- All pregnant women should attend prenatal (antenatal) care by skilled health providers in well-equipped health facilities.
- A pregnant woman should attend a minimum of four prenatal care visits, according to the World Health Organisation.
- Basic prenatal care prevents pre-term births in several ways.
• Pre-term birth is defined as the birth of a baby before 37 weeks.
• Prenatal care allows for early interventions, which can either prevent pre-term births or lead to better survival of babies who are born pre-term.
• Women who receive prenatal care are at a lower risk of having a pre-term birth regardless of the cause.
All pregnant women should attend prenatal (antenatal) care by skilled health providers in well-equipped health facilities.
A pregnant woman should attend a minimum of four prenatal care visits, according to the World Health Organisation.
Basic prenatal care prevents pre-term births in several ways.
Through regular prenatal care, women at a higher risk of having a pre-term birth (a woman with a previous preterm birth) will be identified much earlier and specific interventions to monitor them or offer supportive treatment can be instituted.
Screening and treatment of infections such as syphilis, HIV, bacteriuria, malaria, bacterial vaginosis, tuberculosis and other diseases that can cause pre-term births can also be done.
The nutrition of pregnant women has been shown to have implications on pre-term births. Identifying women with malnutrition and offering nutritional counselling and supplementation, including micro-nutrient supplementation or counselling on food practices and attitudes can be achieved through regular prenatal care.
Both obesity and underweight during pregnancy have been linked to pre-term births and other adverse birth outcomes.
Early labour, bleeding
Prenatal care offers the opportunity to counsel women on how best to prepare for the birth process including identifying early labour signs and symptoms such as early pregnancy bleeding, rupture of membrane, draining of amniotic fluid and early uterine contractions.
Women who experience social and financial challenges including stressful situations during pregnancy can be identified through regular prenatal care.
Maternal stress during pregnancy has been positively associated with the occurrence of preterm births. Screening for maternal stress before or during pregnancy and instituting appropriate interventions, has the potential of preventing pre-term births.
Research has shown that women who experience spouse violence are two times more likely to deliver a pre-term baby.
Newer models of prenatal care, such as group prenatal care that address issues such as maternal stress in pregnancy, depression, substance abuse, intimate-partner-violence, smoking and smoking cessation and exposure to second-hand smoke including other environmental pollutants have been shown to reduce the occurrence of preterm births.
Adolescents get pre-term babies
Adolescents are at a higher risk of pre-term births due to their young age and limited access to preconception and prenatal care and therefore need a more enhanced prenatal care package.
Women with previous pre-term births or with medical complications during pregnancy such as high blood pressure, diabetes, thyroid disease or other complexities in pregnancy like intrauterine growth restriction are at a higher risk of pre-term birth and will require multidisciplinary care, ideally in a ‘one-stop’ kind of prenatal care service.
Such women can benefit from key interventions for improving survival for babies born pre-term such as antenatal corticosteroids to improve pre-term baby’s lung function, antibiotics to prevent infections and magnesium sulphate to protect the pre-term baby’s brain.
A more enhanced prenatal care package for women at higher risk of pre-term birth including services that are specifically tailored to the individual woman’s risk profile (precision medicine) will also lead to a reduction in pre-term birth.
Quality prenatal care supported by interventions at policy, health system and community levels will lead to dramatic decreases in the incidence of pre-term birth.
Dr Musana is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi