ZAPORIZHZHIA, Ukraine (AP) — When Marharyta Nekhoroshyva first looked at her newborn son, fear overwhelmed her. He had arrived at just 26 weeks of pregnancy, weighing a mere 940 grams (2 pounds), and his diapers were no bigger than an adult’s palm.

“The doctors told me that if he could make it through the first three days, he would be all right,” she recalled, her eyes filling with tears. “I don’t believe in God, but I found myself praying.”

Now 9 months old, Mark is spirited and active, yet he suffers from chronic respiratory problems that require regular hospital treatment.

Nekhoroshyva cares for her fragile son while living under the persistent threat of attacks in the southern Ukrainian city of Zaporizhzhia. Hospital windows are reinforced because shockwaves from Russian strikes often shatter glass. She faces this challenge alone as her husband serves on the front lines.

An increasing number of babies in Ukraine are being born prematurely — before 37 weeks of pregnancy — particularly in regions close to active fighting. In some of these areas, the rate of preterm births has nearly doubled since Russia’s full-scale invasion in 2022.

Specialists say premature birth has multiple causes, but the intense psychological and physical strain placed on expectant mothers during wartime is a significant factor. At the same time, the conflict complicates the already delicate task of caring for extremely vulnerable newborns.

Each evening, when their babies are treated at Zaporizhzhia’s main children’s hospital, Nekhoroshyva and other mothers carry them down into the shelter. In dim, narrow corridors, they gently rock their infants, trying to soothe them to sleep amid uncertainty.

Ukraine is seeing a rise in premature births

Although Ukraine’s overall birth rate has declined due to displacement, emigration and other consequences of the war, the proportion of premature births is climbing, according to United Nations data and recent studies.

In the southern Kherson region, the rate of preterm births increased from 5.4% in 2019 to 9.8% in 2025. In neighboring Zaporizhzhia, it rose from 5.7% to 7.6% during the same period. In the northeastern region of Poltava, the figure climbed from 7.7% to 9.8%.

The front line runs through parts of Kherson and Zaporizhzhia, where residential neighborhoods are frequently attacked. Poltava lies farther from the battlefield but is often targeted by aerial strikes.

The connection between stress and premature birth is complex. However, growing research suggests that prolonged psychological distress increases the likelihood of early labor. This may be partly due to a heightened risk of infection, a known trigger for preterm birth, explained Dr. Andrew Weeks, a professor specializing in international maternal health at the University of Liverpool.

“Premature birth is strongly influenced by infection,” he said. “If women cannot access timely diagnosis and treatment, the chances of going into early labor increase.”

Beyond premature births, Ukraine is also experiencing more emergency cesarean sections and other pregnancy complications, said Isaac Hurskin, spokesperson for the U.N. Population Fund.

“There is a clear connection between acute stress and complications during pregnancy and childbirth,” he noted.

These trends deepen an already serious demographic crisis. Ukraine’s fertility rate has fallen to about one child per woman in the past three years — far below the replacement level of 2.1, Hurskin said.

Premature babies need extensive care — and that’s difficult during a war

In the intensive care unit of Zaporizhzhia’s maternity hospital, a baby born at 30 weeks and weighing just 700 grams (1 pound, 9 ounces) lies inside an incubator — well under the World Health Organization’s low birth weight threshold of 2,500 grams (5 pounds, 8 ounces).

The infant’s life depends on the temperature-controlled incubator. Intravenous lines supply nutrients and medication, and a ventilator supports her breathing. A blanket covers the incubator to shield her developing eyes from the harsh fluorescent lighting.

The primary goal of treatment is to help premature babies gain weight and eventually breathe independently, said Dr. Andrii Lobanov, head of neonatal intensive care at Zaporizhzhia’s children’s hospital. Managing oxygen levels is particularly delicate, as excessive exposure can cause abnormal blood vessel growth in the eyes, potentially leading to blindness.

Even after leaving intensive care, many children born too early require long-term — sometimes lifelong — treatment for respiratory, neurological, developmental or immune system conditions.

Providing such care is costly, especially for a country strained by war.

“It is extremely expensive, and in wartime governments must make difficult spending choices,” Weeks said. “Hospital services often suffer, both literally and figuratively.”

Mothers must navigate caring for babies during the war and often on their own

Air raid sirens are now a routine backdrop in neonatal intensive care units. When alarms sound, doctors remain beside the incubators instead of rushing the fragile infants to shelters, knowing that moving them could pose greater danger. The alerts are too frequent to halt work each time.

One morning last month, Dr. Nataliia Bohuslavska, who leads the neonatal unit at Zaporizhzhia’s maternity hospital, began her shift amid warnings of incoming missile strikes. Later that day, a Russian glide bomb hit a commercial district, killing at least 12 people.

Despite the attack, the hospital staff continued their work: performing two cesarean sections, delivering a baby and treating a 42-year-old woman who miscarried after witnessing an airstrike.

The following day, a black flag hung at the hospital entrance in mourning.

Bohuslavska knows each mother in her ward by name — their medical histories, their anxieties and the battles their tiny infants face. She has worked at the hospital for 26 years and was born there herself.

The war intensifies every challenge her patients endure, she said.

“Every woman wonders what kind of world her child will enter, under what circumstances she will give birth, and whether that moment will be joyful or overshadowed by explosions nearby,” she said.

Many women go through pregnancy and childbirth alone while their husbands serve in the military.

“When a patient calls to say her husband has been killed in the war, all I can tell her is, ‘Come to us. We will care for you,’” Bohuslavska said.

“We must constantly support her so that, even in deep grief, she can find the strength to protect her baby and give new life a chance.”

One baby goes home

For Mariia Skladan, the long-awaited day to return home finally arrived.

Her daughter, Elina, was born in January at 26 weeks, weighing just 740 grams (1 pound, 10 ounces). After five months and steady growth to 3 1/2 kilograms (nearly 8 pounds), doctors determined she was strong enough to leave the hospital.

Skladan has a rare liver condition, and physicians had warned she might never conceive. Her pregnancy was considered extraordinary, Bohuslavska said.

“If there is a war, does that mean you stop living?” Skladan asked. “You have to move forward.”

When mother and daughter stepped outside the maternity hospital, relatives greeted them with flowers. Skladan wept with relief and happiness.

But the sense of security did not last.

The very next day, Elina returned to intensive care after catching a virus overnight.