Mothers with hypertension or diabetes up to six times more likely to deliver preterm



    New analysis shows hospital costs for small babies 11 times higher than
    for normal weight babies

    OTTAWA, Jan. 29 /CNW Telbec/ - In 2006-2007, more than 54,000 babies
across Canada were born preterm or small for their gestational age (SGA),
according to new analysis from the Canadian Institute for Health Information
(CIHI). This represents one in seven Canadian births.
    During the year studied, the Canadian preterm birth rate (born before 37
weeks gestation) was 8.1%, or almost 29,000 births, up from around 6.6%(i) in
the early 1990s. The rate of small-for-gestational-age births (babies born
with a weight below the 10th percentile for their gestational age and sex) was
8.3%, down from approximately 11%(i) in the early 1990s.
    "In Canada and throughout North America, we've been seeing a gradual
decline in the number of babies born small for their gestational age, and an
increase in the rate of preterm births," says Jean-Marie Berthelot, CIHI's
Vice President of Programs. "Factors such as delayed child bearing and use of
reproductive technologies are likely contributing to a greater number of
multiple births and preterm deliveries; while a lower smoking rate, for
instance, may be contributing to a decline in babies born underweight for
their age."
    CIHI's study found some provincial variation in preterm birth rates.
Among the provinces, Alberta and Newfoundland and Labrador had the highest
preterm birth rates, at 8.7% and 8.6%, respectively, while New Brunswick and
Prince Edward Island had the lowest rates (both at 7.0%). Nunavut had the
highest preterm birth rate overall, at 10.8%.

    Biological factors a risk for preterm births, social factors for
    SGA births

    CIHI's analysis examined the risk factors associated with both preterm
and SGA births (babies born with a weight below the 10th percentile for their
gestational age and sex), and found some differences between them.
    For example, among the data available for these analyses, biological
factors were more strongly associated with preterm births, whereas social
factors were more strongly associated with SGA births.
    "Babies who are born preterm or small for their gestational age are at an
increased risk of long hospitalizations and complications," says Caroline
Heick, CIHI's Director of Acute and Ambulatory Care Information Services. "It
is important to understand the risk factors for expectant mothers in order to
provide better prenatal care and better plan for appropriate services to offer
these babies the care they need."

    
    Among risk factors for preterm births:

    - Multiple-birth babies were nearly 17 times as likely to be born preterm
      as singleton babies.
    - Mothers who were diagnosed with hypertension and/or diabetes were up to
      six times more likely to deliver a preterm baby compared to women
      without those conditions.
    - In 2006-2007, mothers age 35 and older had a preterm birth rate of
      nearly 10%, compared to 8% for those age 20 to 34.
    - The preterm birth rate was also significantly higher for babies
      delivered by Caesarean section (13.3%) compared to induced (6.9%) or
      non-induced vaginal deliveries (6.5%).

    Among risk factors for small-for-gestational-age (SGA) births:

    - Mothers living in urban areas were 1.3 times or 30% more likely to have
      an SGA birth, while mothers living in low-income neighbourhoods were
      also at increased risk (1.5 times or 50% more likely compared to
      mothers living in high-income neighbourhoods).
    - Women with hypertension were almost twice as likely to deliver an SGA
      baby. Diabetes, on the other hand, was not shown to result in a higher
      rate of SGA births.

    "We have known for some time that conditions such as hypertension and
diabetes increased a woman's chance of delivering preterm, but it was
difficult to quantify just how big a role these risks played," says Dr. Reg
Sauve from the University of Calgary. "With the understanding that chronic
conditions can increase the chances of having a preterm birth sixfold,
additional management of these conditions throughout a pregnancy becomes a
vital step in limiting the instances of preterm births."

    Hospital costs for preterm babies nine times that of full-term babies

    The study found that the lower the birth weight or gestational age of a
newborn, the higher the hospital costs. In 2005-2006, the average in-hospital
cost for a low birth weight baby (less than 2,500 grams or five and a half
pounds) was more than 11 times higher than for those weighing 2,500 grams or
more ($12,354 compared to $1,084). Similar cost differences were seen for
singleton preterm babies, with average hospital costs nine times higher than
for full-term babies ($9,233 versus $1,050). Among multiple-birth babies who
were also preterm, the average cost was about seven times higher ($12,479
versus $1,871).
    SGA babies, in contrast, had an average hospital cost less than twice that
of a non-SGA baby - $2,297 versus $1,407. Small-for-gestational-age status was
not found to be a strong predictor of hospital use and cost at the time of
birth-while the average hospital cost for a singleton non-SGA baby born
extremely preterm (less than 28 weeks gestation) was $85,103, this estimate
rose to $109,286 for a singleton SGA baby born at 28 weeks or less gestation.

    Additional childbirth indicator highlights

    CIHI has additional statistics on various childbirth indicators that can
be easily accessed through QuickStats at www.cihi.ca. Highlights from the
2007-2008 indicators (excluding Quebec) include the following:

    Primary Caesarean section rates

    - In 2007-2008, Newfoundland and Labrador and Prince Edward Island had
      the highest rate of primary Caesarean sections (or women having a
      C-section for the first time), with 22.8% and 22.6% of all live
      births delivered by primary C-section.
    - Manitoba and Saskatchewan had the lowest primary C-section rates,
      at 13.4% and 15.6%, respectively.

    Epidural rate for vaginal deliveries

    - In 2007-2008, 58.2% of vaginal deliveries in Ontario and 51.3% of
      vaginal deliveries in Nova Scotia were preceded by an epidural, the
      highest among the provinces.
    - British Columbia and Prince Edward Island had the lowest epidural
      rates for vaginal delivery, at 29.4% and 33.5%, respectively.

    About CIHI

    The Canadian Institute for Health Information (CIHI) collects and analyzes
information on health and health care in Canada and makes it publicly
available. Canada's federal, provincial and territorial governments created
CIHI as a not-for-profit, independent organization dedicated to forging a
common approach to Canadian health information. CIHI's goal: to provide
timely, accurate and comparable information. CIHI's data and reports inform
health policies, support the effective delivery of health services and raise
awareness among Canadians of the factors that contribute to good health.

    The report and the following figures are available from CIHI's website,
    at www.cihi.ca.

    Figure 1   Preterm Birth Rate: The Picture Across Canada, 2006-2007
               (Figure 3 in the report)

    Figure 2   Small-for-Gestational-Age Rate: The Picture Across Canada,
               2006-2007 (Figure 4 in the report)

    Figure 3   Preterm Birth (PTB) and Small-for-Gestational-Age (SGA) Rate
               by Maternal Diabetes Status in Canada, 2006-2007 (Figure 10 in
               the report)

    Figure 4   Preterm Birth (PTB) and Small-for-Gestational-Age (SGA) Rate
               by Maternal Hypertension (HTN) Status in Canada, 2006-2007
               (Figure 11 in the report)

    Figure 5   Average Hospital Cost for "Typical" Newborns, By Birth Weight
               Category, 2005-2006 (Figure 13 in the report)

    ------------------------
    (i) These statistics were obtained from the Canadian Perinatal
        Surveillance System report, which uses methodology similar to
        that of CIHI (though data from Ontario are excluded).
    




For further information:

For further information: Leona Hollingsworth, (416) 481-2002 ext. 3251,
Cell: (416) 459-6855, lhollingsworth@cihi.ca; Jennie Hoekstra, (613) 241-7860
ext. 4331, Cell: (613) 725-4097, jhoekstra@cihi.ca


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