The rate of premature births in the United States has risen nearly
one-third in the past 25 years, the nation's top medical advisory body
reported Thursday, resulting in costly health problems and
intensifying concerns over infertility treatments that lead to
multiple births and prematurity.

The report by the Institute of Medicine, part of the National
Academies of Science, said premature births result in $26.2 billion a
year in additional medical costs, or $51,600 per preemie.

``For pregnant women and doctors, preterm birth remains the single
greatest cause of disappointing outcomes in pregnancy,'' said Dr. Jay
Iams, an obstetrics and gynecology professor at Ohio State University
College and one of the authors of the report, ``and it's the leading
cause of death and acute and chronic health care problems for the
baby.''

Although not all the causes of premature birth are known, the report
blames part of the rising rate on the proliferation of fertility drugs
that give rise to twins, triplets and more, and on the practice of
implanting more than one embryo during in vitro fertilization.

Babies born too soon often face serious health and developmental
problems, including cerebral palsy, blindness, learning disabilities
and breathing difficulties.

About 12.5 percent of babies born in the United States last year were
premature, arriving more than three weeks early in the typical 40-week
pregnancy.

Doctors have pinpointed some risk factors such as drug use, exposure
to lead, a previous multiple birth and the fact that more women are
delaying childbearing. No test, however, can accurately predict
whether a baby will come early.

There is ``enormous ignorance'' about prematurity, said Menlo
Park-based physician Dr. Richard Berhman of the Federation of
Pediatric Organizations, who led the committee that wrote the report.

Researchers also know little about what the report calls
``significant, persistent and very troubling'' racial, ethnic and
socioeconomic differences in premature birth rates.

Regardless of income, education and access to health care,
African-American women are more likely to have preterm babies. In
2003, 17.8 percent of births to African-American women were preterm,
compared to 11.5 percent for white women, 11.9 percent for Hispanics
and 10.5 percent for Asian women.

Medical advances have helped these babies, who are often placed in
newborn intensive-care units for weeks or months after birth. Today,
hospital stays are shorter and more infants are surviving.

But miracle stories about preemies the size of Coke cans beating the
odds have given many parents a false sense of security.

``I do get the sense that patients generally approach this issue with
optimism, and the gravity of the situation isn't fully grasped,'' said
Dr. James F. Smith, a maternal-fetal physician at Lucile Salter
Packard Children's Hospital at Stanford who specializes in high-risk
pregnancies.

The report calls for ultrasound exams earlier in pregnancy to better
pinpoint a fetus's age and determine a safe date for delivery. They're
now typically done at 18 to 20 weeks of pregnancy to check for birth
defects and multiple fetuses.

Although the authors note that fertility specialists have reduced the
number of embryos they implant during IVF, they call for guidelines
that promote single embryo transfers to reduce the potential for
multiple births. The researchers also called for mandatory reporting
of the use of fertility drugs that spur production of more than one
egg, as well as restrictions on their use.

Those recommendations didn't sit well with Dr. David Adamson, director
of Fertility Physicians of Northern California in Palo Alto.

Although he suggested that the use of fertility drugs be restricted to
specialists experienced in their use, he said a one-embryo policy
would dramatically lower pregnancy rates for IVF, an expensive
procedure often not covered by insurance.

Adamson said he often implants two or three embryos in an IVF
procedure, depending on the woman's age.

``We're all concerned about prematurity. It's a serious problem,''
Adamson said. ``But I'm concerned that we discriminate against
infertile people. They're an easy target to solve this problem.''

The report's findings were no surprise to Angela Campbell, a San Jose
hospice nurse who is pregnant with quadruplets as a result of the
fertility drug Menopur.

Now 19 weeks pregnant after several failed attempts, she is home on
disability. She hopes to hold out at least 10 more weeks before
delivering.

``When we were going through the process, I felt I wanted to be
aggressive,'' said Campbell, who is 30 and pregnant with three boys
and a girl. ``I think you don't really grasp the reality of it until
it happens to you. They're all going to have complications when
they're born.''

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