Pakistani researchers find link between the microbiome and premature birth

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0:35You're listening to State of the World from NPR. The day's most vital international stories up close when they're happening. I'm Christine Arismath. The role of the microbiome in our health is getting more and more attention. As science discovers how these billions of bacteria in our bodies influence everything from our digestion to the immune system, and as researchers in Pakistan are learning, the health of a woman's pregnancy. This study from Pakistan finds that the microbiome may unlock why some women have babies prematurely, that is, born before 37 weeks of gestation, as NPR's Dia Hadid reports.

1:17A wind whipping up trash, dust and dried fecal matter blows around the compound where Sagran lives with her extended family in the fishing settlement of Rehrikot. Salam alaikum. Sagran 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 Sagran, it's only been a week since her baby died.

1:45Sagran says baby Gulshan came two months early. She had him at night. He was cold by morning. Sagran buried him near his baby brother, Roshan. He died last year. He was born early too. He lived for a few days. 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 Rahirigot, 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.

2:29And here, about one in four babies are born early. But miles away in the port city of Karachi, at the Agha Khan University, Dr. Faisal Jihan, Chair of Pediatrics, says women and girls in other countries face similar adversities but aren't having as many premature babies. So the question that came to us was, why are the rates so high? So Jahan says her department. We got interested in the microbiome. That's because? In pregnant women, we think that it has a huge influence. But? We didn't have any data from Pakistan. Local data is key because a person's microbiome is formed by their diet and environment.

3:10So Jahan'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. 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. So this bacterium, Prevotella coppere, emerged as a powerful indicator. The more Prevotella coppere, the more likelihood of a full-term delivery. It was a eureka moment for us. oh, there is a bug, which could potentially explain prematurity.

3:48Jahan 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. Our results, they give us a signal of understanding. They are by no means at a stage where we can translate it into policy. 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 Prevotellacopri to prevent early birth, but he says potentially pregnant women can be screened for Prevotellacopri.

4:30If 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. Jahan of Arakhan University says there's no silver bullet to resolve premature births. Honestly speaking, I mean, if you ask me, improve education and water and sanitation and half the problems will just disappear. But donors are reluctant to undertake expensive work like sanitation, especially around areas like Rehrigat, where the local government is perceived as corrupt. Back in Rehrigat, 17-year-old Mariam is fighting the odds to keep her baby alive.

5:08Five-month-old Ladu fusses in a hammock made from an old scarf. He was born at around seven months' gestation. She says there was no money to keep him in hospital. Maryam says her baby is always sick. His grandmother shows us baby Ladur's bloated stomach. They don't know why it's like that.

5:32There's scars on his back from blisters that formed in the extreme summer heat. She shows us Ladur's little bag of medicine, but says, we can't read or write, so we aren't sure what to do.

5:48Baby Laddu is exposed to even more danger by another common hazard here, health workers dispensing ill-considered advice. Mariam says a doctor told her to stop breastfeeding her son, saying it was making him sick.

6:05She was told to give him formula. even though the water here is unsanitary and dangerous for babies. And Maryam can't afford formula.

6:17So she mixes polluted water with cereal powder she can barely afford, a practice health experts call wildly dangerous for a baby this young. Ladu'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. Dear Hadid, NPR News, Rahri Ghat.

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