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Title icon The Unbearable "Lightness" of Being: Childbearing at Prime Age to Reduce the Risk of Giving Birth to Underweight Babies
Date:2015/07/28 | Update Date:2015/11/12 19:22
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Data Source:Bureau of Health Promotion 




According to the statistics from the Birth Notification System of the Health Promotion Administration, MOHW, in 2014 there were 18,068 low birth weight (hereinafter referred to as LBW) babies whose weights were less than 2,500 grams. They comprised 8.5% of national live births. As stated in the World Health Organization website, LBW affects the growth and cognitive development of babies and can induce chronic diseases in the future. It is also closely related to new born baby and infant mortality and morbidity. The factors that cause LBW include: premature birth, the age of the mother, social environment, nutrition, multiple births and the gender of the baby. In the report from the U.S. Centers for Disease Control and Prevention, the causes of premature birth include multiple births, problems with the cervix or uterus, infections, high blood pressure, diabetes, coagulation disorders, smoking, alcohol or drug usage, etc.; these factors also affect a baby’s and infant's health-related issues, such as intellectual disabilities, slow growth, breathing problems, vision and retina problems, hearing problems, feeding and gastrointestinal problems.




Data Speaks: Childbearing at Prime Age, 25-29, Makes a Huge Difference in Achieving Optimum Results

The report analyzing the 2014 data on the Birth Notification System by the Health Promotion Administration, MOHW, demonstrates that among the maternal age groups, the age group of 25-29 had the lowest percentage, 7.4%, of low birth weight (LBW) babies, followed by the age group of 20-24 at 8.0% and 30-34 at 8.2%; for the maternal ages under 20, the percentage of LBW was 11.5%. For the maternal ages of 35 and over, as the age rose the percentage of LBW increased; 35-39:10.2%; 40-44: 11.4%; and 45 and above: 21.5%. The results demonstrate that with pregnancy for those under 20 or over 35, the percentage of LBW babies is relatively high, which underlines the importance of childbearing at prime age. Moreover, the percentage of LBW babies from the women who conceived through assisted reproductive technology (ART) was 38.8%, vastly outnumbering women who conceived naturally: 7.7%. Meanwhile, the percentage of LBW in premature babies was 56.3%, which exceeded by far the percentage in natural born babies: 3.8%. The percentage of LBW of twins and above (twins: 68.6%; triplets and above: 96.5%) far outweighed singletons: 6.5%. The percentage of LBW of baby girls, 9.5%, was also higher than that of baby boys, 7.6% (Table 1). After further analysis, the outcome shows that, after maternal age and the gender of a new born baby were identified as the controlling factors, LBW babies that were produced through ART, premature birth and in multiples were still statistically significant. The risk of producing LBW babies through ART was 1.2 times higher than through natural production; the risk of LBW in premature babies were 23.61 times higher than that of natural born babies; for twins, it was 9.64 times higher than for a singleton, and for triplets and plus, it was 52.22 times higher than for a singleton (Table 2).




Multiple Births Is Likely to Cause LBW Babies

Through analyzing 2014 data regarding LBW and fetus numbers in relation to babies that were produced through ART and naturally (Table 1), LBW singletons that were produced through ART were higher, 11.3%, than for singletons that were produced naturally, 6.4%. However, for twins, regardless of conception method, the chance of LBW was higher than 68%. LBW in triplets and above was over 95%. Therefore, the chance of delivering LBW in twins and triplets-plus was much higher than in singletons.




Mothers' Age, Either Too Young or Over 35, Plays a Critical Role in Delivering LBW Babies

Regarding singleton live babies that were produced through ART and naturally in relation to maternal age in 2014 (Table 2), the percentage of LBW in live babies produced from ART increased as maternal age increased. The percentage of LBW in singleton live babies from the maternal age group of 25-29 was 8.7%; 12.2% from the maternal age group of 40-44 and a whopping 22.7% from the maternal group over 45. The percentages of LBW in singleton live babies that conceived naturally from maternal ages that were under 20 and over 45 were 10.8% and 10.2%, respectively.




Reducing Numbers of Embryo Implantations to Reduce the Risk of Multiple Gestation Pregnancy

ART brings the hope of childbearing to infertile couples. However, when too many embryos are implanted, it often results in multiple (twins or more) gestation and births, which easily leads to LBW. On the 2012 report of ART, among all the ART cycles, 3 embryos were implanted, 34.7%, which occupied the largest percentage of the implantation cycles, followed by 4 embryos at 28.5% and 1-2 embryo(s) at 36.8%. Although the numbers of implanted embryos are decreasing year by year, when compared to European countries' 75.6% of 1-2 embryo implantations, there is still room for improvement. To follow the trend of the world’s effort in reducing the percentage of multiple gestation, the Health Promotion Administration, MOHW and the medical community are joining forces to encourage doctors to use their their professional judgment to implant a reasonable number of embryos according to a woman's age. In 2014, the Artificial Reproduction Act was amended. A 55% assessment index of implanting 2 or fewer embryo(s) for women under 35 was added to encourage the reduction in the number of embryos in one implantation setting, in order to reduce the occurrences of multiple gestation. The calculation method of live birthrate to the accumulated treatment cycle live birthrate was amended to include frozen embryo live birthrate and fresh transfer live birthrate to encourage frozen embryo implantation, and to reduce the percentage of the current practice of implanting 3 embryos in one setting. The regulation not only reduces the birth of LBW and the follow-up treatment costs, but also reduces possible complications caused by multiple gestation, such as preterm birth, pre-preeclampsia (toxemia of pregnancy), gestational diabetes, postpartum hemorrhage and others. It is indeed beneficial to maternal and infant health. Additionally, the Ministry will continually oversee how ART organizations monitor and improve their treatments of moderate and severe ovarian response syndrome to reduce complications and improve ART organizations' service quality.


 


Providing Pregnant Maternal Service and Reinforcing Premature Birth Prevention Measures

To treat and prevent LBW premature birth, the Health Promotion Administration, MOHW, provides various measures for pregnant and maternal women and premature babies:

1. Pregnant maternal service:

A. Grants and provides 10 prenatal examinations through specially arranged hospitals and clinics for expectant mothers.

B. Provides information about "recognizing signs of premature birth" and "guidance for premature delivery prevention and treatment" in a maternal health manual.

C. Conducts a one on one premature delivery assessment, and provides health guidance during the prenatal examinations. Conducts a risk grading and pregnancy registry according to the assessment on expectant mothers' healthy living style, provides high risk pregnant women with referral to hospitals that are close to them, with care facilities to handle "moderate to severe levels of emergency" to perform prenatal examinations and delivery hospitalization, while educating them to identify the symptoms of premature birth, to reduce the premature birth-related deaths.


2. Reinforce Premature Baby's Health Care:

A. Through the Birth Notification System, combined with the city and county's Public Health Bureaus to monitor the premature babies' birth condition

B. Provides diverse health care resources, including a child health handbook to provide information about premature infant care and the support systems

C. Performs assessment and evaluation on premature babies according to their corrected age. Offers 7 preventive health care services to children under 7 years old; 7 sessions of one on one health education conducted by doctors are given.

D. Refers suspected cases of delayed development to 47 Child Development Evaluation Centers in Taiwan for further assessment and diagnosis, also for early treatments.




Shu-Ti Chiou, Director-General of the Health Promotion Administration, MOHW, stated that the prime time for childbearing often is concurrent with the golden stage of career development. Director-General Chiou reminded and appealed to citizens who want to have children not to ignore the importance of the "prime time for childbearing" due to their busy schedules. Multiple gestation is risky to mothers and newborns which often develops preterm birth, LBW and other health problems. When receiving an ART treatment, full communication with physicians is a must to understand the necessity, methods, success rate, risks and complications to select the reasonable number of embryos to implant and to avoid multiple gestation, to reduce the LBW births while improving mothers’ and new born babies' care quality and to reduce the morbidity rate of mothers and babies. Our primary goal is that mothers and babies all are safe. 

 

Contact:Bureau of Health Promotion


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