ZAPORIZHZHIA, Ukraine (AP) — When Marharyta Nekhoroshyva first saw her newborn son, she was gripped by fear. Born after just 26 weeks of pregnancy, he weighed only 940 grams (2 pounds) and wore diapers no larger than the palm of an adult hand.
“The doctors told me that if he survived the first three days, everything would be OK,” she said, tears filling her eyes. “I don’t believe in God, but I was praying.”
Now 9 months old, Mark is energetic and lively,
but he has chronic breathing problems and requires frequent hospital stays.
Nekhoroshyva must navigate her son’s illness while living under the constant threat of attack in the Ukrainian city of Zaporizhzhia, where hospitals board up their windows because blast waves from Russian strikes routinely shatter glass. She is doing it alone while her husband fights in the war.
A rising number of babies are being born prematurely — before 37 weeks of pregnancy — in Ukraine, particularly in regions near the front lines, where some areas have seen rates nearly double since the conflict started with Russia's invasion in 2022.
Experts say the reasons for premature births are complex, but the profound psychological and physical stress the war is inflicting on pregnant mothers is contributing. The delicate work of keeping the fragile newborns alive is made only more difficult by the conflict.
When their babies are at the main children's hospital in Zaporizhzhia, Nekhoroshyva and other mothers descend with their children into the shelter each night. In the narrow, dimly lit hallways, they rock and soothe their infants to sleep.
While fewer women in Ukraine are giving birth overall due to displacement, emigration and other factors during the war, a growing share of births are premature, according to data from the United Nations and recent scientific studies.
In the southern region of Kherson, the preterm birth rate nearly doubled from 5.4% in 2019 to 9.8% in 2025, according to the U.N. In the Zaporizhzhia region, also in the south, it rose from 5.7% in 2019 to 7.6% in 2025. In Poltava, a region in northeastern Ukraine, the rate rose from 7.7% to 9.8% over the same period.
The front line cuts through both the Kherson and Zaporizhzhia regions, which frequently see attacks on residential areas. Poltava is some distance away from the front but is frequently hit by aerial strikes.
The link between maternal stress and premature birth is complex, but a growing body of research suggests that prolonged psychological strain increases the risk of babies being born early, experts say. It may be tied to an increased risk of infection, a known trigger for preterm labor, said Dr. Andrew Weeks, a professor of international maternal healthcare at the University of Liverpool.
“Premature birth is very affected by infection,” he said. “And if you can’t get to a place where you can get appropriate diagnosis and treatment early, then actually the chance of you going into premature labor is higher.”
It’s not just premature births that are rising in Ukraine; emergency cesarean sections and other complications are, too, said Isaac Hurskin, spokesperson for the U.N. Population Fund.
“We’re seeing this real link between acute stress and birthing and pregnancy-related complications,” he said.
Those complications could compound a demographic crisis. Ukraine’s fertility rate has fallen to among the lowest in the world, dropping to roughly one child per woman over the past three years — far below the 2.1 replacement rate, Hurskin said.
Inside an incubator in the intensive care unit at the maternity hospital in the city of Zaporizhzhia lies a baby born at 30 weeks and weighing only 700 grams (1 pound, 9 ounces) — well below the threshold of 2,500 grams (5 pounds, 8 ounces) that the World Health Organization classifies as low birth weight.
Her tiny body is kept alive inside the temperature-controlled incubator. IV lines deliver nutrients and medication, while a ventilator helps her breathe. The incubator is draped with a blanket to protect her fragile, developing eyes from the harsh fluorescent lights of the ward.
Treatment focuses on helping premature babies gain weight and eventually breathe on their own, but complications can be extensive, said Dr. Andrii Lobanov, head of the neonatal intensive care at Zaporizhzhia's children's hospital. Oxygen levels, for instance, must be managed precisely because of the risk of abnormal blood vessel growth in the eyes, leading to blindness in severe cases.
Even after they leave intensive care, children born prematurely often require long-term care — possibly for life — for respiratory, neurological, developmental or immune-related conditions.
That is a burden on cash-strapped countries like Ukraine.
“It is very expensive and of course a country in a war situation has to decide what it’s going to spend on, so hospital services invariably get hit. Both literally and metaphorically,” Weeks said.
Air raid sirens have become part of daily life inside neonatal intensive care units. When they sound, doctors stay beside the babies rather than rushing them to shelters, knowing that moving the fragile newborns could be even more dangerous. The sirens go off too frequently to stop work each time anyway.
Dr. Nataliia Bohuslavska, head of the neonatal unit at the maternity hospital in Zaporizhzhia, began one day last month with air raid alerts warning of incoming missile attacks. By the afternoon, a Russian glide bomb had struck a commercial area of the city, killing at least 12 people.
Care continued all along: Doctors performed two cesarean sections and delivered a baby while also treating a 42-year-old woman who miscarried after witnessing an airstrike.
The next day, a black flag fluttered by the hospital entrance to mourn those killed.
Bohuslavska knows every mother on her ward by first name — their complicated cases, their fears, and their tiny babies fighting for survival. Bohuslavska has worked at the hospital for 26 years and was born there herself.
The war compounds the difficulties experienced by every pregnant woman she cares for, she said.
“She wonders what kind of world her child will be born into, under what conditions the birth will happen, and whether it will be a moment of joy or one gripped by fear with shells exploding nearby,” she said.
Many mothers endure the ordeal alone while their husbands are fighting.
“When a patient calls to say her husband has been killed in the war, the only thing I can tell her is: ‘Come to us. We will take care of you,’” Bohuslavska said.
“We have to support her constantly, so that even in the midst of this terrible loss, she can find the strength to give new life a chance and save her baby.”
For Mariia Skladan, it was finally time to go home.
Her daughter, Elina, was born in January at just 26 weeks, weighing 740 grams (1 pound, 10 ounces). Five months later, after growing to a healthy 3 1/2 kilograms (nearly 8 pounds), doctors said she was strong enough to be discharged.
Skladan has a rare liver disease that doctors warned would make it nearly impossible for her to conceive. Her pregnancy was considered a miracle, Bohuslavska said.
“If there’s a war, what does it mean? Not to live?” Skladan asked. "You want to keep going."
When she and Elina emerged from the maternity hospital, her family was waiting with flowers. Skladan broke down in tears of joy.
But the relief was short-lived.
The very next day, Elina was back in intensive care after contracting a virus overnight.
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Associated Press journalist Volodymyr Yurchuk contributed from Kyiv, Ukraine.
