By JOSIE HUANG

MaineToday Media, Inc.

The contractions, so tiny that they were imperceptible, showed up on an ultrasound just five months into Wendy Napolitano's pregnancy with triplets.

The Portland woman was going into premature labor, and her babies faced a high risk of death or lifelong health problems. But she got treatment immediately and was prescribed intravenous drugs and bed rest, which extended her pregnancy by about 10 weeks, vastly improving her babies' chances of survival.

"It's important that women are seen and continuously get follow-ups," Napolitano said on Tuesday.

With the rate of premature births in Maine rising faster than the national average, Napolitano is among those who are trying to spotlight the important role of prenatal care. The idea is that recognizing risk factors and symptoms will help expectant mothers make it past Week 37 -- the cut-off age for preemies -- and get as close as possible to their due date, typically Week 40.

Nearly 1,500 babies were born prematurely in Maine -- about 10.6 percent of all live births -- according to 2004 data, the most recent available from the March of Dimes. That's below the national average of 12.5 percent.

But health advocates point out that Maine's rate grew 20 percent from 1994 to 2004, compared with 14 percent nationwide.

"This is a big public health issue," said Sharon Schulberger, director of program services for the Maine chapter of the March of Dimes in Falmouth. "These children may be sick for the rest of their lives."

With less time for their organs to develop in the womb, children who are born prematurely are at greater risk for neurological problems, breathing difficulty and digestive complications. As they get older, Schulberger said, many of them will suffer chronic conditions such as cerebral palsy, mental retardation and blindness.

Premature births affect more than families, Schulberger said. Employers lose out when parents have to take days off to care for preemies. Tax money goes toward caring for the children through the state Medicaid and special education programs.

"This really affects everybody in the long run," Schulberger said.

Experts say the precise reason for Maine's increase in premature births is not known, though it may include factors cited nationally, such as the growing prevalence of fertility treatments, which often result in risky, multiple births.

There is also a rising demand for earlier deliveries through Caesarean sections and induced labor, according to the National Center for Health Statistics.

Some health experts have cited growing diversity -- premature births are most prevalent among blacks and Asians in Maine, according to the March of Dimes -- though others say the slight increase in minorities in the state is not enough to explain the rising preemie rate.

Each week, about 50 premature babies are born in Maine, the March of Dimes estimates. To accommodate the growing number, the Barbara Bush Children's Hospital at Maine Medical Center in Portland plans to expand its neonatal unit from 36 beds to 50 by next year, said Dr. Peter Marro, a neonatologist.

About half of all premature births involve risk factors such as age, smoking, weight, diabetes, high blood pressure and stress. A history of premature births in a family also is a predictor.

In the other half of cases, mothers do not have any risk factors, Marro said, underscoring how critical it is for all pregnant women to talk to their doctors about pre-term labor.

Signs may include contractions every 10 minutes or more often, and pelvic pressure.

"We can't prevent all preterm deliveries, but oftentimes, the signs can be picked up early enough that it can be prevented and controlled," Marro said.

To mark Prematurity Awareness Day, the March of Dimes distributed more than 1,800 preemie diapers to employees at hospitals and businesses around Maine.

Napolitano, who works in the finance department at Mercy Hospital in Portland, wore a 3-inch-by-4-inch diaper on her shirt as she told her story, sometimes tearfully, at a news conference held by the March of Dimes at Maine Med Tuesday.

Napolitano, 38, got pregnant through in vitro fertilization. After the contractions began in her 21st week of pregnancy, she was ordered to stay in bed. After 77 days of bed rest at Maine Med, she gave birth to her three girls on Dec. 21.

Nearly eleven months later, Isabella, Julia and Hannah are healthy and coming up on their first Thanksgiving.

"They truly are miracles," Napolitano said. "We are very blessed."