Premature Birth

It’s way down under lockdown/social distancing etc, down 90% in Denmark. There is an obvious likely explanation, or there would be, if the zombies hadn’t already eaten almost everyone’s brain.

 

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73 Responses to Premature Birth

  1. Tl Howard says:

    Less contact with pathogens? Fewer infections?

    • Out of Macon says:

      Chlamydia can cause preterm, although that seems unlikely to be a cause.

    • Woof says:

      Women are at home and not in the rat race, stressing out and dropping their kid prematurely

      • Pregnant Rando says:

        I’m not convinced it’s the lack of work stress. Fretting about a pandemic and isolating from their parents etc during pregnancy sounds more stressful, not less. Not to mention these working women are now either working from home, or facing having a new baby with drastically less income. Neither are stress-free.

        I think either pathogen exposure or less time on your feet is the key. However it shakes out, I’ll be grateful if this pandemic gives us a solid recipe for slashing premature birth rates.

        • Woof says:

          Are deadlines and competition at work worse than worrying about bills and being stuck at home? Stressors that are seen to be beyond ones control can lead to fatalistic acceptance and a sort of peace, while things that are seen as within your control can lead to frantically second guessing your decisions and to revisiting them over and over. I do think stress does play a role but am open to other causes being just as, or even more important.

  2. Tl Howard says:

    Be interesting if fewer babies from such pregnancies during this period turn out to be gay.

    • magusjanus says:

      identical twin discordance suggests infant/toddler infection as opposed to womb (where presumably both would get it). But who knows.

      • Tl Howard says:

        The perinatal period is important so if moms are pretty much “sequestered” at home a month before birth and her and the baby’s contacts are limited a month or so after birth that could matter.

    • ASR says:

      Also schizophrenia. And there are probably other candidates that might be caused by in utero infections.

      • Rosenmop says:

        Isn’t schizophrenia mostly genetic?

        • Henry Scrope says:

          I seems to be genetic but there must be something else as well because birth month is a factor. So unless astrology is real…

          • Pregnant Rando says:

            Vitamin D seems to be a good candidate, although I’m not convinced that’s the whole story. Low serum vitamin D in the mother has been linked to a higher risk for autism in the baby, so we know it affects neurological development.

          • Tom Hart says:

            Astrology is real; it’s just only girls do it now, so the quality has gone downhill—we need to get a few men out of physics and into astrology.

  3. About 10% of all births, half of those idiopathic. Estimate about $50K additional cost for a preterm baby, that’s about $20B in yearly costs for the US, just in terms of medical expenses for the preterm baby itself. Much less losing a baby or the longer term impacts.

    Strikes me that it shouldn’t be too hard to track the little fucker down after the current pandemic resolves. Looking at pubmed, the pattern is seasonal, with variations in different cities. Looks like consistently higher rates in the winter, which might point someone in a useful direction. I also found an interesting study on pre-eclampsia that found seasonal differences in incidence in white women but not in black women.

    Worth pointing some competent researchers at the problem. $20B a year is nothing to sneeze at, and it’s probably a lot easier to solve than cancer, since vaccines are straightforward. I was going to say Alzheimers, but then, we could probably use some competent researchers there as well.

    • BTW, my favorite explanation from that article was “less stress for the mothers” due to the pandemic.

      • Andrea says:

        There is ample evidence showing that immunological tolerance of the fetus during pregnancy is dependent on IDO induction, which in turn results in a down regulation of the Th1 immune response.
        [Side note: there’s also evidence that the Th1 and Th2 arms of adaptive immunity are in a dynamic equilibrium and that IDO-driven Th1 downregulation may be balanced by an increased Th2 response, which would explain the increase in allergies and hypersensitivities reported among pregnant women.]
        It’s conceivable that an infection may break such tolerance.
        There is no direct conclusive evidence that altered IDO functionality is involved in preterm labor, but it’s at least plausible: https://sci-hub.tw/10.1111/aji.12786
        However, I am not sure about the “single pathogen” theory, as it seems like other mammals suffer from a similar problem (note that it may be worse than reported, as not much effort goes into studying these things in the wild): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493222/
        In my opinion it’s more likely that a variety of (species-specific) common pathogens may all result in loss of tolerance.
        Another intriguing option is that the breaking of Th1 tolerance induced by common pathogens may lead the immune system to “uncover” another intracellular microbe that had been hiding there (including in the uterus) all along.
        [Side note 2: this may explain why “autoimmune” diseases are reported to improve during pregnancy and worsen after delivery: the offending microbe, whilst still there, is temporarily being ignored by the immune system for the sake of insuring survival of the fetus.]
        As far as I know, there is a single intracellular microbe that colonizies pretty much all organs of all humans for life, cannot be eradicated by the immune system no matter hwat and has been found in a variety of Metazoan animals, starting with sponges (and is beginning to be implicated in a variety of diseases of internal organs, including the ones you mention: cancer and AD): Malassezia.
        None of the above is settled science (except for Malassezia’s ubiquitous presence), but it’s a plausible starting point. Final gift: https://academic.oup.com/biolreprod/article/100/5/1306/5266296
        [The NLRP3 inflammasome is a key component in the immune response against Malassezia.]

      • Pregnant Rando says:

        Ha, the “less stress in a pandemic” but was my favorite bit too. Certainly hasn’t been my experience.

        I’m certainly walking less, standing less, and coming into contact with strangers less, though. And spending 90% of my waking hours reclined in a moderately comfy chair. I do wonder if we’re all reclining more, leading to less pressure on the cervix or something.

      • Malcolm Kirkpatrick says:

        How stressful was gathering edible roots, watching for lions and enomous snakes while the men hunted? Our female ancestors lived this life for hundreds of thousands of years. Presumably, we adapted. What’s the San rate of premature birth? If it’s stress, it’s a specific type of stress.

  4. B Frederickson says:

    Is it because pregnant women are, on average, working fewer hours and getting more sleep? Stress from work. long hours spent on one’s feet, and night shifts are all risk factors for premature birth.

    • gcochran9 says:

      Just as stress caused duodenal ulcers.

      • B Frederickson says:

        Fair enough. So the likeliest explanation is that fewer moms-to-be are exposed to pathogens, therefore fewer cases of premature births caused by maternal/fetal inflammatory response?

        Not sure which pathogens you had in mind. Would be interesting to see how rates of non-COVID infections have fallen during the pandemic.

        I can imagine that the closure of gyms, public bathrooms, etc. would reduce the number of reproductive tract infections (I assume these are particularly worrisome during pregnancy). Also, fewer sexual encounters with new partners during lockdown probably has salutary effects.

  5. Anonymous says:

    Are you saying that premature births are the result of a flu-like infection?

  6. jules ross says:

    Don’t Doctors induce a lot of premature births? Pregnant women aren’t seeing medics as often.

    • Mycroft Jones says:

      Ding ding ding. We have a winner. Simplest explanation, with huge explanatory power based on real facts.

    • Rosenmop says:

      Doctors would normally only induce in the last 2 or 3 weeks. Too much risk before that. I guess there could be some rare cases where induction happens earlier. But the mothers in the studies were getting normal prenatal care, so none of that should have changed.

      • 3g4me says:

        Depends on the country. In Singapore, at least in the 1990s, they would induce at least up to a month early, sometimes more – to ensure not only that the birth time was convenient for the family, but also that the child was born on an ‘auspicious’ date/month/year. And for those who trust all government statistics, I have a purported pandemic to panic you with.

    • Pregnant Rando says:

      I thought that as well, but look closer at the data. The most significant decrease they’re seeing is among very preterm births, not later term ones. I could easily buy that there are fewer women being induced at 35 weeks, but the data shows there’s fewer women having babies at 26 weeks, across the world. Something else has to be at play here.

  7. Zodphaybroxlebeeb says:

    Oh shit it’s caused by an infection.

    • Pregnant Rando says:

      I’m wondering if we’ll discover a virus like CMV (just for example) is behind a lot of preterm births. CMV infection is so mild many people never even notice when they catch it, yet if you contract it for the first time when pregnant your baby will have severe brain damage. A virus that similarly travels through populations silently, but is devastating to the small fraction pregnant in the second or early third trimester, could explain these results.

      • Rosenmop says:

        I’ve never heard of CMV. I just read about it now. I wonder why this isn’t more widely known. When I was pregnant in the 70’s and 80’s I was paranoid about stuff like that. But all we heard about was German measles. I’ve never heard my daughters speak of this when they were pregnant, never saw anything in the news. I’ve read about toxoplasmosis from cats, and zika.

        • metacelsus says:

          Yeah, CMV is actually quite nastier than people think. Just dealing with the latent infection can use up to 30% of your T-cell capacity, and it may take a few years off of your life.

          EBV (a similar virus) is also a big cause of cancer and multiple sclerosis.

  8. catte says:

    My first thought was less exposure to doctors and hospitals recommending useless or harmful medical interventions.

    • Lior says:

      Quarter of premature births are due to labor induction so that could partly be the case, although greg was thinking of less contact with pathogens.

    • mcdemarco says:

      They tend not to do those in pregnancy. Also, the (similar) report out of Ireland said the women had received the usual level of care.

    • owentt says:

      Yes. Hospitals are strongly discouraging their regular customers, so doctors are performing fewer useless interventions.

      The birth process is distinguished by the massive (and profitable) quantity of unnecessary and useless interventions that doctors and hospitals usually insist on. Smart pregnant women actually hire professional advisors (doulas), often state licensed, for the purpose of preventing useless and dangerous OBGYN interventions.

      • mcdemarco says:

        Such as? There’s a lot of monitoring, the utility of which is debatable, but not a lot of actual intervening beyond induction and/or caesarean section. These may add up financially, but they don’t explain changes in the pattern of preterm birth.

  9. dearieme says:

    Oh come on! It’s because they are drinking less Starbucks coffee and scoffing fewer Big Macs.

    If you don’t believe me just ask the people who are paid to put out puritanical government propaganda about nutrition.

  10. Smithie says:

    I wonder if there will be a noticeable change in the rates of any autoimmune diseases.

  11. j says:

    “Women are not being monitored. If I pick up a baby who is compromised I deliver them early – and that’s one of the causes of pre-term birth. Around a third of pre-term births take place because we decide to deliver them early,” said the doctor whose brain has not been eaten yet.

    • mcdemarco says:

      In Ireland they were still receiving care, so induced preterm births (whether or not you consider those unnecessary) would still have happened, but the preterm rates were still down, and stillbirths were not up.

  12. So, my wife delivered a child three weeks early. In the first week of January, 2020. The pregnancy had been considered high-risk for several months, and the doctor said that we would either have an induction or a C-Section around 37 weeks…mostly because four weeks pre-term was a little too early, and the risk to both mom and baby didn’t change after three weeks pre-term.

    The labor and delivery floor of the hospital was pretty quiet. Somewhere between 15% and 25% of the rooms were occupied, and the nurses at the front desk looked like they had lots of down-time.

    From what I can make out, January is ~10% less in births than months like August or September. But my impression at that hospital is that the first week of January was closer to ~50% less activity than most other weeks of the year. Maybe I’m off. Wiki tells me that the first week of January has lower numbers of live births than most other days of the year, but it doesn’t tell me what the percentage-below-normal value is for births during that week.

    I have a suspicion that the early-C-Section might not have happened if the due date had landed in April 2020 or May 2020.

    Is there any data on whether the reduction is mostly in induced labor, or mostly in scheduled-C-Section births?

    • mcdemarco says:

      The study from Ireland looked at very low birth weight preterm births, so not really the case of inducing in the last month for safety: https://www.medrxiv.org/content/10.1101/2020.06.03.20121442v1

      As I noted elsewhere, the women in Ireland were receiving the usual standard of care. I don’t know that anyone would delay a medically-indicated induction because of COVID, because who’s expecting the pandemic situation to improve in a week or three, and who wants to deliver their high-risk baby at home?

  13. Mike H says:

    Hmm.. if it was pathogenic, and it maybe, we’d expect it to be more likely in subsequent pregnancies, since you get more pathogens when you live with little monsters who put everything in their mouths. Interesting, this isn’t true for pre-term birth, at least from my brief googling it doesn’t seem so. it is true for homosexuality, so draw your own conclusions.

    • Pregnant Rando says:

      Actually, having a preschooler at home is itself considered a risk factor for premature birth among multiple pregnancies. See https://web.archive.org/web/20190916155356/http://www.drbarbaraluke.com/PrematurityQuiz.aspx (site is currently down.) Having two or more children of any age in the home is also a risk factor. I don’t think there’s ever been any studies done to drill down into why – more bending and lifting of small children/toy debris could also be a cause. But this preterm birth data is making me rethink that. I wonder if the decline in preterm births is more pronounced among first time mothers. Although it might be hard to isolate this effect, since little kids aren’t going to daycare or preschool right now anyway. Maybe a comparison between lreterm births to pregnany mothers of toddlers in areas where daycare is still open, vs areas where it’s shut down?

  14. GeorgVon1 says:

    Could be the fetus does not want to come out 😀

    The question is if there is more overdue pregnancy

  15. Dave says:

    I was going to guess iatrogenic causes: women are not seeing their doctors as often during the plague which improves their birth outcomes?
    Perhaps obstetrics clinics are a nexus for passing some unknown pathogen?

  16. Rosenmop says:

    https://www.reuters.com/article/us-health-coronavirus-science-idUSKCN24E2N3

    “The number of stillbirths at one large London hospital has jumped significantly during the pandemic. In the four months preceding the pandemic, there were roughly two stillbirths among every 1,000 births at St George’s University Hospital. From February through mid-June, there were roughly nine stillbirths per 1,000 births. The research appeared on Friday in the Journal of the American Medical Association. None of the women with stillbirths during the pandemic period had been diagnosed with COVID-19, the researchers said. But they noted that the coronavirus still may have been responsible given that previous research showed that up to 90% of infected pregnant women in Britain had no symptoms and therefore could not get tested for the virus. The increase in stillbirths also may be an indirect effect of the pandemic, they said. If women avoided visiting a doctor or hospital for fear of infection, serious problems might have been missed such as reduced fetal movements or dangerous pregnancy-related high blood pressure. (bit.ly/2Wf86bT)”

  17. John Massey says:

    Some people just don’t seem to want to believe it. “Likely clutching at straws” is really over the top, when it looks like a real effect with a likely real cause: reduced exposure to pathogens due to social distancing, improved hand hygiene and sheltering in place. And, dare I say it, wearing masks in public. But then, it’s the University of the Sunshine Coast, where the zombies are particularly active, so…please notice that I have avoided mentioning that both authors have blonde hair.

    https://theconversation.com/its-tempting-to-believe-good-news-but-are-there-really-fewer-premature-babies-in-lockdown-were-likely-clutching-at-straws-143353

    They don’t mention that there has been a dramatic reduction in influenza deaths, for the self evident reason that a lot less people have been infected with influenza. They’re supposed to be university researchers, but they haven’t bothered to check the numbers in Australia (surely not hard to get), which is in the middle of its winter influenza season – they’d much rather try to look scholarly and talk about clutching at straws.

    You don’t need a weather man to know which way the wind blows. It helps to have a functioning brain, though.

    • Pregnant Rando says:

      Thanks for linking that article, I just read it, and god, what morons.

      “In Denmark, there was a significant drop (around 90%) in the rate of babies born extremely premature (under 28 weeks gestation) during the nationwide lockdown, compared with a stable rate in the previous five years.
      However, the researchers did not see a drop in the rate of other preterm babies born (at greater than 28 weeks but under 37 weeks).”

      And then they go on to poo poo this, and suggest that maybe the corona virus will increase preterm births instead, despite just having delivered data showing the opposite.

      I especially loved the “Can we really expect future pregnant women to….not work so hard on their feet…so we can see what happens? It may have the exact opposite effect on their well-being.”
      Yes, because working hard on my feet all day just gives me the warm fuzzies. I’d much rather have a premature baby for the ‘privilege’ of standing for 10 hours a day to make ends meet. Give me a break… These authors are the ones grasping at straws, desperate for any interpretation that won’t encourage women to work less.

  18. simontmn says:

    Less stress on pregnant women is the obvious one, in particular reduced work stress. I know a female junior doctor who was over-working in Scotland, she was 17 weeks premature. Probably should be a law against it – 60 hour work weeks far more dangerous to the foetus than occasional glass of wine!

    • simontmn says:

      I guess she might have been premature due to pathogens picked up in hospital rather than the UK junior doctor insane work hours.

  19. syonredux says:

    Off-topic:
    any thoughts on the masks vs face shields debate? I have some friends who have significant psychological issues with masks (claustrophobic panic, gagging, etc) and are more comfortable with face shields, but they are not sure if face shields are a viable alternative in terms of blocking the coronavirus.

    • Pregnant Rando says:

      I have no data, but I’m leary the face shields don’t do a good enough job, what with all that fretting over how your mask had to fit snugly over your nose, jaw, etc. If germs can be blown around the edges of a mask, why not a shield? That said, I think it’s better than nothing, for people really struggling with masks.

  20. syonredux says:

    Off-topic:

    Any thoughts on the masks vs face shields debate? I have some friends who have significant psychological problems with masks (claustrophobic panic, gagging, etc) and are more comfortable with face shields, but they are not sure if face shields are a viable alternative in terms of offering protection from the coronavirus.

    • gcochran9 says:

      Masks work fairly well, face shields considerably less well. I’ve seen someone make a transparent mask but I don’t think they’re generally available.

      Spacesuits are good.

  21. uhoh says:

    Is the original puzzle game still on? If not, I’d love to know what the answer is. I didn’t see an answer above.

  22. j says:

    Let’s try again. A mothers immune system is altered during pregnancy so that the fetus is not rejected by her body. When this balance goes awry, the immune system causes miscarriage. The corona virus causes the hyper activation of the immune system, causing the premature births noted above. Please note than I was wrong before, I predicted that the virus, like all flu epidemics, would die off by the summer, but here we are in August with more infections than ever. Nunquam desistas, never give up.

  23. I’m going to guess that Greg is referring to something specific to the Denmark case, which I see is almost entirely ignored in the comments.

    But I can’t quite figure out what is specific to Denmark…

  24. Pingback: A Pregnant Woman Is in the Home | New Amsterdam Paleoconservative

  25. Ethan says:

    Dr Cochran, what do you think of this theory about homosexuality:

    Evolution made some men more masculine than others. Not just in terms of their bodies, but in terms of their brains. It is not ideal for all males to follow a super aggressive reproductive strategy, like Ghengis Khan. Alternative, more peaceful strategies evolved, such as faithfulness to a woman and investment in her children. We see these alternative mating strategies in many species.

    As a quick and dirty solution to produce the second kind of males, their brains were somewhat feminized in the womb. Evolution is fine with quick and dirty solutions, as long as they work in the environment of that time.

    In the ancestral environment this brain feminization did not often produce homosexuals, because if it did it would have been selected out. With the hormone profiles that existed in the ancestral environment it quite reliably produced a more effeminate but still completely heterosexual provider male.

    However, as civilization advanced, both male and female hormone profiles deteriorated because of environmental factors. For example, average testosterone levels dropped 17% between 1987 and 2004. They may have dropped a lot more than 17% between 1900 and 2013 (or whatever).

    http://jcem.endojournals.org/content/92/1/196.abstract

    In this new environment, old genes had new effects. Men became less masculine overall. The guys whose genes were coded for a Ghengis Khan strategy still came out relatively masculine, but the guys whose genes were coded for more feminized brains were at risk.

    The effect that used to produce a slightly feminized brain following a provider strategy was no longer completely reliable in the era of degraded hormone profiles. It occasionally went too far and produced males with excessively feminized brains that had female-like sexual attraction mechanisms.

    This flaw is currently being selected out of the population, but it has a long way to go because hormone profiles keep getting worse and worse, making new sets of formerly beneficial genes vulnerable to the problem. That’s why young men are much more likely to be homosexual than older men.

    One thing here is that the groups we would expect to be more providerish (e.g. Whites and Asians) would have a lower percentage of male homosexuals than West Africans or Latin Americans. And they do! (According to a huge 2012 poll by Pew).

  26. Abelard Lindsey says:

    There has been internet discussion over the years about the major cause of premee births being illicit drug use by the birth mother. The travel restrictions due to COVID-19 has reduced drug trafficking in many areas, although it is coming back now. I suspect its the sudden decline of illicit drug use that has significantly cut the premee birth rate.

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