A pregnancy typically progresses normally and lasts an average of 40 weeks, or about nine months. Sometimes complications arise, and a baby is born earlier than expected.
Pregnancy and birth
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Certain lifestyle adjustments and preventive measures can help reduce the risk of preterm birth and other complications during pregnancy and for the baby. However, even when all the right choices are made, unexpected events can still occur that lead to a baby being born too early.
Risk factors
It is not always clear why a baby is born too early. Medical or social factors may play a role. Some of these risk factors can be influenced, while others cannot.
Medical factors
Various medical factors can increase the risk of preterm birth. Pre-existing conditions such as diabetes, obesity, kidney disease, and high blood pressure contribute to this risk. Genetic factors and pregnancy‑specific elements, such as multiple pregnancies and pregnancies conceived through fertility treatments (including IVF and ICSI), can also raise the likelihood of preterm birth.
Additionally, preeclampsia, cervical abnormalities, placental complications, and infections may lead to early delivery. Personal medical history matters as well: individuals who have experienced a preterm birth are at significantly higher risk of experiencing another in subsequent pregnancies. A short interval between pregnancies (fewer than 12 months) further increases the risk. These factors highlight the importance of proper medical follow‑up and early recognition of potential risks.
Lifestyle factors
A healthy lifestyle plays an important role in the course of a pregnancy. Factors such as unhealthy eating habits, poor dental hygiene, insufficient physical activity, alcohol consumption, smoking, drug use, and stress can disrupt the body’s balance and affect the baby’s development.
Social and demographic factors
Social and demographic circumstances can also influence the risk of preterm birth. Age is an important factor: pregnancies occurring before the age of 17 or after the age of 35 carry a higher risk. Socio‑cultural influences also play a role, with certain groups, such as women of African descent, experiencing higher rates of preterm birth. Other factors, including low income, limited formal education, and restricted access to healthcare, are similarly associated with an increased risk.
Presentation of preterm birth
Preterm contractions or preterm labor
Preterm labor refers to the onset of contractions before 37 weeks of pregnancy. This increases the risk of preterm birth and requires timely recognition. Signs that may indicate preterm labor include early contractions that do not subside with rest or are accompanied by vaginal bleeding. Increasing lower back pain, a feeling of pelvic pressure, and a tightening sensation in the abdomen caused by uterine contractions are also warning signs.
Experiencing these symptoms does not always mean that birth will occur immediately. Early recognition and treatment can reduce the likelihood of preterm birth. Contact with a healthcare provider is recommended when one or more of these warning signs occur.
Preterm premature rupture of membranes (PPROM)
Preterm premature rupture of the membranes (PPROM) increases the risk of infection and preterm birth. A sudden gush of amniotic fluid or continuous leaking may indicate this condition. When PPROM is suspected, immediate contact with a healthcare provider is important, as timely medical assessment is crucial for the health of both mother and baby.
Placental or other complications
Preeclampsia is a placental disorder characterized by high blood pressure, swelling of the feet, legs, or wrists, and the presence of protein in the urine (identified by a healthcare provider). This condition can progress to HELLP syndrome, which presents with symptoms such as pain in the upper right abdomen, nausea, vomiting, a feeling of extreme unwellness, anxiety, panic, and sometimes yellowing of the skin or itching.
Eclampsia, seizures resulting from severely elevated blood pressure, is another serious complication, often preceded by persistent headaches, ringing in the ears, visual disturbances, and nausea.
Other complications such as placenta previa, placental abruption, intrahepatic cholestasis of pregnancy, or early dilation of the cervix can also lead to preterm birth.
For each of these warning signs, prompt medical evaluation is essential. In some cases, admission to a Maternal Intensive Care unit (MIC) may be required to provide the highest level of care.
Prevention
The risk of preterm birth can be reduced in several ways. Primary prevention focuses on all women before or during pregnancy to prevent preterm birth and lower the overall risk. This includes general health‑promotion measures such as smoking cessation, healthy nutrition, and good dental hygiene.
Secondary prevention is intended for women who have an increased risk of preterm birth, for example due to a previous preterm delivery or risk factors present in the current pregnancy. Interventions aim to detect and treat problems early in order to halt spontaneous preterm contractions at an early stage.
Tertiary prevention applies once symptoms such as preterm contractions or preterm premature rupture of membranes (PPROM) occur. The goal is to reduce the risk of illness, complications, and mortality for the baby.
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Delivery and neonatal admission
Sometimes preterm birth cannot (or can no longer) be prevented. A preterm delivery differs from a birth after a full-term pregnancy. The choice between a vaginal birth and a cesarean section depends on the medical situation. Healthcare professionals, together with the parents, determine what is best for the mother and the baby (or babies).
During a preterm birth, several healthcare providers are often present: obstetricians, general pediatricians or neonatologists, nurses, midwives, and resident physicians. Their presence is essential to provide the highest standard of care, though it may feel overwhelming for parents.
Immediately after birth, the baby may require medical support. A specialized team provides these initial interventions. When the situation allows, efforts are made to enable first contact between parents and baby. Once the baby is stable, skin‑to‑skin contact can take place with one of the parents. When skin‑to‑skin contact occurs with the mother, this helps stimulate milk production.
Due to preterm birth, a low birth weight (< 2500 grams), or other neonatal concerns, referral to a neonatal unit (N*) or a neonatal intensive care unit (NIC) may be necessary. Transfer to a NIC takes place under the supervision of a specialized transport team. Upon arrival, the baby is settled in and further medical care is initiated.
If preterm birth is expected and there is still sufficient time, the mother, depending on gestational age, is ideally transferred before delivery to a hospital with both a Maternal Intensive Care unit (MIC) and a Neonatal Intensive Care unit (NIC). Transporting the pregnant mother (intra‑uterine transport) is safer for the baby than transport after birth (postnatal transport), which is avoided whenever possible.