Minnesota's pre-term birth rate worsens; racial disparity undermines efforts

Minnesota's pre-term birth rate has grown worse. The change isn't drastic; the rate climbed just three-tenths of a percent last year, from 9.9 percent in 2011 to 10.2 percent in 2012.

But the shift is in the wrong direction, raising concerns among doctors and others that the state isn't doing enough to make sure that all mothers and babies receive proper care.

March of Dimes officials in the Twin Cities, who released Minnesota's numbers, say they hope the swing is just a blip. They point out that Minnesota has fewer preterm births than most states, and campaigns to further lower the rate are widespread.

But Minnesota also has some of the most significant disparities in the nation between whites and people of color, and some health experts say those disparities are likely undermining Minnesota's efforts to reduce premature births.

"Despite our overall good health statistics, there are populations that are not benefitting from living in Minnesota, and that is one of our challenges."

Babies who are born too early are at high risk for lifelong health problems and premature death, according to the March of Dimes report, which tracks births that occur before the 37th week of pregnancy. A typical pregnancy lasts around 40 weeks.

Compared to much of the nation, Minnesota gets good marks for its premature birth rate. The state has received a "B" score from the March of Dimes seven years in a row. The national rate is 11.5 percent, or a "C" score.

This year 33 states saw their premature birthrate drop. Minnesota was not among them.

"It's disappointing for us," said Danielle Prenevost, a spokeswoman for the March of Dimes Minnesota Chapter. "We really did expect to do better."

Preterm birth is a complex problem. In 40 percent of cases doctors can't identify a reason why the baby was born early. In other cases, some well-known factors contribute to the problem, including poor maternal health and lack of prenatal care.

Ed Ehlinger, commissioner of the Minnesota Department of Health, said rapid demographic changes in Minnesota have revealed that white mothers are less likely to have health problems than black, Latino and Native American mothers. He said those differences are showing up in the state's preterm birth rate.

"I think that it is a challenge to us," Ehlinger said. "Despite our overall good health statistics, there are populations that are not benefitting from living in Minnesota, and that is one of our challenges."

Ehlinger said 25 percent of the births in Minnesota are among people of color. The March of Dimes report shows that non whites have much higher preterm birth rates.

Among Minnesota's American Indians, 13 percent of babies are born prematurely, and 12.7 percent of black infants are, compared to 9.4 percent for whites.

"It's really a math problem," Ehlinger said. "As we get an increasingly diverse community with persistent disparities our rates are not going to improve as rapidly as they should."

Complicating the situation is the trend toward delayed childbearing.

As more mothers over the age of 35 have babies, doctors are treating more pregnant patients who are obese, said Dr. Lisa Saul, a high-risk pregnancy physician at Minnesota Perinatal Physicians.

"Along with that goes other medical complications, such as hypertension and diabetes which we know historically then contributes to premature birth rates," Saul said.

While it would appear that Minnesota is facing an uphill battle as it seeks to lower its preterm birth rate, it is not as hard as it sounds, said Akh Miri, a doula (a birthing assistant or coach) for The Cultural Wellness Center in Minneapolis.

"The more support you have, the less that prematurity will happen," said Miri, who works with African and African-American mothers.

That means finding ways to help all moms get to their prenatal doctor's appointments, and helping them eat better foods.

But Miri said it will take a grassroots movement launched within diverse communities to make progress toward reducing Minnesota's premature births.

"We have to have people that look like us, that help us, who support people and know where people really are at, what people really are going through," she said.

The March of Dimes report shows that Minnesota had improvements in two key health areas this year: the rate of uninsured women dropped, as did the percentage of women who smoke.

While those gains weren't enough to help reduce the state's preterm birth rate, public health officials say they are important signs of progress.