SACHA PFEIFFER, HOST:
Our health is profoundly affected by our microbiome. That's the billions of bacteria that inhabit our body. Now, a study from Pakistan has found that the microbiome may play a role in why some women have babies prematurely, meaning born before 37 weeks of gestation. NPR's Diaa Hadid explains, and please know that one woman discusses the deaths of her babies.
(SOUNDBITE OF CAR HORN HONKING)
DIAA HADID, BYLINE: A wind whipping up trash, dust and dried fecal matter blows around the compound where Sughran lives with her extended family in the fishing settlement of Rehri Goth.
SUGHRAN: (Speaking Arabic).
UNIDENTIFIED PERSON #1: (Speaking Arabic).
UNIDENTIFIED PERSON #2: (Speaking Sindhi).
HADID: Sughran only has one name. She doesn't know her age. Kids mill about in tattered clothes. Five are hers. There were more. When we meet Sughran, it's only been a week since her baby died.
SUGHRAN: (Speaking Sindhi).
HADID: Sughran says Baby Gulshan came two months early. She had him at night. He was cold by morning.
SUGHRAN: (Speaking Sindhi).
HADID: Sughran buried him near his baby brother, Roshan. He died last year. He was born early too. He lived for a few days.
(SOUNDBITE OF BIRDS CROWING)
HADID: The World Health Organization says in the West, a baby born around 32 weeks gestation has an excellent chance of survival. In poorer countries, those babies have about a 50% chance of dying. Just looking around Rehri Goth, you can see some of the factors why women and girls are giving birth prematurely. They're malnourished. There's extreme heat, poor sanitation. Many are barely literate, and a girl's education is key to her future baby's health. And here, about 1 in 4 babies are born early.
(SOUNDBITE OF WIND BLOWING)
HADID: But miles away in the port city of Karachi, at The Aga Khan University, Dr. Fyezah Jehan, chair of pediatric, says women and girls in other countries face similar adversities, but aren't having as many premature babies.
FYEZAH JEHAN: So the question that came to us was, why are the rates so high?
HADID: So Jehan says her department...
JEHAN: We got interested in the microbiome.
HADID: That's because...
JEHAN: In pregnant women, we think that it has a huge influence.
HADID: But...
JEHAN: We didn't have any data from Pakistan.
HADID: Local data's key because a person's microbiome is formed by their diet and environment. So Jehan's team looked at the microbiome of 108 Pakistani women who'd just given birth by examining their stool. About half were from women who gave birth full term, the other half, women whose babies were born premature.
JEHAN: What we found was there's this one bacterium, Prevotella, which was far less in women who had delivered preterm compared to women who had delivered term.
HADID: So this bacterium, Prevotella copri, emerged as a powerful indicator. The more Prevotella copri, the more likelihood of a full-term delivery.
JEHAN: It was a eureka moment for us. Oh, there is a bug, which could potentially explain prematurity.
HADID: Jehan says her team is replicating the experiments to see if the result holds. They're also trying to cultivate that strain of Prevotella copri in the lab to give to at-risk pregnant women to see if it helps them get to term. Still, she cautions...
JEHAN: Our results, they give us a signal of understanding. They are by no means at a stage where we can translate it into policy.
HADID: Dr. Vincent B. Young is an infectious disease physician at the University of Michigan Medical School. He agrees there's still a distance between this study and using Prevotella copri to prevent early birth, but he says potentially pregnant women can be screened for Prevotella copri.
VINCENT B YOUNG: If you can just use it as a marker, you can use an association as a way to help guide your therapy and guide care, especially in resource-limited areas.
HADID: Jehan of Aga Khan University says there's no silver bullet to resolve premature births.
JEHAN: Honestly speaking, I mean, if you ask me, improve education and water and sanitation, and half the problems will just disappear.
HADID: But donors are reluctant to undertake expensive work like sanitation, especially around areas like Rehri Goth where the local government is perceived as corrupt.
LADOO: (Crying).
HADID: Back in Rehri Goth, 17-year-old Mariam is fighting the odds to keep her baby alive. Five-month-old Ladoo fusses in a hammock made from an old scarf.
LADOO: (Crying).
HADID: He was born at around seven months gestation. She says there was no money to keep him in hospital.
LADOO: (Crying).
HADID: Mariam says her baby is always sick. His grandmother shows us baby Ladoo's bloated stomach. They don't know why it's like that.
UNIDENTIFIED PERSON #3: (Speaking Sindhi).
HADID: There's scars on his back from blisters that formed in the extreme summer heat.
(SOUNDBITE OF RUSTLING THROUGH PLASTIC BAG)
HADID: She shows us Ladoo's little bag of medicine but says, we can't read or write, so we aren't sure what to do.
UNIDENTIFIED PERSON #3: (Speaking Sindhi).
HADID: Baby Ladoo is exposed to even more danger by another common hazard here, health workers dispensing ill-considered advice.
MARIAM: (Speaking Sindhi).
HADID: Mariam says a doctor told her to stop breastfeeding her son, saying it was making him sick.
MARIAM: (Speaking Sindhi).
HADID: She was told to give him formula, even though the water here is unsanitary and dangerous for babies. And Mariam can't afford formula.
MARIAM: (Speaking Sindhi).
HADID: So she mixes polluted water with cereal powder she can barely afford, a practice health experts called wildly dangerous for a baby this young. Ladoo's grandmother shoos away the flies that have settled on his milk bottle and feeds the baby. She says, we'll do our best to keep this boy alive.
Diaa Hadid, NPR News, Rehri Goth. Transcript provided by NPR, Copyright NPR.
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