mother and infant." Illegal drugs like cocaine can have a similar effect. Drinking alcohol can cause certain birth defects and can also prevent the fetus from growing properly, which can increase the odds for preterm birth.
What You Can Do: 
The key is to stop smoking, drinking and using drugs immediately, ideally before you become pregnant. "Eliminating these exposures prior to pregnancy optimizes the growth of the baby and decreases the odds of having (or needing) a preterm delivery," says Lynn Simpson, M.D., division chief of maternal fetal medicine in the department of obstetrics and gynecology at NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City. Of course, for some people that's easier said than done. Talk to your doctor about getting the help you need.

2. Risk Factor: Urinary Tract Infections
Urinary tract infections (UTIs) are never fun, but they can be serious during pregnancy. "The bacteria can spread upward from the bladder to the kidneys, which is particularly dangerous because it can then enter the blood stream and infect the placenta," says Dr. Simpson. "When this happens, preterm labor can occur because the body's natural defense mechanism is to empty the uterus when the placenta or membranes are infected." What You Can Do: To avoid a UTI in the first place, make sure you stay well-hydrated, don't hold back the urge to pee (as if a pregnant woman could!) and always wipe front to back. It's also important to watch for signs of a UTI, such as pain or burning while urinating, feeling a frequent and/or uncontrollable urge to pee, cloudy urine, and, sometimes, a low-grade fever. If you think you might have a UTI, contact your doctor immediately. She can test your urine and if there is an infection, can prescribe a dose of antibiotics that will nip it in the bud.

3. Risk Factor: Sexually Transmitted Diseases
Untreated sexually transmitted diseases (STDs) like HIV, chlamydia, gonorrhea, and bacterial vaginosis, can all harm a pregnancy. "If left untreated, chlamydia and gonorrhea can cause inflammation in the uterine lining and amniotic sack that, in turn, can trigger premature contractions," says Dr. Ashton. "HIV should be treated during pregnancy to prevent passing the infection to the baby and to keep the mother healthy. Vaginal infections such as bacterial vaginosis have also been associated with low birth weight, premature spontaneous rupture of the membrane and preterm birth."
What You Can Do: Get screened for STDs and treat any illnesses as soon as possible, ideally before pregnancy. All is takes is a simple blood test, urine culture or vaginal culture -- but finding out this information can greatly protect your child-to-be. For instance, if a woman finds out she is HIV-positive, there are drug treatments that lower the odds she'll pass the virus to her baby to 2 percent or less, according to the Centers for Disease Control and Prevention. Treating other STDs can also help prevent complications.

4. Risk Factor: Previous Preterm Birth
If you've had a preterm birth in the past, your risk of having another one can be as high as 50 percent -- it's actually the biggest risk factor of all.
What You Can Do:
If you fall into this category, make sure you see a doctor as soon as possible. She might suggest sending you to a high-risk pregnancy specialist or put you on progesterone supplements -- the Food and Drug administration approved hydroxyprogesterone caproate injections (brand name: Makena.), for pregnant women with a history of preterm births. (Studies show this method is only effective for women carrying one fetus, not multiples.) "During pregnancy, the hormone progesterone helps to keep the uterus relaxed and prevents contractions," says Dr. Ashton. "A possible reason is that progesterone quiets the uterine cells that contract." Talk to your doctor about whether or not progesterone supplements are right for you. In some cases, physicians recommend it for women who haven't had previous preterm births. "For instance, women who are found to have a short cervix during their pregnancy, even if they have not had a prior preterm birth, can also benefit from progesterone treatments," adds Dr. Ashton. "In general, treatment should be started at 16 to 24 weeks of pregnancy and continue until 36 weeks."

5. Risk Factor: Stress and Long Work Hours
Extreme stress can increase hormones such as cortisol and epinephrine, which can cause substantial hormonal changes that can trigger uterine contractions and, in turn, case preterm labor. "Stress can also weaken your immune function and result in increased susceptibility to infections that can complicate a pregnancy," says Dr. Ashton. For that reason, experts advise that pregnant women manage their anxiety as much as possible.
What You Can Do:Getting enough sleep, developing a support network of friends and family, and seeking professional assistance can also help if you think your stress levels are getting out of hand. Adds Dr. Simpson, "If your life is hectic and you're busy running from here to there, try to stay hydrated, rest as much as possible, and get off your feet periodically, especially if your job involves prolonged standing." Bottom line: Learn how to say no!

6. Risk Factor: Gum Disease
Poor dental hygiene can cause gum disease -- also called periodontal disease -- which has been linked to preterm labor. "Bacterial infections in the mouth and gums can enter the bloodstream and circulate around the body, which can cause chronic inflammation in the mother and trigger an early delivery," explains Dr. Ashton. Another theory: The bacteria can reach the fetus and cause preterm birth. "Ideally it may be best to make sure your dental problems are taken care of before becoming pregnant," says Dr. Ashton.
What You Can Do:Mothers-to-be (and, really, all of us) should see a dentist at least twice a year and always take care of their pearly whites by brushing at least twice a day, and flossing.

7. Risk Factor: Gaining Too Much or Too Little Weight 
On average, a woman with a normal BMI should gain around 25 to 35 pounds during her pregnancy. Gaining much more than that can increase her risk for complications like high blood pressure and gestational diabetes that can, in turn, lead to preterm birth. On the flip side, gaining too little weight or being underweight before pregnancy can also lead to preterm birth and other pregnancy complications, particularly because if you're not getting enough nutrients, then neither is your baby.
What You Can Do:
If you're overweight, talk to your doctor about the ideal amount to gain during pregnancy. On average, the recommendation is 15 to 25 pounds for overweight women; 11 to 20 pounds for obese women; and extremely obese women might be counseled not to gain anything at all or even lose weight, while being strictly monitored by their doctor. If you're underweight or having trouble eating (as many women battling morning sickness often do), ask your doctor for help. And remember, eating for two does not mean doubling your calories. “The reality is you only need an additional 300 calories a day when you're pregnant,” explains Dr. Ashton. The key is to aim for a well-balanced diet (read: not carb-free) of around 2,000 calories a day. If you're not getting adequate nutrients from multiple food groups, your baby-to-be might suffer.

8. Risk Factor: Little or No Prenatal Care
So many risk factors for preterm labor can be managed as long as a woman is getting the proper care. Through blood tests and urine samples, doctors can screen for UTIs, STDs, anemia, and other health issues, which they can then treat before they become a serious problem for the baby.
What You Can Do:
If you're pregnant or, ideally, even thinking about becoming pregnant, see your doctor as soon as possible. Your doctor can administer tests and make sure you're eating well, gaining the ideal amount of weight, and taking prenatal vitamins that help ensure a healthy pregnancy. For instance, according to the Centers for Disease Control and Prevention, 28 percent of pregnant women have a vitamin D deficiency, which can lead to a preterm birth. Taking supplements can help prevent this.

9. Risk Factor: Having Multiples
If you find out you're pregnant with twins, triplets or (gasp!) more, it's important to know that your risk of delivering early increases dramatically. "A woman delivers four weeks earlier, on average, per fetus in the uterus," says Dr. Simpson. "So if the average pregnancy lasts 40 weeks, it would last 36 weeks for twins, 32 weeks for triplets, and so on."  One explanation: "There’s extra pressure on the cervix and the uterus starts to contract because it's being stretched to the max," adds Dr. Simpson.
What You Can Do:
If you're expecting multiples, make sure you're seeing an obstetrician who specializes in high-risk pregnancies or a maternal-fetal medicine specialist. Your physician will likely monitor you more frequently. Also, while there’s no definitive proof that bed rest is effective in preventing preterm labor, anecdotally many women (and some doctors) swear by it. In general, doctors advise that women carrying multiples, especially triplets or more, decrease physical activity and avoid staying on their feet for long periods of time. Again, ask your doctor what she recommends for you.

10. Risk Factor: Reproductive Problems
Certain abnormalities of the reproductive system can cause preterm labor. When a woman has "cervical insufficiency" -- the cervix is weak and doesn't maintain the pregnancy well -- early delivery is a risk. Unfortunately, women often don't know they have one until after they've already experienced a pregnancy loss or preterm birth.
What You Can Do: Once cervical insufficiency has been diagnosed, doctors may perform a cervical cerclage, which is a stitch in the cervix that strengthens it and gives it extra support so that it doesn't dilate prematurely, says Dr. Simpson. Your doctor can remove the stitch around 37 weeks, or whenever she deems it safe for you to deliver. Also, women who have abnormalities of the uterus, such as a malformation, might also be considered for a cervical cerclage. And if you're diagnosed with large fibroids, removing them prior to conception can help prevent complications in a future pregnancy.

11. Risk Factor: Short Time Between Pregnancies
Of course, there are many benefits to having children close in age: They have a constant playmate, and you get to say good-bye to diapers sooner rather than later. However, there is such a thing as too soon. "After pregnancy, you need to give your body adequate time to recuperate, heal, and build back enough strength to increase your chances of carrying the next baby to term," says Dr. Ashton.
What You Can Do: On average, experts recommend waiting 16 to 18 months before trying for baby #2. However, it's important to talk to your doctor about what's best for you: For instance, if you're older than 35, you might not want to wait that long since fertility declines as you age.

12. Risk Factor: Abnormal Amniotic Fluid Levels
Certain maternal and fetal conditions can result in abnormal amniotic fluid levels around the baby. "For instance, when a woman is diagnosed with gestational diabetes during pregnancy, her baby can become very large and produce a lot of urine," says Dr. Simpson. "That excess fluid can lead to uterine distension and, in turn, preterm labor." Also, fetal anomalies, such as when the baby has impaired swallowing, can also cause excess fluid to build up.
What to do:
Watch out for signs that you're producing too much fluid: For instance, if you gain a lot of weight in one week or if your uterus suddenly looks or feels huge, contact your doctor. If need be, he can remove some of the fluid by withdrawing it with a needle. On the flip side, women can produce too little fluid -- a condition called oligohydramnios, which can also lead to the need for an early delivery. Signs include fluid leaking from the vagina, not gaining enough weight, and/or the baby doesn’t seem to be growing quickly enough. Depending on how far along you are in your pregnancy, your doctor might just monitor you closely, suggest bed rest, encourage you to drink more fluids, and/or possibly perform an amniofusion (where he puts saline solution into the uterus.)

13. Risk Factor: Maternal Illnesses
High blood pressure due to preeclampsia, diabetes, or renal disease -- any serious maternal illness can directly affect the fetus and cause a preterm delivery.
What You Can Do:
Getting diagnosed and treated for your condition both before and during pregnancy helps. "If a patient is hypertensive before pregnancy, for example, her doctor can make sure she's on safe medication to control her blood pressure," says Dr. Ashton. Also, eating well, exercising, and maintaining a healthy weight can help prevent the onset of certain conditions such as gestational diabetes and high blood pressure.

14. Risk Factor: Not Knowing the Signs
While preterm labor is very scary, it doesn't always lead to a preterm birth. In other words, doctors can stop labor in some cases.
What You Can Do:
The key is to know the signs of preterm labor, so you can notify your physician immediately. These include: Contractions every ten minutes or more frequently; a low, dull backache; menstrual-like cramps; pelvic pressure; and any fluid leaking from the vagina. "The earlier you identify the symptoms and get to physician, the better your chances of stopping the contractions," says Dr. Ashton. "Once a woman's cervix dilates past 4 centimeters, it's fairly certain she will go on to deliver." If there's a specific reason for preterm labor, such as a UTI, then treating the infection will usually stop the contractions. However, in many cases there may be no identifiable cause, so women will typically receive fluids to stay hydrated and possible medications to help slow uterine contractions. 

Dina Roth Port is a freelance writer and author of Previvors: Facing the Breast Cancer Gene and Making Life-Changing Decisions.

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