The number of preterm births in the United States rose in 2015 for the first time in eight years, according to data presented Tuesday by the March of Dimes. Babies born too early face a risk of health complications that can last a lifetime.

The organization also reported that racial minorities continue to experience early labor at higher rates.

Preterm births increased from 9.57 to 9.63 percent of births in 2015, an additional 2,000 babies born prematurely in the U.S., the report found.

Seven states — Arkansas, Connecticut, Idaho, Nebraska, New Mexico, Utah and Wisconsin — had higher preterm birth percentages than in 2014. Four states — Vermont, Oregon, New Hampshire and Washington — earned the highest marks from the organization for having a preterm birth rate at 8.1 percent or below.

Overall, the national uptick earned the U.S. a C rating on an A to F scale. The March of Dimes researchers used data compiled by the National Center for Health Statistics and assigned grades using a formula that compared the state’s current prenatal birth rate to the national average in 2014 and the organization’s goal of 8.1 percent.

Despite its wealth and medical prowess in saving the lives of premature newborns, the U.S. lags behind the majority of industrialized countries and some less developed ones in preventing their early arrival. According to the latest data available from the World Health Organization, the U.S in 2010 ranked in the middle of the pack, falling behind Somalia, Afghanistan and Thailand.

Lowering the rate of preterm births to 8.1 percent would place the U.S. among countries with the lowest rates of preterm births. The March of Dimes says the U.S. should reach this goal by 2020, but the lack of progress signals to Edward McCabe, the chief medical officer of the organization, that new responses are needed. “We feel that this is a recognition that we need to work harder as a nation, that we need to focus,” he says.

Preterm birth is defined as a child born before 37 weeks of pregnancy. It’s the leading cause of neurological disorders such as cerebral palsy, according to the Centers for Disease Control and Prevention, and also can cause blindness, hearing problems and developmental delays. It’s the single largest cause of infant death.

Preterm births cost society more than $26 billion a year, according to a 2005 report from the National Academy of Medicine.

Disparities continue across geographic, ethnic and racial lines, McCabe said. Asians and Pacific Islanders fared best, with a preterm birth rate of 8.5 percent, a full percent lower than the national average. Preterm birth rates in Hispanics and whites hovered at about 9 percent.

African-American women were most likely to give birth prematurely, with 13 percent of births affected, according to the report. States with large African-American populations and a lack of access to health care, such as Louisiana, Mississippi and Alabama, had the highest percentages of preterm births.

“We want every baby, no matter where they’re born, no matter their birth ethnicity, to be born with the best start in life,” McCabe says.

Vermont officials agree. The state boasts a 7.3 percent birth rate, the lowest rate in the U.S. It runs the Vermont Regional Perinatal Program, which allows smaller medical facilities to transfer high-risk pregnant women to larger tertiary hospitals. It also supports nurse home visits to help new mothers.

Breena Holmes, maternal and child health director at the Vermont Department of Health, says though she is proud of the state’s low rate, she still worries that there are too many preterm babies born there. “I’m still aware that every time a baby comes early, there was a system problem that we could have worked on,” she says.

The racial and ethnic divides reveal an overemphasis on medical intervention and a lack of knowledge among women, says Claire Brindis, director of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. Planning for pregnancy does not start with prenatal care, she says, but with understanding risk factors and a woman’s wishes regarding family planning.

The causes of preterm birth aren’t clear, but risk factors include high blood pressure, diabetes, smoking and having had a previous premature birth.

While not every preterm birth can be prevented, McCabe acknowledges, a woman should be able to have the best pregnancy possible.

“Every woman is trying to do the best that she can,” he says. “We need to show her what can be done.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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Young children and teenagers are increasingly likely to be poisoned by opioid painkillers that are often prescribed for other family members, a study finds.

The rate of children hospitalized for opioid poisoning increased 165 percent from 1997 to 2012, from about 1.40 per 100,000 kids to 3.71 per 100,000.

“Opioids are ubiquitous now,” says Julie Gaither, a postdoctoral fellow at Yale School of Public Health and the study’s lead author. “Enough opioids are prescribed every year to put a bottle of painkillers in every household. They’re everywhere, and kids are getting into them.”

The study, which was published Monday in JAMA Pediatrics, examined more than 13,000 hospital-discharge records from 1997 to 2012 for opioid poisonings and used census data to extrapolate rates. The discharge data was collected by the Agency for Healthcare Research and Quality.

The data stops in 2012, so it may not reflect more recent trends in opioid prescribing and public awareness. But the findings track with adult rates of abuse and addiction, which have dropped since 2012 but remain troublingly high, experts say.

The rate of toddlers hospitalized more than doubled, going from 0.86 per 100,000 to 2.62 per 100,000. It’s likely that these very young patients take the drugs because they think they are candy or a treat. Opioids can be dispensed as pills, patches or a flavored lollipop.

Teens are also at risk of overdosing on their parents’ meds. Of all children, this age group is most likely to be hospitalized for opioid poisoning, and teens are more likely to do be poisoned deliberately — likely, the researchers wrote, because teenagers are at a particularly high risk of depression and suicide. In 2012, 10.17 per 100,000 teenagers were hospitalized for opioid poisoning.

The findings, Gaither and her co-authors say, indicate a need for public health approaches that not only address overprescribing, but also try to raise awareness about the need for safe storage of these painkillers.

Doctors need to to talk to patients about ways to store drugs safely, especially if children are in the household, Gaither says.

That’s a good idea in theory, says Jonathan Chen, a physician at Stanford Medicine who has researched how guidelines for prescribing opioids affect primary care. But doctors already face a lengthy list of sensitive subjects they should discuss with patients. And they aren’t always conditioned to consider how a patient’s medications could affect other family members.

“Conceptually, yes, of course that should be part of the conversation,” Chen says. But he notes that doctors have a long list of things to discuss with patients, and “there’s a lot of things we should discuss.” Chen was not involved with the study.

Pediatricians could also play a role by asking parents at well-child and well-baby visits about whether there’s a risk of children being exposed to opioids. But that sort of screening hasn’t traditionally been drilled into doctors the same way as discussing other risks, such as safe storage of cleaning supplies, whether the family has a swimming pool and whether there are guns in the home.

Doctors also may not be conditioned to considering toddlers as particularly at risk of opioid poisoning.

“This is largely seen as an adolescent problem or an adult problem,” says Sharon Levy, who directs the adolescent substance abuse program at Boston Children’s Hospital and is an associate professor of pediatrics at Harvard Medical School. “But this paper really highlights that this really knows no age boundaries.” Levy was also not involved with the study.

It’s also unclear, Levy says, what the long-term health effects, including addiction, are for children who ingest opioids they weren’t prescribed.

And there are serious short-term risks, including death. “Opioids cause respiratory suppression,” she said. “If you are a 30-pound person and getting into the medication that was supposed to be for a 150-pound person, it’s going to be a whopping dose for you.”

The findings also suggest doctors should be more thoughtful in prescribing to children, especially teenagers. About 1 in 10 high school students reports having taken opioids for a nonmedical reason, and close to 40 percent of them say they got those drugs through their own prior prescriptions.

The American Academy of Pediatrics notes that the rate of young patients being prescribed opioids almost doubled between the 1990s and 2000s.

The Centers for Disease Control and Prevention has been pushing doctors to prescribe opioids more safely by prescribing for just a few days. That could help reduce the number of leftover pills. Large prescriptions — coupled with the fact that many people don’t know how to dispose of drugs when they no longer need them — can make it easier for children and teens to get ahold of them, Gaither says.

That’s an important factor to consider, Chen says. “Leftover pills aren’t used, but do they get returned to the pharmacy, or thrown in the trash? Nope. They’re stored in the medicine cabinet.”

Smaller prescriptions will likely help, but they won’t solve everything, Chen notes. After all, there are situations where a larger opioid dosage makes sense. For instance, someone suffering long-term cancer probably needs a larger amount of heavy duty painkillers, even if he or she has children in the house.

But the risk to children must be a part of the conversation, Gaither says. “We’ve got to pay attention to children and the toll the opioid crisis is taking on them,” she says. “Kids make up about a fourth of the U.S. population, and they’re suffering from this crisis, too.”

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Just about every day, genetic counselor Shawn Fayer heads to the maternity ward at Brigham and Women’s Hospital in Boston and tries to convince new parents to give him a blood sample.

Fayer is offering gene sequencing for newborns. It gives parents a tantalizing look at their baby’s genetic information.

New parents Lauren and Ian Patrick, from Marion, Mass., were excited when they were first approached earlier this month.

“My initial reaction — why wouldn’t someone do this? Why wouldn’t they want the information?” Ian Patrick says as he cradles his newborn son, Finn. “For me, more information is better, even if it’s not always good.”

If his parents sign him up, Finn would join the BabySeq project, an NIH-funded study led by Dr. Robert Green, a medical geneticist at Brigham and Women’s Hospital. With genetic testing getting cheaper and cheaper, Green wants to figure out what happens when parents know their child’s genetic blueprint from day one.

Half of the babies who join the study will have their protein-coding genes sequenced and screened for variants that are associated with diseases of childhood, with a method called whole-exome sequencing. The other half will get the regular heel-prick blood test offered to all newborns which screens for major genetic disorders like cystic fibrosis.

Researchers will follow both sets of babies to figure out how genetic sequencing impacts them. They want to find out if knowing a child’s genetic makeup could actually make them healthier, or if it could increase their health care costs, or even change their relationship with their parents.

“We are looking for all sorts of unanticipated variations in DNA,” Green says. “And we say right up front we don’t know what they all mean. We don’t know what they’re all going to mean for your baby,”

Green is particularly interested in a list of 1,514 genes where there are good reasons to reveal a mutation because a disease might be treated or prevented. But there are so many changes in everyone’s DNA, he says he’s finding something to report in every baby he sequences.

Right now, that’s a pretty small number of babies. Green has sequenced the genes of 51 newborns so far, and he’s found five who have genetic mutations families wouldn’t have known about otherwise. Two babies have pharmacogenetic variants — mutations that mean certain drugs might not work as well on them. Three have heart conditions they inherited from a parent who appears to be totally healthy.

One of those babies is Kai Gracia. His parents, Alyssa and Jason Gracia, agreed to the test when Kai was just a few days old. They didn’t expect to find much. Alyssa had her own genome sequenced a few years before, and the information she got was mostly trivial — she learned she metabolized caffeine particularly quickly and she discovered she didn’t have the photic sneeze reflex, meaning she wasn’t likely to sneeze when suddenly exposed to bright light. So when the results on her baby came back,she was shocked. Right there in Kai’s genetic report was this: supravalvular aortic stenosis.

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Alyssa and Jason Gracia agreed to have their son Kai’s genes sequenced when he was just a few days old. Mary Harris/WNYC hide caption

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Mary Harris/WNYC

It turns out Kai has a mutation in a gene that codes for a protein called elastin. Elastin helps heart muscles bend and stretch. Not producing enough of it can cause the aorta to narrow. People can die from this, or need multiple surgeries as they grow.

Now that she knew her baby might get sick, Alyssa Gracia had lots of questions. Would Kai be able to play sports when he got older? Did he need surgery? Could crying too much be dangerous?

She made appointments with pediatric cardiologists and brought in Kai’s genetic report. One doctor said he looked fine, and only needed to be monitored every few years. Another said his parents should bring him back after just a few months. Usually, a condition like Kai’s isn’t diagnosed until a child is showing symptoms. That means doctors still aren’t quite sure how to treat Kai.

This is the kind of story that both thrills and terrifies the observers of this new technology, according to Green.

“There’s no consensus on how to manage these findings,” he says. And it’s unclear if the follow-up is worth it, or if it might actually do harm.

And gene sequencing reveals medical information not just about one person, but potentially a whole family. So all that follow-up is being done not just on Kai, but on his dad and his grandmother — all people who might be carrying this gene and might be at risk themselves.

So what can families do with all this information? Dr. Green says that for one family, this genetic report was potentially lifesaving.

It showed an inherited mutation in the baby’s BRCA2 gene, which increases the risk of breast, ovarian, prostate and pancreatic cancers. This means not only is the baby at risk, but the child’s mother or father could be, too.

Before they told the family, the researchers had to deal with “a really pernicious ethical problem,” says Green. He and his colleagues had agreed they would only tell parents about genetic variants that could impact babies in childhood, since the children weren’t able to decide for themselves whether they wanted to know their genetic risks. BRCA2 causes cancer in adults, not children.

But this information was so important, Green decided to break protocol.

“You know what the first four words were out of the mother’s mouth when she was told?” Green asks. ” ‘Oh, that explains it.’ “

It turns out the mother knew distant relatives who had died from cancer, but she hadn’t thought it meant anything for her. Without her baby’s test, she might never have learned about her own risk.

Not every mutation is actionable like this. Green is also finding a lot of single recessive mutations for conditions like cystic fibrosis, Tay-Sachs, and sickle cell. Since it takes two mutations, one each from mother and father, to cause the disease, it becomes an issue only when these babies grow up and decide to have children themselves.

One thing Green hadn’t anticipated is how hard it has been to convince new parents to do this screening in the first place. Early research showed the majority of parents were interested in the medical information. But 94 percent of parents Green and his team are approaching are saying no.

Lauren and Ian Patrick, the parents of baby Finn, are a good case study.

Initially, they were convinced they wanted the screening. But after an hour talking to a genetic counselor about all the ways this sequencing could go wrong, they decided against it.

They learned that any genetic sequencing would go in their son’s medical record, and it wouldn’t be able to be removed. And while federal law prohibits genetic discrimination by health care providers and in the workplace, life insurers can still use genetic information to pick and choose who they’ll sell policies to. By the time the meeting was over, the Patricks’ excitement had been replaced with concern.

“It really gave me pause that this would be part of the medical record that private companies would have access to,” Lauren Patrick says. “That was my full stop in the end.”

After all, for the first time she’s making a decision for someone who has no say, she says. “That’s the biggest thing on my mind, this new dynamic.”

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The largest provider of health coverage on the Affordable Care Act’s online marketplace in Maine has dropped coverage of elective abortion services.

Community Health Options, an insurance co-op, decided to eliminate the coverage as it tries to dig itself out of a $31 million financial hole that it accumulated in 2015. (It’s one of six co-ops remaining of the 23 initially created by the Affordable Care Act.)

“This decision was really driven by economic considerations,” says CEO Kevin Lewis, “as well as the construction of the Affordable Care Act and how it regards essential health benefits in the individual marketplace.”

Elective abortions aren’t considered an essential health benefit under the federal health care law. Neither is adult vision care, which Community Health Options also dropped. Both services were included in all of the 56,291 policies the co-op sold on the individual market in 2015.

Lewis says he can’t pinpoint exactly how much the co-op will save, but eliminating elective abortion coverage is one of several changes the co-op made to rein in an already steep premium hike of 25 percent. Without the changes, Lewis says, the average increase would have been 33 percent.

While Community Health Options describes the change in abortion coverage as one piece of an overall strategy to contain costs, abortion services providers in Maine are calling it a major decision that erects barriers to women’s health care.

“It further stigmatizes a normal procedure that we’re trying to help people understand is part of the comprehensive experience of women’s health care,” says Andrea Irwin, executive director of the Mabel Wadsworth Health Center in Bangor, one of three main providers of abortion services in the state.

Though Community Health Options says it provides coverage for birth control above and beyond the requirements of the Affordable Care Act, Irwin says sometimes birth control doesn’t work and women need another option. Most people buying insurance in the online marketplace “are by definition working people with low to moderate income who need help buying health coverage,” she says.

A spokeswoman for Planned Parenthood of Northern New England, Nicole Clegg, says she appreciates the financial issues Community Health Options is facing but is skeptical that cutting coverage of abortion services will do much to help buoy the co-op. The cost for a first trimester abortion is about $550, she says. Community Health Options says 33 women in Maine used their elective abortion coverage in 2015.

Clegg says Community Health Option’s decision can’t be viewed in isolation. “You kind of need to look at the larger strategies that have been deployed by Congress, by legislators, to restrict access to safe and legal abortions,” she says. “And one of the tools that they use is to make it harder for insurance to cover it.”

Abortion is the only service under the Affordable Care Act that is explicitly allowed to be banned, says senior policy analyst Laurie Sobel of the Kaiser Family Foundation. Twenty-five states ban it, she says, and “six of the remaining states that have no ban on abortion coverage did not have any plans that offered coverage in 2016.”

For plans that do provide coverage, there is administrative complexity. Funds for abortion services must be segregated, and insurance companies are subject to extra reporting and audit requirements.

Even though the state of Maine doesn’t ban marketplace coverage, Sobel says Community Health Options’ decision is “a reflection of abortion coverage being extremely restricted in the country as a whole.”

This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.

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