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Pre-term births can happen to any expectant mother. Doctors say right now, they do not know all of the causes of pre-term birth, but there are some risk factors that can increase the chance of one.

Jade Elliott sat down with Sean Esplin, MD, Maternal Fetal Medicine Specialist, Intermountain Healthcare, to discuss pre-term birth, the causes and how technology is helping doctors learn more about it.

Common causes or risk factors that increase the chance of pre-term birth:

• Infection is most common. There are different types of infections and it depends on how the body responds to that infection.
• Smoking or substance abuse during pregnancy
• Short time between pregnancies
• Expecting multiples, twins, triplets, etc. This is becoming more common. Identical twins who share a placenta are especially risky. 50 percent of twins come early.
• Abnormal vaginal bleeding
• Abnormal shape of the uterus or a cervix that is short or weak.
• Maternal and fetal stress

What kinds of symptoms of preterm labor should a woman call her doctor about?

• Call your obstetrician or other health care professional right away if you notice any of these signs or symptoms:
• Change in type of vaginal discharge (watery, mucus, or bloody)
• Increase in amount of discharge
• Pelvic or lower abdominal pressure
• Constant low, dull backache
• Mild abdominal cramps, with or without diarrhea
• Regular or frequent contractions or uterine tightening, often painless
• Ruptured membranes (your water breaks with a gush or a trickle of fluid)

For more information on symptoms and risk factors, click here.

Why is it so difficult to prevent pre-term birth?

Of every 100 women, 10 percent will deliver pre-term. Doctors don’t know which 10 percent. When they have a heads up it’s easier to prevent. There’s a 30-40 percent recurrence rate if a woman has previously had a pre-term birth. In most cases doctors have no prior knowledge that a woman will have pre-term labor or deliver prematurely. Sometimes they can do surgery to stitch the cervix together if it’s opened prematurely. At 20 weeks gestation, it’s standard practice to look at the cervix in an ultrasound. Sometimes doctors insert a pessary device that helps holds the cervix closed. Sometimes doctors do everything we can, but we can’t stop the labor.

Doctors at Intermountain Healthcare are changing their focus to actively identify those at risk for preterm birth

They are looking at genetics. They are working to identify women who are at high risk demographically. Checking up on women and giving them reminders about taking care of themselves and symptoms to watch for can help.

What is the Prevent Preterm Birth study that started in May of 2018? How long has it been going and when will you have results?

Intermountain Healthcare is just finishing the study. The last babies were born in June and will leave the hospital soon. Doctors will have results in about two months. The study involved 1200 women. There are some blood markers of preterm birth we’re identifying.

Intermountain is working in partnership with U of U. It involves a new Mom to Be Network of 10,000 women in U.S. at eight sites.

For more information on the study, click here.

What are the different ways Intermountain is using technology to help prevent pre-term birth?

Intermountain is using an app that sends nudges or reminders to pregnant moms that helps them follow through to get pre-natal care and take care of themselves while they’re pregnant

During the study the app gives pregnant women reminders about what they can do at home and to remind them to go to their prenatal visits and seek care when they have certain symptoms. The app uses Nudge Theory.

What is nudge theory and why does it work especially well with expectant mothers?

The idea behind Nudge Theory is basically that when people are gently reminded and given positive reinforcement they’re more likely to follow through with good behaviors. Pregnant women are motivated. They want the best outcome for the baby. People want to stop smoking. Being pregnant gives them a reason. Pregnancy is a temporary condition, they’re more likely to succeed at doing the recommended behaviors short term.

How does the app work?

The App is live, so patients have access to a caregiver right when they have symptoms. The app was only available to women in the study. It was through Care Centra, My MoBe. It includes a 30 question survey that assesses their strengths and motivations, healthcare literacy, how tech savvy they are and their physical activities. The app then tailors the nudges to be something they respond to. Knowledge is power. The app provides them with more access to ask questions. The purpose of the app is to allow the physician to motivate people to do specific things. Doctors then give them more information about why those behaviors are important.

There’s also a postpartum part of the app that we’re unrolling. It provides reminders about breastfeeding, contraception, depression screening etc.

What other ways is Intermountain using technology?

Intermountain is using artificial intelligence and algorithms to prevent preterm birth

Intermountain is using machine learning and AI driven “nudges” sent directly to patients. The solution generates a personalized motivational/behavior map (called a MoBE map) for each patient, helping their care team to know when and how to work with that patient to help them do the behaviors that will improve their health.

This information, coupled with a personalized care plan, connects the patients to their care team 24/7 through personalized nudges and communication delivered according to the patient’s preference (calls, texts, emails, video visits, mobile phone app, etc.).

Preliminary results:

In Intermountain’ first efforts with this program, 124 women were identified as being at high risk for a pre-term birth through a patented genomic lab test. Each of these women were invited to participate in the program. 93 percent engaged in the program and 89 percent completed the program. Only one woman out of this group delivered her baby prior to week 37 of her pregnancy. All other deliveries were full term.

They’re studying and using genetics to learn how to predict preterm birth through Intermountain’s Heredigene population study. They want pregnant women and their partners to participate. Can they find the gene? Researchers wants 30,000 samples to have enough data to make predictions to prevent pre-term birth.

Intermountain has a partnership with Sera diagnostics to use a patented genetic lab test to predict risk of preterm birth.

There may be certain genes some women carry that mean they’re more likely to deliver prematurely. The test analyzes protein in the blood. There are some markers associated with pre-term birth, like having a shorter cervix.

Intermountain is using Instagram to reach out to expectant moms and see what kind of nudges moms will respond positively to. The Instagram account @imamom2be, is helping to bring together moms and expectant moms.

The feedback on Instagram helps us determine what kind of nudges will work best. Having weekly contact with patients helps. The patients have a sense that they’re supported. Their questions are answered. The demographic most benefited by high intensity care management are those that don’t have strong social support. They can share symptoms, connection, and a community feeling when they realize other people have the same concerns.

How is Intermountain leading the way in this field?

Intermountain is using technology and genetics to help predict preterm birth. Intermountain is constantly involved in monitoring outcomes and providing better care. Over 25 years they’ve been part of research networks and asking the most important questions. The volunteer ethic here is unique. People are interested in family history and genetics. 85-90 percent of people want to help. They want to participate and help serve even if it’s not directly benefiting them.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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When you have young kids, sleep is an essential part of your survival as a parent. When your kids sleep well, you sleep well. Thankfully, a bedtime routine can help your kids sleep better. Instead of letting your kids fall asleep whenever and wherever, a bedtime routine can bring structure and security to your child’s day. You and your child will get more sleep when they feel safe and secure.

Jade Elliott sat down with pediatrician Tyson Tidwell, DO, Intermountain Healthcare, on this episode of the Baby Your Baby Podcast to discuss the dos and don’ts of sleep routines.

Bedtime routines with your child can help everyone sleep better

So how can you make it happen? A bedtime routine doesn’t have to be difficult or drawn out. A routine is just something that you do every time your child goes to bed. Your child’s bedtime routine will help them form positive sleep associations. Here are some tips for forming a positive bedtime routine for your child.

Recommended sleep guidelines for babies and children by age

1 to 4 weeks old- Newborns sleep about 16-17 hours a day with periods of wakefulness lasting 1-3 hours. However, most newborns have not developed a night/day sleep cycle, so their sleep time can vary to all hours of the day.

1 to 4 months old- Babies of this age still tend to sleep about the same amount of hours, but their night/day sleep cycles begin to kick in, allowing them to sleep longer at night, although they still wake for feedings and changes.

4 months to 1 year- Babies of this age still require between 14-15 hours of sleep every day. Many of them are able to sleep the night, and take up to three naps during the day and evening. During this period, it’s very important to establish healthy sleep habits.

1 to 3 years- Most toddlers need about 12-14 hours of sleep, but often get less due to the schedules of parents and older children in the house. They will more than likely lose their early morning nap and early evening nap and tend to only take one nap a day.

3 to 6 years- Approximately 11-12 hours of sleep. Younger children of this group may still require a short nap during the day, but the need to nap usually diminishes by the time they enter the first grade.

7 to 12 years- Children of this age group tend to need about 10-12 hours of sleep, but often only get about 9-10 hours.

13 to 18 years- Teens require about 8-10 hours of sleep, but rarely get the full amount. The demands of schoolwork and after-school activities often cut into their sleep. Most teens report getting about 6-8 hours of sleep.

Start the bedtime routine early

Your child’s bedtime routine doesn’t have to happen right before bed. In fact, you should actually start your child’s bedtime routine at least 30 minutes before it’s time to start getting ready for bed. Start to wind down. Put an end to raucous games. Move slower. Dim the lights. Turn off the TV and electronic devices. Talk softer. Prepare your child’s mind and body for their upcoming bedtime routine and sleep.

Your child’s bedtime routine

No matter what you do, pick an easy and predictable routine that happens every time your child goes to bed. Try not to draw out your child’s bedtime routine. Fifteen minutes or so should be plenty of time for a good bedtime routine. Decide what is going to help your child fall asleep, and stick with it. Consistency is much more important that what you actually do during your routine. Some examples of bedtime routine elements include:

• Bath
• Reading books
• Telling stories
• Singing a song
• Saying prayers
• Brushing teeth
• Putting on pajamas
• Goodnight kisses and hugs
• Diaper change or going to the bathroom
• Snuggling together or tucking them in
• Set the stage for good sleep

You’ve prepped your child for a good night of sleep. Don’t just leave them in a space that isn’t going to help them sleep. Don’t leave TVs, tablets, computers or phones in their bedroom. Keep the space dark enough for good sleep, while still comfortable for those who are scared of the dark. Night lights can help. Make the bed up comfortably. Check the temperature so it’s cool enough to sleep without leaving your kids cold. Invest in a white noise machine or fan.

Bedtime Routine Do’s and Don’ts

Avoid poor sleep associations

A sleep association happens when your child learns to fall asleep using certain tools or methods. Most of the time, poor sleep associations sneak in when parents try to get their kids to sleep in sheer desperation. A poor sleep association is one that can harm your child, or is unsustainable so that your child can’t fall asleep on their own. Examples of poor sleep associations include:

• Going to sleep with a bottle
• Falling asleep to the TV or music
• Being rocked to sleep
• Falling asleep to a backrub
• Sleeping somewhere other than their own crib or bed (usually a parent’s bed)

Safe sleep for infants to help reduce the risk of sudden infant death

1.Always put your baby to sleep on his back until he can roll over.

2.Never bed-share with a newborn. It’s best for baby to sleep in their own crib within earshot of parents for first six months. If mom is sleepy, put baby in bassinette or crib.

3.Crib mattress should be firm, keep soft objects and loose bedding out of crib.

4.Do not overdress baby for sleep.

At what age can you start letting your baby fall asleep on their own or cry it out?

There are many different opinions on this. It’s really about parent preferences. Infants under 3-4 months won’t learn to put themselves to sleep. They need soothing. You can start sleep training at 4-5 months of age. Sleep routines are important for both naptime and bedtime.

When nursing or bottle-feeding, leave the lights on. Then turn off the lights and lay your baby down in their crib and say goodnight or sing or rub their back for just 60 seconds. Wait five minutes. Lay child back down and rub their back again and reassure them. Then, step out of the room for 10 minutes. If they’re still crying. Repeat and reassure them, this time stepping out of the room for 15 minutes. If your baby or toddler is hysterical or very upset you’ll want to console them briefly. They’ll figure it out in 2-3 days.

With a consistent and positive bedtime routine, your child will fall asleep faster and happier. Leaving you plenty of time to get your own shut eye.

Dr. Tidwell suggests these books and websites: Happiest Baby on the Block by Harvey Karp, M.D. and the website Taking Cara Babies, https://takingcarababies.com/ especially the section called The ABC’s of Sleep.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.