Why Preterm Births And Infant Deaths Continue To Rise: Are We Missing The Early Warning Signs?

When a baby arrives before 37 weeks of pregnancy—it can bring along a host of health problems for the baby that leads to emotional stress for the family. While medical care has improved, many preterm births are still preventable if warning signs are identified early and proper care is given.

Experts say a range of factors, including maternal health, fetal conditions, and lack of timely medical attention, play a role in early deliveries. To understand this better, we got in touch with expert who explains the common causes of preterm birth, steps to prevent it, and why better access to healthcare is key to improving outcomes for both mothers and babies.

Causes Behind Premature Birth

According to Dr Shilpa Aroskar, Consultant in Paediatrics and Neonatology at Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, "Preterm births can result from several interrelated factors involving the placenta, uterus, fetus, mother’s health, and past obstetric history."

Placental and uterine abnormalities are among the key culprits. Conditions like placenta previa or vasa previa or structural issues such as a septate or bicornuate uterus increase the chances of early labor. “We also see a higher risk in women with a history of classical cesarean delivery or those who have undergone myomectomy,” she adds.

Fetal health plays a crucial role as well. Low or high amniotic fluid levels (oligohydramnios and polyhydramnios), fetal growth restrictions, or abnormal umbilical artery Doppler studies can prompt early delivery. “Multiple pregnancies, especially twins or more, as well as alloimmunization or pregnancies requiring intrauterine transfusion, are considered high-risk and often lead to preterm birth,” Dr Aroskar shares.

Maternal conditions such as gestational diabetes, preeclampsia, and intrahepatic cholestasis of pregnancy are also concerning. “Chronic conditions like hypertension or even infections during pregnancy can trigger premature labor if not addressed promptly,” she explains.

A previous history of preterm birth, PPROM (Preterm Premature Rupture of Membranes), or stillbirth increases the likelihood of recurrence. “Infections like bacterial or viral chorioamnionitis further exacerbate this risk,” Dr Aroskar explains.

Preventing Preterm Deliveries

Preventive care—both before and during pregnancy—can drastically reduce the risk of preterm births. General lifestyle interventions like avoiding adolescent pregnancies, ensuring optimal birth spacing, and following a balanced diet with adequate micronutrients go a long way in supporting healthy pregnancies.

“Women should ideally visit an obstetrician before conception,” says Dr Aroskar. “This gives us a chance to assess for underlying risk factors, optimize chronic conditions, and start supplements like folic acid, which are critical for fetal development.”

Focused preconception care is especially vital for women with known health conditions. Dr Aroskar advises, “Managing addictions, treating sexually transmitted infections, and controlling diabetes or hypertension before pregnancy improves maternal outcomes and significantly reduces the chances of preterm birth.”

Who Is Most At Risk?

While clinical causes are well-documented, the broader societal issues behind preterm births can’t be ignored. “Preterm delivery and infant mortality often reflect deeper systemic problems like maternal stress, poor access to prenatal care, and poverty,” says Dr Rashmi Bhardwaj, Senior Consultant, Paediatric Intensive Care and Incharge - PICU at Marengo Asia Hospitals, Gurugram.

Maternal stress, in particular, is a silent contributor to early labor. “Chronic stress—especially in women from disadvantaged backgrounds—triggers hormonal imbalances that can cause labor to begin before the baby is ready,” explains Dr Bhardwaj.

Lack of proper antenatal care is another significant risk. “Many women, particularly in rural or economically backward areas, miss timely checkups that could detect complications like gestational diabetes, anemia, or pregnancy-induced hypertension,” she adds.

Low educational status and poverty is the main issue. “These women often don’t have access to nutritious food, clean living conditions, or even basic health information. Adolescent and unplanned pregnancies in such groups further increase the likelihood of complications,” warns Dr Bhardwaj.

What Is The Solutions?Both experts agree that improving healthcare access and education is key to curbing premature births. Strengthening prenatal screening procedures is one of the most effective ways to catch red flags early. “Frequent checkups, fetal monitoring, and maternal health assessments can help us intervene before complications escalate,” Dr Aroskar advises.

Community programs also have a crucial role to play. “Outreach efforts that educate women about nutrition, stress management, and the importance of medical supervision during pregnancy can be lifesaving,” says Dr Bhardwaj.

Equally important is postnatal care. “Exclusive breastfeeding, timely vaccinations, and early detection of infections can prevent many cases of infant mortality,” she adds. “We must ensure that mothers, especially those from vulnerable communities, are guided and supported even after delivery.”

Dr Bhardwaj shares, “Despite increased awareness, socio-economic barriers continue to result in neglected warning signs. Healthcare professionals, policymakers, and communities must collaborate to bridge these gaps. Holistic maternal health programs and grassroots-level education can go a long way in reducing both preterm births and infant deaths.”

How Can We Overcome This Challenge?

Tackling preterm births requires a multi-pronged approach—clinical vigilance, preventive healthcare, and social reform. As India continues to strive toward improving maternal and child health indicators, the focus must shift not only to technological advancements in neonatal care but also to addressing the root causes that lead to premature deliveries.

From early obstetric consultations to stronger public health policies, a coordinated effort can make all the difference—for mothers, their babies, and future generations.

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