Mothers in Alaska’s northern and western regions are more likely than other Alaska mothers to give birth to preterm and underweight babies, according to a new study by researchers at the University of Alaska Anchorage.
The research analyzes over 218,000 childbirths recorded in the state from 2000 to 2020 and reveals striking geographic disparities in rates of preterm and very preterm births. These are defined as births that occur before 37 and 32 weeks’ gestation, respectively, as well as cases of low birth weight.
Preterm births are associated with numerous health problems, including breathing and heart complications, long-term issues like cerebral palsy, and higher rates of sudden infant death syndrome, according to the Mayo Clinic.
The factors contributing to adverse childbirth impacts are multifaceted, the UAA study found. They encompass tobacco use during pregnancy, pre-pregnancy diabetes or hypertension, the ages of mothers, and a lack of adequate prenatal care.
Study co-author Micah Hahn, an epidemiologist at UAA’s Institute of Circumpolar Health, noted that for many women, the issues leading to negative outcomes are cumulative.
“It’s kind of like a constellation of things that contribute to preterm birth,” said Hahn.
A significant factor affecting Alaska’s newborns is the necessity for mothers to travel for delivery, the study found.
Nearly 40% of babies born during the 20-year period had mothers who traveled outside of their home communities for childbirth, introducing additional stressors, as indicated by the research.
Routine prenatal care for women in rural Alaska often requires travel, making access to such care difficult prior to childbirth.
In communities where the population is predominantly Alaska Native, it takes significantly more effort for mothers to go for prenatal care, said Hahn.
Beyond the travel itself, which can be financially burdensome, mothers need childcare and support from partners, family members, or friends to handle various responsibilities.
Women flying in from rural areas might need two or three days to get to their appointments, in stark contrast to the experience of urban residents such as Hahn, who described driving just a few miles to her doctor’s office in Anchorage.
The research highlights that many factors leading to adverse birth outcomes overlap.
Rural women with high-risk pregnancies may be required to travel to larger cities for delivery, while low-risk pregnancies might allow women to stay home. However, travel and prolonged stays in unfamiliar settings introduce complications for already high-risk pregnancies, the study stated.
“If a mother travels to a service hub for prenatal care or delivery, they will incur costs for flights, accommodation, food, and missed work, which may not be covered by insurance,” the study pointed out.
Moreover, mothers may face tough decisions about whether their partners should accompany them or stay home to work and care for other children, increasing stress levels exacerbated by a lack of social support and the challenges of being in unfamiliar surroundings.
On a positive note, the study revealed improvements in rates of prenatal care utilization among Alaska Native women.
By 2020, around 40% of pregnant Native women received at least 11 prenatal visits, an impressive increase from the 2005-2010 period. In contrast, more than half of pregnant white women achieved similar prenatal visit numbers in 2020.
“You can see that one good news story is that in Alaska we are closing the gap on prenatal care utilization by race,” Hahn said.
While babies born to mothers in northern and western Alaska face adverse outcomes at rates higher than the state average, it is noteworthy that these rates are not worse than the national averages.
About 1 in 10 babies in the United States are born preterm, which aligns with the rates found in the study for babies born to mothers from these regions of Alaska.
Hahn expressed that the findings can help inform health policies in the state aimed at better supporting women and their babies.
Tobacco cessation programs could prove beneficial, she indicated, along with initiatives that reduce the need for travel or improve the ease and comfort of necessary travel.
Telehealth services may be employed for some prenatal care visits for rural women, although specific appointments will still require in-person evaluations, Hahn pointed out.
Senate Bill 83, a pending measure in the Alaska Legislature, seeks to make telehealth services more accessible by requiring insurers to reimburse providers fully for such services.
A holistic approach that considers the needs and cultures of rural and Alaska Native populations could further mitigate risks of adverse birth outcomes, Hahn asserted.
One organization playing a significant role in this area is the Alaska Native Birthworkers Community, composed of Indigenous midwives, doulas, breastfeeding consultants, and other health experts who offer prenatal and postpartum support and education.
Factors beyond the scope of this new study, such as environmental influences affecting birth outcomes, will be the focus of separate research by Hahn and colleagues, which is expected to be published later this year.
They plan to examine the impacts of wildfire smoke on childbirth outcomes, a recognized health hazard linked to increased risks of preterm births in locations like California and Brazil.
In Alaska, climate change is lengthening wildfire seasons and intensifying wildfire risks, consequently raising smoke-related health concerns in various communities over time.
For instance, a report from the University of Alaska Fairbanks indicates that Fairbanks, which typically experienced smoke-free summers prior to 2000, has only had two such summers since then.
From 2022 to 2024, Fairbanks recorded three consecutive summers with over 100 hours of smoke thick enough to compromise air quality.
Hahn emphasized that wildfire smoke is not just a localized issue, noting that even if the fires are concentrated in particular areas, smoke affects most of Alaska during significant fire seasons.
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