Rates of premature births, which are associated with greater risk of death or disability and higher health care costs, are rising in Allegheny County, mirroring trends throughout Pennsylvania and nationwide.

		Chart: Preterm births: Allegheny, Pennsylvania, U.S.

The county's rates topped 12 percent in 2004, the highest figure in at least 16 years. Since 1989, the rates have increased by about 50 percent.

"It's an unmistakable upward trend, and certainly we're concerned," said Guillermo Cole, county health department spokesman.

In Pennsylvania, the statewide rate reached 11.6 percent in 2003, the highest in at least 11 years. The U.S. rate was 12.3 percent that year, a 27 percent increase since 1982.

Experts who took part in a one-day conference in Pittsburgh yesterday acknowledged concerns about the increases, but said the causes and how to address them are much less clear.

"In a majority of cases, we don't know why this is happening," said Dr. Hyagriv Simhan, director of the center for prematurity at Magee-Womens Hospital.

One in eight babies born in the United States each year -- about 500,000 children -- are premature, and more than 100,000 of them have long-term disabilities related to being born early, said Dr. Ron Thomas, director of maternal and fetal medicine at Allegheny General Hospital.

"It truly is a health care crisis," he said.

The two doctors co-chaired a conference yesterday at the Western Pennsylvania School for Blind Children to raise awareness of premature birth and discuss solutions. About 200 health care professionals and others attended the "prematurity summit" hosted by the March of Dimes, which is conducting a campaign to reduce the rates.

Babies born prematurely have less-developed organs than full-term babies and are more likely to face serious health problems following delivery, the organization noted.

A study published this month in the journal Pediatrics found that preterm birth is the most frequent cause of infant death in the United States, accounting for at least one-third of those deaths in 2002.

While many children born prematurely grow up healthy, others may have vision or hearing loss, cerebral palsy, mental retardation, chronic lung disease or other lifelong disabilities.

The demand resulting from premature births is one reason the Children's Home of Pittsburgh is increasing pediatric specialty beds at its new facility in Friendship, said Debrah Flowers, chief clinical officer.

Last year, the cost of preterm births was $26.2 billion, according to a July report by the Institute of Medicine. Most of the expense was for medical care, though there were costs for special education and other needs.

Not all premature births occur spontaneously. Some are induced to address certain medical problems like preeclampsia, Dr. Simhan said.

Other causes of premature birth are not well understood, but risk factors include pregnancies involving multiple fetuses, which can result from infertility treatment, as well as a past history of preterm delivery and some uterine or cervical problems.

Others may include high blood pressure, diabetes, obesity, certain infections, cigarette smoking, and alcohol use or illegal drug use.

About 40 percent of pregnant women in Allegheny County are smokers, Dr. Thomas noted. For low-income women, the rates are even higher.

Premature birth rates also are higher among blacks and among younger teen mothers and older women, he noted.

While socioeconomic factors may be a factor in some cases, many premature births occur among women who have good prenatal care and do not have other obvious risk factors, Dr. Simhan said.

Both doctors said much more research is needed.

In its report, the Institute of Medicine recommended more study of how to prevent preterm births among certain populations and the causes and consequences of premature births resulting from infertility treatment.

The report also recommended that medical societies join with state and federal agencies to develop new guidelines to limit multiple births related to those treatments.

And it said the National Institutes of Health and private foundations should establish integrated, multidisciplinary centers to examine the causes of preterm birth and the outcomes for women and their children.