Getting to Nine

While many preterm births are unexplainable, certain factors have been shown to lead to early delivery. Women who are thinking about becoming pregnant should familiarize themselves with these known causes of preterm birth, while pregnant women should make every effort to maintain a healthy pregnancy by minimizing these risk factors

Delayed Prenatal Care:

One of the most basic aspects of pregnancy, prenatal care, is also one of the most important when it comes to preventing premature labor. Pregnant women need to be seen by an OB/GYN on a consistent basis throughout their pregnancy to ensure that their baby is developing properly and that medical complications are dealt with in a timely manner. Your first prenatal visit should take place somewhere between 7-9 weeks’ gestation. If you are considered “high risk,” your physician may want to see you sooner and more often.

To find a provider who accepts your insurance, please visit ZocDoc
Alternatively, could link directly to Sharp, Scripps, UCSD, etc.

Being Overweight or Underweight Prior to Pregnancy:

Being underweight or overweight at any point during your life is never a good idea, but prior to and during pregnancy your weight can have serious effects on your health and the health of your unborn baby.

Prior to becoming pregnant, you should calculate your Body Mass Index (BMI) to determine if you are underweight, normal weight, overweight, or obese. Once you have this information, you can start to take the appropriate steps that will help you achieve a healthy weight. A consistent exercise practice and a focus on healthy eating can both help you achieve your weight goals.

If you are currently pregnant, talk to your doctor about the appropriate amount of weight you should gain over the next nine months. Generally speaking, women with a normal pre-pregnancy weight should gain anywhere from 1 – 4.5 pounds during the entire first trimester, and 1 – 2 pounds per week during the second and third trimester. This equates to a caloric intake of 1,800 calories during the first trimester, 2,200 during the second trimester, and 2,400 during the third trimester. If you are underweight or overweight when you find out you are pregnant, your physician will work with you to achieve the optimal weight gain for a healthy pregnancy. Moms expecting multiples should also consult their OB/GYN to learn more about their specific weight gain recommendations.

Smoking, Alcohol, and Illegal Drugs:

Every food or substance that a pregnant woman ingests can directly affect the health of her unborn baby. If a woman smokes during pregnancy, her baby is exposed to harmful chemicals such as tar, nicotine, and carbon monoxide. Nicotine causes blood vessels to constrict, so less oxygen and nutrients reach the fetus, and carbon monoxide can decrease the amount of oxygen the baby receives. When a pregnant woman drinks alcohol, it quickly reaches the fetus through the placenta. An adult’s liver can break down the alcohol ingested, but because the baby’s liver is not fully developed, it is unable to do so, causing significant health problems. Fetal Alcohol Syndrome is a serious repercussion of drinking during pregnancy that can have lasting detrimental effects.

If you need help quitting smoking, please call 1-800-QUIT-NOW (1-800-784-8669). If you have a problem with illegal drugs or need help to quit drinking during pregnancy, please reach out to your OB/GYN for help. They can direct you to the appropriate resources depending on the severity of your problem.

Mental Health:

Perinatal depression is the most common complication of childbirth. The American College of Obstetricians and Gynecologists (ACOG) estimates that 14% – 23% of women will suffer with symptoms of depression during pregnancy, and at least one in seven women (14%) will experience significant depression within the first year after childbirth. Approximately 6% of pregnant women and 10% of postpartum women will develop anxiety. While these statistics are alarming on their own, what’s even more concerning is the fact that only 15% of women perinatal depression and anxiety will ever seek treatment.

Untreated depression during pregnancy has been associated with poor pregnancy and birth outcomes including maternal preeclampsia, low birth weight, smaller head circumferences, increased risk of premature delivery, increased surgical delivery interventions, lower APGAR scores, and a higher rate of admission to the neonatal intensive care unit. If a woman experiences depression postpartum, her baby may experience long-term effects that include poor mother-infant attachment, delayed cognitive and linguistic skills, impaired emotional development, and behavioral issues.

Stressful life events are another issue that can have serious repercussions for women who are currently pregnant. Although we often cannot control these events (death of a family member, job loss, etc.) from happening, making sure that you have a good social support network and access to qualified mental health professionals can help ensure that you process the event appropriately, while continuing to focus on your prenatal health.

To find a mental health care provider near you, please visit Postpartum Health Alliance’s website.

If you are a NICU parent and want to connect with others who have experienced a similar situation, consider joining the Miracle Babies Parents Supporting Parents, a social support service.


Of the 10% – 15% of infants who are born premature every year, 40% of these births are attributed to untreated intrauterine infections. Bacterial Vaginosis (BV) and Urinary Tract Infections (UTI) are two of the most common infections during pregnancy, and often times the symptoms are so mild you may be unaware that you even have an active infection.

Approximately 10% – 30% percent of pregnant women will contract BV at some point during their pregnancy. This infection is the result of an imbalance of bacteria in the vagina, and symptoms can include a foul smelling vaginal odor, discharge, and vaginal itching. Although BV is not a sexually transmitted infection, it is associated with vaginal intercourse, and women increase their risk of contracting this infection by having a new sexual partner, multiple sexual partners, or by douching.

A urinary tract infection, also known as a bladder infection, is an inflammation in the urinary system. Common symptoms include a sense of urgency, passing small amounts of urine, a burning sensation, cloudy urine, or blood in the urine. UTI’s are most common between 6 and 24 weeks of pregnancy, as the uterus starts to grow and begins to block drainage of urine to the bladder. All pregnant women should submit a urine sample to their OB/GYN at the beginning of their pregnancy to determine if there is bacteria present in their urinary tract. If detected, UTI’s can be safely treated with antibiotics.

Carrying Multiples:

Women who are pregnant with multiples (twins, triplets, or more!) are six times more likely to delivery prematurely. Genetics, age, assisted reproductive technology, and chance can all play a role in the likelihood of carrying multiples. Once you find out you are carrying more than one baby, your physician will talk to you about certain precautions you may need to take as you progress in your pregnancy. Additional ultrasounds, increased frequency of prenatal visits, possible need for a C-section, and early bedrest are all factors that may be discussed.

To learn more about the potential complications inherent in a multiples pregnancy, please visit the American Pregnancy Association’s website.

Fetal Programming

Fetal programming is an emerging concept that links environmental conditions during embryonic and fetal development with increased risk of certain diseases later in life. Researchers have found that the environment in the womb, during specific periods of development, can significantly alter the development of the fetus, leading to significant and long-term effects.

The health impacts of certain exposures during pregnancy (i.e. smoking, alcohol, thalidomide) are well known. More subtle changes, such as variations in nutrition and periods of maternal stress, have also been shown to seriously impact the fetal environment, causing changes in gene expression during the development of certain tissues and organs. We now know that these collective changes shape an individual’s future health, and often times may determine their risk for developing certain diseases such as obesity, Type 2 Diabetes, and allergies.

Women who are pregnant, or who plan to become pregnant should make a concentrated effort to eat healthy, exercise, and reduce stress in order to create the best environment for their baby to develop and grow in. By controlling these external factors, women have the potential to greatly impact their baby’s short and long-term health outcomes.

Learn more about fetal programming by visiting the Begin Before Birth website and reviewing the recent articles below.

History of Preterm Birth:

Women with a spontaneous preterm birth are more likely to experience preterm labor and delivery in subsequent pregnancies. The earlier a previous premature birth took place, the more likely it is that the next birth occurs as early or even earlier. Make sure that your Doctor knows about your pregnancy history so that she or he can take all the necessary precautions to prevent a preterm birth from occurring again. If your previous preterm birth was the direct result of a known risk factor (many of which are described on this page), you should attempt to change your behavior prior to becoming pregnant again, or as early into your subsequent pregnancy as possible.

17 alpha-hydroxyprogesterone caproate (more commonly known as 17P, or by the brand name Makena) is a synthetic form of progesterone that has been shown to reduce the recurrence of preterm birth for women with singleton gestations that have a history of at least one preterm delivery. Studies have shown that on average, women who use 17P reduce their chance of having another preterm birth by 33%. If you think you are a candidate for this medication, talk to your physician about how to obtain a prescription.

Inadequate Birth Spacing:

Birth spacing is an important issue that researchers are starting to look at more closely. Women who get pregnant within a year of giving birth are twice as likely to deliver prematurely, compared with women who wait at least 18 months between pregnancies. Limited studies have also shown that a subsequent pregnancy within 18 months of giving birth can result in a higher likelihood of low birth weight, small size for gestational age, and preterm birth.

Some experts believe that closely spaced pregnancies don’t give a mother enough time to recover from the physical stress of one pregnancy before moving on to the next. Additionally, pregnancy and breastfeeding are known to deplete a woman’s stores of essential nutrients, such as iron and folate, and if she were to become pregnant again before replacing those stores, it could negatively affect the health of her unborn baby. On the other side of the argument, researchers point to the fact that closely spaced pregnancies are more likely to be unplanned, and that women who get pregnant shortly after giving birth are more likely to be economically disadvantaged. These factors make accessing prenatal care more challenging, which in itself could be the reason for the complications that women experience when their pregnancies are close together.
As research continues to develop, we encourage women considering a subsequent pregnancy within 18 months of delivering to consult with their physician. Ensuring that you are healthy and prepared to carry a second, third, or fourth baby to term will have positive long-term effects on both mom and child.

In Vitro Fertilization (IVF):

IVF is one of the greatest inventions of modern time, allowing women who otherwise would not have been able to get pregnant the opportunity to carry their own child. Unfortunately, research is starting to show that this practice can put a woman at risk of delivering prematurely. In fact, when compared with a naturally conceived baby, IVF singletons have been found to be twice as likely to be born premature, and twins conceived via IVF are 23% more likely to be born early than twins conceived naturally.

Some researchers attribute the association between IVF and preterm birth to hormonal factors. Women are often given a large dose of hormones to increase the number of eggs they will release, and some scientists believe that these hormones affect the way that the embryo implants in the uterine wall. Others who have looked at the relationship believe that women who tend to seek out IVF services often have underlying risk factors (advanced maternal age, overweight, underlying mental health issues) that cause them to deliver prematurely more often than their natural pregnancy counterparts.

In order to decrease your risk of delivering prematurely when undergoing IVF, you should strive to be as physically and mentally healthy as possible before starting the procedure. Women and their partners should also consider working with trusted fertility Doctors that promote single embryo transfers, a technique that decrease the chance of unplanned multiples.

Maternal Age:

Women who are younger than 17 or older than 35 at the time of delivery, are more likely to have a premature baby. These individuals are often classified as “high-risk” and will likely be monitored more closely by their physician throughout their pregnancy. When planning a pregnancy, women should always take into consideration their age, and the potential health complications that may arise as a result of getting pregnant on the early or later end of the reproductive age spectrum.

Poor Nutrition:

Proper nutrition is such an important part of achieving a healthy pregnancy, and one of the most easily modifiable behaviors. Studies have found that women who eat a diet rich in vegetable, fruits, and whole grains, and those that consume plenty of water are less likely to deliver prematurely.

Most pregnant women need an additional 300 calories each day, although the exact amount depend on your pre-pregnancy weight. Women should make sure that they are eating foods from each of the five food groups, choosing foods that are high in protein, and putting as much color on their plates as possible. Additionally, staying well hydrated is one of the most important things you can do to prevent some of the minor discomforts of pregnancy. Pregnant women should aim to drink at least 8 glasses of water every day.

The My Plate Checklist Calculator is a great tool for pregnant and breastfeeding moms who want to monitor their caloric intake and meet their food group targets.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. For more information or to enroll in the WIC program, please contact your state WIC contact.