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The U.S. Centers for Disease Control and Prevention recently reported the startling news that the U.S. infant mortality rate increased in 2002 for the first time since 1958. An increase in premature births was the leading cause.

Instead of revealing a weakness in the health care system, however, the CDC statistics suggest that as strange as it sounds, advances in medical technology and capabilities are behind the increase.

Group health agents and brokers need to understand what is happening so that they can help clients develop strategies for improving the health of mothers and babies and reducing the costs associated with preterm births.

One key detail is the fact that the death rate in 2002 for preterm infants was 15 times that of term infants.

Improvements in neonatal medicine and assisted reproductive technologies mean that babies born after 23 weeks to 25 weeks of gestation, who once would have died soon after delivery, are now counted as high-risk infants.

Why are premature births increasing?

Besides technology and treatment advances, there are other factors that contribute to an increase in premature births:

o Infertility. According to an American Society for Reproductive Medicine study released in January 2005, 1 in 10 American couples is infertile, and about 100,000 pregnancy attempts are made each year using “in vitro fertilization.” With IVF or other assisted reproductive technologies there is a greater possibility of multiple births, and the main risk factor with multiple births is prematurity.

o Advanced maternal age. How old is too old to have a baby? Many women in their 20s are choosing careers before motherhood. Although preterm labor can happen to any woman, women over 35 have twice the relative risk of premature delivery.

o Improved neonatal management. The use of surfactant to improve the health of babies’ lungs, improved ventilation, nutrition techniques, tertiary care centers and other improvements in this area increase the number of infants that survive in the delivery room.

These advances, however, are not necessarily directly related to survival through the first year of life.

o Changes in reporting. Changes in our abilities to keep an infant alive have changed the definition of viability. According to the CDC, improvements in pregnancy outcomes for infants at borderline ages (about 23 weeks to 24 weeks gestation) have shifted events that once would have been recorded as fetal deaths into the column for live births of babies with a high mortality rate.

Health plans have contributed greatly to developing programs and resources for preventing premature births by improving management of high-risk pregnancies.

Many health plans recognize that education is the best tool for helping mothers bring their deliveries to term. Those plans have created case management programs, prenatal education programs and risk-assessment aimed at pregnant women.

For group health agents and brokers, the best response to this information is to encourage employers to offer solid prenatal care benefits and encourage pregnant employees to keep up with their prenatal appointments and follow their physicians’ recommendations.

Patricia Buck, R.N., is a neonatal case manager at ING Re, and Kathleen Thiesen is a market research analyst at ING Re. ING Re is the reinsurance business of ReliaStar Life Insurance Company, Minneapolis, a unit of ING Groep N.V., Amsterdam. Buck can be reached at patricia.buck@ing-re.com, and Thiesen can be reached at kathleen.thiesen@ing-re.com.