The prestigious Institutes of Medicine of the National Academies issued the most comprehensive snapshot ever of premature births in the U.S., and the image is startling.

The number of babies born before 37 weeks gestation has jumped 30 percent nationally since 1981, a spike that requires greater attention among researchers, policymakers and physicians, according to the report released Thursday.

One of Utah's most prominent obstetricians couldn't agree more.

"It's the No. 1 problem in obstetrics, and it's the No. 1 problem in neonatology," said T. Flint Porter, director of maternal fetal medicine clinical programs for Intermountain Healthcare. "The vast majority of newborn problems occur because of premature birth."

Americans pay at least $26.2 billion for lifetime health care, special education, early intervention and other services needed among babies born too early in a given year, the new report estimated.

In 2004, 12.5 percent of American babies were born prematurely. The same year, 10 percent of Utah babies - 5,059 - arrived too early, according to the Utah Department of Health.

Although Utah's rate of preterm birth is below the national rate, it is rising.

"It's an area of concern, but there's no silver bullet," said Lois Bloebaum, manager of the state health department's reproductive health program. "There are a variety of factors that contribute to premature birth, so it's really a hard thing to get your arms around."

The report identifies biological, psychological, social, behavioral and medical factors that contribute to preterm births, including advances in infertility treatment.

Reproductive technology: In 2002, 33,000 American women delivered babies with the help of assisted reproductive technology (ART) procedures such as in vitro fertilization.

Those procedures often result in multiple gestations, which are at greater risk for preterm birth. More than half of the 45,751 babies born through ART in 2002 were multiples, according to the report. Of those babies conceived through ART, 61.7 percent of twins were born before 37 weeks, as were 97.2 percent of higher-order multiples, compared with just 14.5 percent of single babies.

"While many people are paying out of pocket for the technology, society pays a large burden for the consequences," said Norman Waitzman, a health economist and University of Utah economics professor who served on the IOM panel.

The report recommends reducing the number of multiple gestations. Possible measures include limiting in vitro treatment to transferring one embryo created in a lab to a woman's uterus, rather than implanting multiple embryos to increase the odds of success.

Physician Russell Foulk, a reproductive endocrinologist with clinics in Idaho and Nevada, called the institute's recommendations "a laudable goal."

For a decade, U.S. physicians have been striving to improve the success rates for single-embryo transfers.

The odds are largely dependent on a woman's age and the health of the eggs being used. But on average, each embryo has a 20 percent chance of implanting. Two embryos improve the odds to 40 percent and three embryos to 60 percent, but after that, it plateaus, said Foulk.

IVF treatments are expensive, averaging $8,000, excluding the price of medications taken to ensure the pregnancy "sticks" - a cost rarely covered by insurance plans. That leaves patients at great financial risk, said Foulk. "Understandably, many would rather take the risk of twins over not being pregnant at all."

Though increasingly frequent, preterm births resulting from infertility treatments represent a small percentage of the problem.

Other causes: Women who have already had one preterm birth are at greatest risk for having another, but more research needs to be done to identify additional risk factors, the report says.

Beyond a history of preterm birth and multiple gestation, obstetricians don't have much to go on when trying to identify which patients are at risk.

"There have been a bunch of risk-assessment profiles developed, but none of them have worked," said Porter, the IHC physician. "It's very frustrating."

State health officials hope to prevent some early births by increasing awareness about the importance of a woman's health before she becomes pregnant.

For example, women should stop smoking and drinking, take a multivitamin with folic acid, maintain a healthy weight through diet and exercise and get medical conditions such as diabetes or high blood pressure under control.

Health officials also encourage women to space pregnancies by at least 18 months.

"Short interpregnancy intervals can lead to prematurity, which in Utah could be an issue because of our high birth rate and large families," Bloebaum said. A recent study found that that for each month under 18 months between pregnancies, the risk of premature birth increased 1.9 percent.

Improved survival: Medical advances have helped save millions of premature babies who never would have survived even 20 years ago. That survival often comes with complications, such as immature organ systems that require extensive support in hospitals' neonatal intensive care units.

Other complications include cerebral palsy, learning disabilities, developmental delays, behavioral problems and socio-emotional difficulties.

"Though great strides have been made in saving more and more babies, what many people don't realize is that these babies and their families are going to face a lifetime of early interventions, many, many health care visits and surgeries," said Steve McDonald, spokesman for the March of Dimes' Utah chapter.

Waitzman's economic analysis put a dollar figure on the cost of survival. Hospital costs accounted for most of the $26 billion economic impact, he said.

"The medical care costs alone were over $16 billion, and most of those medical costs occurred very early in life," Waitzman said.

He extrapolated national economic costs from birth data of 23,000 babies born within Intermountain Healthcare's health plans between 1998 and 2000.

Prevention measures: Medicine knows even less about prevention. Even bed rest, a common prescription for women at risk, has not been proved to prevent preterm births.

"The therapies we have to prevent preterm labor all have drawbacks because they don't prolong pregnancy for more than a couple of days," said Porter, the IHC physician.

That's enough time to get mothers to adequate medical facilities where physicians can administer steroids to help strengthen babies' lungs before delivery.

The only preventive measure that has been found to be helpful is a special kind of progesterone. But even that can't be given until late in the second trimester and only to women at greatest risk, Porter said.

New measures may be on the horizon.

Intermountain Healthcare and University Health Care are participating in a federally funded clinical trial to test whether a combination of progesterone and omega-3 fatty acids prevent preterm delivery.

Among the report's other findings:

l Preterm births are much higher among African American women, who deliver babies before 37 weeks gestation twice as often as women of other races.

l Preterm births varied by the length of time women had been in the United States. About 14 percent of foreign-born African American women delivered prematurely, compared with 18 percent of U.S.-born African-American women.

l Limited studies indicate heredity may influence preterm and low birth-weight births. A woman's family history and personal medical history could help physicians assess risk of preterm birth, and a better understanding of hereditary factors could lead to better diagnosis, prevention and treatment of those women.

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Tribune reporter Kirsten Stewart contributed to this report.