Prematurity Risks: What Today’s Black Parent Needs To Know

Father touching pregnant belly

(BlackDoctor.org) — Every parent hopes to have a complication-free pregnancy and to give birth to a healthy baby after a full 40 weeks. Unfortunately, premature births – that is, any births before 37 completed weeks of gestation – are too common within the African-American community. While prematurity is a problem for American women of all ethnicities, African Americans have the highest chance of delivering a baby prematurely. About 100,000 Black babies are born too early each year, representing nearly 20% of all preterm births in the U.S.

Why Are African-American Babies More Likely to be Premature?

Unfortunately, science has yet to explain all of the reasons for preterm labor, or why prematurity is more prevalent among African Americans. Even if a woman takes every possible precaution, she can still have a premature baby. There are, however, some known risk factors for premature birth, some of which are common among African-American women.

High blood pressure and diabetes – both risk factors for prematurity – are significant health problems among African-American women. These are often brought on by being overweight and having high cholesterol levels. In addition, studies show that smoking during pregnancy often leads to premature labor. Approximately 25% of Black women in the U.S. do not receive early prenatal care within the first trimester of pregnancy. This may contribute to increased prematurity rates among African-American women.

What Challenges Does a Premature Baby Face?

Being born early disrupts normal organ development.  For example, the lungs of the premature baby are not as capable of absorbing oxygen and they collapse more because they do not have enough of a type of cell that makes important substances that allow for the lung to stay open. This puts premature babies at increased risk for respiratory complications. Preemies are also born without all the virus-fighting antibodies they need and get from their mother while in the womb. This means they have an immature immune system and are more prone to infections such as respiratory syncytial virus (RSV), a widespread seasonal virus that is very common during the fall and winter months.

Even babies born just a few weeks early are at increased risk for health problems. In fact, the majority of preemies are born between 32 and 35 weeks gestation. Parents of larger premature babies need to remember that while their baby may look healthy, he or she might still face complications.

What is RSV and Why Are African-American Infants at Risk?

RSV is a very common virus. It’s so common that virtually 100% of all children contract it by the age of 2. In most healthy children, the symptoms are similar to the common cold and parents may never know  that their child has it. But for preemies and babies with certain heart and lung conditions, RSV can lead to a very serious infection requiring medical attention. In fact, RSV infection is the leading cause of infant hospitalization in the U.S., representing 1 in 13 pediatrician’s visits and 1 in 38 trips to the Emergency Department.

According to some studies, infants from multicultural communities—particularly African-American babies—are at increased risk of developing severe RSV, resulting in hospitalization and even death. In fact, one study of almost 20 years of data showed that twice as many Black infants die from RSV each year, compared to White children. While we don’t know the exact reason for the increased risk of RSV among African-American babies, the fact that more premature babies are born in this community than any other may be a contributing factor.

Other known risk factors that may increase the chances of getting RSV include school aged siblings, maternal tobacco use, day care attendance, exposure to environmental smoke/air pollutants, and crowded living conditions.

How Can Parents Protect Their Babies from RSV? 

There is no treatment for RSV, so prevention is key. RSV is highly contagious, so washing hands and/or using a hand sanitizer gel, cleaning toys and bedding frequently and avoiding bringing your baby around people who are sick or in large crowds, where they may be exposed to the virus, can help. Babies at high-risk for RSV infection may qualify for a preventive therapy. Parents should speak to their child’s health care provider about preventing RSV. To learn more about the virus, visit www.RSVprotection.com.

Mammograms: What Now??

woman getting mammogram(BlackDoctor.org) — In the latest findings to fuel the debate on when to start getting mammograms, new research adds support to those suggesting that annual breast X-rays should begin at age 40.

Screening younger women has been controversial, with 2009 guidelines from a U.S. federal task force recommending against routine mammography screening for average-risk women in their 40s.

The new study showed that mammograms were just as likely to find invasive breast cancers in women with no family history of breast cancer as in women with a family history of the disease. Invasive breast cancer grows beyond the milk ducts or lobules of the breast.

The women in the study were aged 40 to 49.

And women with and without a family history were just as likely to have cancer that had spread to the lymph nodes, says study leader Stamatia Destounis, MD, a radiologist at Elizabeth Wende Breast Care, LLC, in Rochester, N.Y.

Women without a family history are “average-risk” women, suggesting that annual mammograms are indeed beneficial for this age group, she says.

A criticism of screening younger women is that “you find small cancers that will never be a problem. But we found a considerable number that can’t wait,” Destounis says. “Invasive breast cancers can spread and kill.”

The findings were presented here at the annual meeting of the Radiological Society of North America. Destounis receives funding to conduct clinical research from several breast imaging companies, including Siemens AG. But the current study was independently funded without company support.

Family History May Not Be Only Risk

More than 230,000 women will be diagnosed with breast cancer in the U.S. in 2011, more than 26,000 of whom will be under age 45, according to the American Cancer Society.

Destounis and colleagues reviewed the medical records of 1,071 women in their 40s who had screening mammograms at their medical center between 2000 and 2010. A total of 373 were diagnosed with breast cancer.

Sixty-one percent of the women with cancer did not have a family history of the disease, meaning they did not have mothers, sisters, grandmothers, or cousins who had breast cancer. Of these women, 64% had invasive breast cancer.

Similarly, 63% of women who did have a family history of breast cancer had invasive disease. Also, about 30% of women in both groups had cancer that had spread to the lymph nodes, the study showed.

The Mammograms Debate Rages On

The frequency of screening mammograms — and the appropriate age to begin them — has been debated since the U.S. Preventive Services Task Force in 2009 recommended that women routinely get screening mammograms every other year starting at age 50.

The task force says the decision to start regular mammograms before age 50 should be an individual choice based on each woman’s situation. But overall, the benefit of screening all women in their 40s does not outweigh the risks, including that of having to undergo unnecessary biopsies, the task force says.

The American Cancer Society and the National Cancer Institute both continue to recommend annual screening beginning at age 40, however, leading to confusion among doctors and patients, Destounis says.

The new findings are unlikely to put an end to the debate, says Edith Perez, MD, a breast cancer specialist at the Mayo Clinic in Jacksonville, Fla.

What they do suggest is that family history is not useful for deciding which younger women would benefit from annual screening mammograms.

Screening recommendations are aimed at the general population, not the individual patient, says Claudine Isaacs, MD, director of the clinical breast cancer program at Georgetown’s Lombardi Comprehensive Cancer Center in Washington, D.C.

“This is an area of considerable controversy and, as always, it is best for women to check with their own doctors,” she says.