Premature births are declining in New Jersey — contrary to the national trend — but the rate remains above a public-health target and reflects a racial disparity that leaves black children vulnerable to long-term health problems, according to a new report.
New Jersey was one of 11 states that scored a C+ on the March of Dimes 2019 report card, an annual measure of maternal and infant health outcomes including pre-term birth, which impacts one in 10 newborns nationwide. Delaware and Pennsylvania also earned a C+ while New York received a B- in the report released Monday.
According to the organization, which advocates for healthy mothers and infants, babies that are born before 37 weeks in the womb can suffer long-term physical and intellectual problems that impact lung function, immune response, behavior and learning.
“It is the leading cause of death and disability (in American children) up to age 5,” said Dr. Todd Rosen, director of maternal-fetal medicine with Rutgers Robert Wood Johnson Medical School. “It’s a giant problem that we haven’t solved yet.”
While the rate of children born pre-term has crept up in 30 states recently, the national advocacy organization found that in New Jersey it declined to 9.5% in 2018, down from 9.9% in 2016 and 10.5% in 2008.
At the same time, though, the rate of premature deliveries is 46% higher for black women than for all other mothers, and the state has a way to go to reach the March of Dimes goal of an overall 8.1% rate by 2020.
Good news, and bad
The downward trend is “good news for New Jersey,” Rosen said. “But overall we’ve done a pretty terrible job preventing pre-term birth nationwide.”
Maternal and infant health have become a top priority in recent years for government and health care leaders in New Jersey, with much attention focused on reducing the state’s maternal mortality rate, considered among the highest for any state. Overall, 37.3 in 100,000 women here die during pregnancy or within a year of childbirth or miscarriage, according to state data. The rate ranges from 12.8 for white women to 46.5 for black mothers.
“Maternal and infant outcomes are intertwined. NJ has among the worst pregnancy-related mortality, severe maternal morbidity, and disparities outcomes in the country,” the March of Dimes writes in its report.
In a “Spotlight on New Jersey” section, the group credited the Garden State’s efforts to invest in community health workers, to train doulas, and to expand access to contraception. It also praised First Lady Tammy Murphy’s Nurture NJ campaign to increase awareness of these issues and took note of the state’s own new report card on maternal care, which allows people to see how each birthing center performs. In September, the state also received $10.5 million in federal funding to create a blueprint to improve maternal health outcomes.
“Every mother deserves the opportunity for a healthy birth experience and a healthy child,” said the First Lady in announcing the five-year federal grant at a maternal health summit. “Skin color should not impact the quality of care received or chances of surviving childbirth, nor should it determine whether children live to see their first birthday.”
‘Tough problem to solve’
Pre-term birth “is a really tough problem to solve,” said Rosen, who has studied the issue for years. Access to care may influence these outcomes to some degree, but much of it is controlled by a woman’s own biochemistry.
“There’s a clock that governs pregnancy,” he said, “but we don’t even know why (women) go into labor when they do.”
There are surgical and pharmaceutical interventions that can help decrease premature births, Rosen said, many of which have been in use for decades. Reducing the pregnancy rate among teens, who are more likely to delivery early, and discouraging pregnant women from smoking have also been beneficial, he said.
The vast majority of babies born pre-term are delivered between 32 and 37 weeks, Rosen explained, and most of these catch up as they age. A third or more early births happen on purpose, in order to protect the health of the mother or baby, he added.
But the small percentage of infants born before 32 weeks are extremely fragile and at risk, and can spend weeks in a neonatal intensive care unit, where treatment costs as much as $10,000 a day, he said.
The new March of Dimes report is the first to include estimates of the cost of premature births. In the Garden State, each costs society an average of $72,000 in medical costs for mom and baby, intervention expenses and lost productivity. Nationwide, the equivalent cost is closer to $65,000, up at least 25% in a decade.
The March of Dimes found the nationwide pre-term birth rate has risen to more than 10% in 2018 from 9.6% in 2015. The organization gave the country a C grade for its results. Only one state — Oregon — earned an A. Twelve states received some form of B, 21 got a C grade, and nine ended up with a D rating.
Six states — all in the Southeast — and Puerto Rico scored an F.