Preterm Labor: A Root Cause Medicine Approach to Reducing Risk

Growing life inside the womb is typically a 40-week process, but for some women, that journey can be abruptly shortened. Preterm labor is increasing in the United States, with a current rate of 10% of births being a result of premature birth. While 3 out of 10 premature labors will resolve on their own, many women will need medical attention and support to sustain a pregnancy or prepare them for premature delivery. 

This article provides a comprehensive insight into the signs, causes, risk factors, and complications of preterm labor. It also sheds light on how functional medicine and integrative health modalities can support women in achieving full-term pregnancy. 

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What is Preterm Labor?

A full pregnancy lasts approximately 40 weeks. A pregnancy that is sustained until 37 weeks is considered full-term. For various reasons, some pregnancies result in preterm labor, which is categorized as labor signs and symptoms beginning anywhere between 20 and 37 weeks of pregnancy. Preterm labor consists of the cervix opening early due to contractions. While many cases result in preterm birth, not all instances mean you will have your baby prematurely. In addition to contractions, there are other signs that indicate labor is occurring too soon. This includes an increase in vaginal discharge that is clear fluid, mucus-like or bloody, pressure in the pelvis, low back pain, and abdominal cramping. Seeking immediate care is necessary, so proper evaluation and management can begin. 

Causes And Risk Factors Associated With Preterm Labor 

There are a handful of associated risk factors and causes that lead up to preterm labor. The most common causes include a history of having a premature birth in the past, being pregnant with multiples, and an anatomically short cervix. Women who have a previous preterm birth that resulted in labor have a 2 to 3 times higher chance of having a preterm birth with a future child. There are medical factors that have been identified that can lead to subsequent preterm labor and premature birth experience. The main medical red flags would be pre-existing hypertension or preeclampsia, diabetes, and urinary tract infections (UTIs). This study also found that Black women and females who have short intervals (less than 6 months) between pregnancies are at higher risk of going into premature labor.

One key lifestyle cause of repetitive preterm labor is illicit drug use, which impacts both the mother and fetus. An additional lifestyle factor is your diet and nutrition. Data has shown an increased risk of preterm birth in diets deficient in key vitamins like B12 and folate, along with omega-3 fatty acids. Pregnancy with twins, triplets, and higher number multiples comes with the possibility of medical complications due to the number of growing fetuses causing excessive uterine distention. The cervix is the lower portion of the uterus that connects to the vagina and should typically remain elongated and firm until dilation and labor occur. Some women's cervix is naturally shorter, and some women's will shorten too early, leading to early labor signs. Last but not least, scientific information has concluded that stress, along with depression and/or anxiety in pregnancy, can increase the odds of preterm labor and birth. When preparing for pregnancy and what birth can look like, it's important to understand these factors that can lead to premature labor or possibly an early birth.

Potential Complications And Long-Term Effects For Preterm Infants

The main concern of preterm labor is preterm birth which can have immediate and long-term implications for the baby. Premature babies are at a higher risk of complications due to low birth weight, underdevelopment of organ systems, ocular issues, and respiratory difficulties. One long-term study of 903,402 preterm and full-term individuals consisted of gathering data from multiple consecutive decades of their life to see if any complications arose from an early start to life. The study found that the risk of social and medical disabilities significantly increased with the earlier the person was born. For example, the occurrence of cerebral palsy was 9.1% in those born between 24 to 27 weeks gestation compared to 0.1% for infants born full term (37 plus weeks).

America's Preterm children are also more likely to have neurodevelopmental outcomes such as attention deficit hyperactivity disorder (ADHD), anxiety, autism spectrum disorder, depression, and other behavior, language, motor, and sensory deficits. Due to the complications that can happen after birth and in their first few years of life, preterm infants should be monitored for growth and development for at least the first two years of life. Neurocognitive and developmental delays can arise after age two and should be investigated if your child does not seem to be hitting appropriate milestones. 

Functional Medicine Labs to Run That Can Help Monitor Mother's Health and Individualized Approaches 

Determining risks toward preterm labor by utilizing functional medicine testing can be a great asset to care. Here are four functional medicine panels to consider for pregnant women. 

First Trimester Pregnancy Panel

Monitoring health through bloodwork in the first trimester, or if an illness arises, can detect infections or signs of distress. Access Medical Laboratories has an Obstetric Panel, which will reveal infections or repercussions of an infection, such as anemia. This allows the care team to formulate a plan in hopes of preventing long-term pregnancy complications. 

Urinary Analysis

If you are someone prone to UTIs or you start having symptoms during pregnancy, it's best to test your urine to screen for infection. You can get a Microscopic Urinalysis that will look at key markers impacted by urinary tract infections. This test can be used to help treat appropriately and minimize a preterm labor risk. 

Micronutrient Panel

Studies have correlated an association between micronutrient depletion and gestational diabetes which can put you at risk for preterm labor. A micronutrient test that includes Omega-3 fatty acids plus vitamins is a great option for investigating if you are deficient in these essential nutrients.

Cortisol 

Elevated cortisol is a biomarker that indicates stress is being improperly controlled by the body. This can be measured through blood testing as a one-time snapshot, but the more accurate way to test for chronic stress is through Diurnal Salivary Cortisol testing. This test will require you to do four salivary collections throughout the day. Assessment of this will provide a context of how your cortisol ebbs and flows throughout the day, which provides insight as to how your body is responding to stress.

Diabetes Screening

Preexisting diabetes can put you at risk of going into preterm labor. While a specialist should be monitoring your diabetes during pregnancy, a holistic practitioner can assist in your care by running functional medicine tests and supporting you through complementary medicine. Markers, like glucose, insulin, and hemoglobin A1c (HbA1c) are valuable for diagnosing and monitoring diabetes.

Hypertension Blood Testing

If you have hypertension prior to pregnancy or are at risk for it, regularly monitoring your blood pressure is important. A Cardiovascular Risk Profile includes biomarkers that indicate risks or early detection of cardiovascular disease. This includes a lipid profile, C-Reactive Protein, and Homocysteine. Ruling out unsuspected heart or vascular disease processes would be ideal in situations of preexisting hypertension. 

Additional Labs to Check  

If you have signs and symptoms of preterm labor, getting properly assessed through examination and imaging by your OB/GYN or midwife is vital. Speculum examination is the recommended method due to the potential of infection with a digital exam. Your doctor will also test any fluid leakage to look for proteins that would indicate that the amniotic sac has ruptured. If suspected signs of a membrane rupture have occurred, getting an ultrasound for assessment of amniotic fluid levels is essential. 

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Integrative Approaches to Reduce Preterm Labor Risk

Supporting the mother with integrative care throughout her pregnancy can reduce her risk of preterm birth in comparison to women only receiving routine care. 

Nutrition and Diet

Adequate nutrition and dietary choices can be the driving force for health outcomes. One study regarding nutrition and preterm birth suggested just that. The Journal of Nutrition published research that indicated women who consumed a mostly poor diet consisting of high-fat and high-sugar foods were more likely to go into preterm labor and have a premature delivery in comparison to women who ate predominately lean protein, whole grains, fruits, and vegetables.

Experts also suggest eating healthy omega-3 fatty acids to support pregnancy and potentially lower your risk for preterm labor. This information provides context that a whole-foods, low-inflammatory diet is ideal for pregnancy nutrition. Following a Mediterranean Diet that focuses on lean protein, low mercury content fish, whole grains, fresh fruits and vegetables, nuts, minimal dairy, and processed red meats would ensure you get nutrient-dense whole foods that are supportive for sustaining a full-term pregnancy. This way of eating can also be helpful if you are diabetic or are concerned that you need support managing blood sugar during pregnancy. 

Supplements

The use of nutraceuticals to naturally support a mother's body in pregnancy is one complementary avenue you might explore. In terms of vitamins and nutrients that can help with preterm labor signs, there are a few that have been studied. One study looked at an oral supplement consisting of magnesium, vitamin B6, vitamin D, and alpha-lipoic acid (ALA). The results suggested that in a cohort of women presenting with a higher risk for preterm birth, the treatment group had less cervical length decrease than the control group. This study provided practical means to counteracting cervical shortening in pregnant women who are at risk for this common preterm labor causation. Dosing in these situations should be strictly monitored and prescribed by a trained healthcare provider when prevention of preterm labor is at play. In general, pregnant women can take a recommended daily allowance of these nutrients to support a healthy pregnancy.

Urinary tract infections can be detrimental to a pregnant woman and should always be properly treated. D-mannose, which is a simple sugar found in fruits such as apples, in capsule form, may help manage UTIs in pregnancy. Evidence suggests that it can block bacteria from attaching to the urinary system tissue, thus potentially preventing the absorption of the pathogen. It's important to stay hydrated as well, as this will help flush the urinary tract. 

Stress Reduction and Mind-Body Techniques

Pregnancy can be an exciting time in women's lives, but it can also be both mentally and physiologically stressful. Your body is changing drastically, which can take a toll on you in many ways. Implementing strategies to counteract distress in your life can not only be relaxing but may decrease your risk of early birth. Some stress relief techniques that have shown to be effective in pregnancy include: getting rest when your body needs it, engaging in light to moderate-intensity weekly exercise, meditating, seeking support from a therapist, leaning on family and friends for help, and knowing what your stress triggers are so you can prepare your mind or avoid them when possible. Meditation is also a well-proven intervention to support those that suffer from hypertension. 

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Summary

Preterm labor oftentimes leads to preterm birth, which has potential negative consequences for the infant, mother, and the mother's future pregnancies. Screening for risk factors for preterm labor and birth is paramount in creating appropriate care for pregnant women. If the mother has a known risk, such as hypertension, implementing healthy nutrition, exercise, stress management, and vitamins for optimal support is highly recommended. Conventional medical care for pregnancy, along with complementary and integrative support, can hold promising results for full-term labor outcomes. As research evolves in this area, I am hopeful that we'll see a downward trend in premature labor occurrences.