Of the nearly 1.5 million babies born annually in the country, more than 120,000 are premature or born before 34 weeks of gestation.
Premature births are a serious health issue as they mean distress not only for the baby, but for the family as well, said Mohammad Heidarzadeh, head of the Neonatal Health Office at the Health Ministry.
“Health problems are not the only consequence of preterm births; there are many economic and social consequences as well,” IRNA quoted him as saying.
Parents of premature babies are mostly young, between the ages 20 and 27 and lack the experience to deal with the emotional and economic distress associated with preterm delivery. Especially for those who have just started marital life, a preterm birth or the baby’s arrival weeks or months before the due date, can cause psychological and emotional reaction, including depression, he said.
According to a recent survey by the Neonatal Health Office, more than 70% of mothers of infants admitted to neonatal intensive care units (NICU) suffer from depression. Most of them feel pangs of guilt or self-loathing for not carrying the pregnancy to full term.
“As a high number are seen to face severe conflict in their marital life, a special package of services has recently been developed with the aim to provide long-term psychological and spiritual support for parents of preemies.”
Official figures say that 3% to 5% of babies are hospitalized in NICU every year, mainly for premature birth. About 10% to 15% of extremely preterm babies (28 weeks gestation) lose their lives annually, putting their parents at the risk of psychological stress.
Also many pre-term survivors face a lifetime of disability, including learning disabilities and visual and hearing problems. All these issues impose a huge financial burden on families and the government as well.
Economic Cost
“At state-run hospitals, the monthly NICU treatment cost exceeds $1,500-$2,000 per infant,” and parents have to pick up the tab, Heidarzadeh said. “Not all the babies are admitted by state-run hospitals, as the government has a limited funding for this purpose; on the other hand the tariff at private hospitals is high.”
Medicines and equipment needed for treatment of preemies are also expensive, adding to the staggering costs.
The treatment and intervention for improving outcome of preterm births include those provided to the mother – for example steroid injections before birth, antibiotics when the amniotic fluid or water bag breaks before the onset of labor, and magnesium sulfate to prevent future neurological impairment of the child. Interventions for the newborn baby include thermal care, safe oxygen use, and other treatments to help babies breathe more easily.
In some developed countries, the cost of treatment of premature babies is covered by medical insurance.
Expectant mothers above the age of 35, or those with previous cases of children with genetic defects, or who have consanguineous marriages, should go for genetic screening regularly during pregnancy, as they constitute the high risk group. Unfortunately, at present, the tests are not free of cost, the official said.
However, the Health Ministry has plans to offer free genetic screening, at least for the high-risk group. A pilot project in this regard is underway in Tabriz, capital of East Azarbaijan Province.
Heidarzadeh also pointed out that if genetic abnormalities are diagnosed before the fetus is 16 weeks, legal permission for medical termination of pregnancy (MTP) is allowed. Valid genetic testing, ultrasound, written consent of the mother, besides approval by three medical specialists is mandatory for therapeutic abortion.
Due to the lack of timely genetic testing, many pregnant women are unaware of fetal abnormalities and therefore don’t get legal permission for MTP after 16 weeks of gestation.
Many of these mothers are seen to suffer from irrational feelings of guilt later after giving birth to children with genetic disorders.
Health Literacy
“Family health literacy can play an important role in reducing premature births, but currently the rate is only 18%. This indicates that only 18 out of 100 Iranian parents know how to live healthy lifestyles.”
One of the main reasons for premature births is exposure to secondhand smoke. The other is simple infections during pregnancy which can be prevented with routine tasks like washing hands regularly.
Cardiovascular diseases, thyroid problems and kidney diseases are also among health complications which can increase incidence of premature births. Healthcare during pregnancy is important.
The ministry’s recent survey indicates that there is a significant difference between the country’s top 20% wealthiest families and 20% poorest families in this respect; the rate of preterm births is 2 times more in the latter category.
