Family Matters

World Prematurity Day: 5 Ways to Reduce Preterm Births

To mark the second annual World Prematurity Day, there is both encouraging and discouraging news about premature birth trends.

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To mark the second annual World Prematurity Day, there is both encouraging and discouraging news about premature birth trends.

The good news: a new study in the Lancet finds that five interventions, including the elimination of medically unnecessary C-sections and discouraging pregnant women from smoking, can reduce preterm birth rates by 58,000 births. The bad news: even if the 39 higher-income countries in the study were to vigorously incorporate those interventions, they would result in just a 5% relative decrease in premature births by 2015.

Each year, 15 million babies arrive too soon — before 37 weeks of pregnancy — but experts are still largely in the dark about why this is happening.
“Preterm birth is still a big black box,” says Chris Howson, vice president for global programs at the March of Dimes and a study author. “We don’t know the cause of 50% of all preterm births, and we still don’t fully understand the causes and mechanisms behind the other half.”

What is obvious is that the following five interventions can reduce the preterm birth rate from about 9.6% of live births to 9.1% and save $3 billion in the process:

  1. Discouraging elective C-sections and labor inductions unless there’s a compelling medical reason
  2. Reducing the number of embryos transferred during fertility treatment
  3. Helping pregnant women give up smoking
  4. Providing women with high-risk pregnancies with progesterone supplementation
  5. Performing cervical cerclage, a minor surgical procedure, on pregnant women with short cervixes

(MOREStudy: Children Born Too Early Have Lower Reading and Math Scores)

The benefit in lowering preterm births would be greater in countries that have higher rates and lower in those that have fewer preterm births. In the U.S., it means that the rate of preterm births could drop by 8% while it would decrease by just 2% in the United Kingdom.

The five recommended actions detailed in the Lancet emerged from a comprehensive report on prematurity called Born Too Soon released in May by the Partnership for Maternal, Newborn and Child Health, a 50-organization international coalition on child health. That report called for developing specific solutions to limit preterm births. Because data was inconsistent in low-resource countries, the Lancet study focused on 39 higher-income nations, concluding that preterm rates among them could fall by 5%.

“You can say it’s just a 5% reduction, but if I was one of the parents who averted a preterm birth, I’d say, ‘Go for it,’” says Howson, who says the next step is for more researchers to prioritize preterm birth as worthy of study. “We need to know more about the causes and mechanisms of preterm birth. Research needs to be funded, and it needs to be vigorous and coordinated.”

An article in the American Journal of Obstetrics and Gynecology addressed that deficit and identified a lack of consensus when it comes to studying and developing potential solutions to preterm birth. Combined with stillbirths, prematurity claims the lives of about 4 million babies each year and is the leading cause of death in the newborn period.

“This is not just happening in the developing world,” says Dr. Craig Rubens, executive director of the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s Hospital, and a study author. “It’s also a huge problem in the developed world. The U.S. has one of the highest rates of prematurity in the world. Getting people and funders and policymakers to understand that is a huge burden.”

The U.S. alone has half a million preterm babies each year, and in its annual “premature birth report card,” the March of Dimes gave the U.S. a “C” for its efforts in reducing prematurity. Although preterm rates have decreased for five years in a row — to 11.7% in 2011 — the March of Dimes says progress hasn’t been substantial enough toward the ultimate goal of 9.6%.

What can be done? Options include stressing to the public and to researchers that being born prematurely, depending on how early, can have long-lasting effects on health well into adulthood. To better understand biological factors that contribute to premature births, “bio-banks” containing tissue and other biological samples from pregnant women and their preterm babies are also needed; GAPPS created one in Seattle, where it is headquartered.

Understanding the cost — both economically and psychologically — of too many preterm births may also help in directing more resources toward finding better solutions. “We need scientists, government and funding organizations to say, ‘Here is a big problem research-wise,’” says Rubens. “We need a more coordinated approach.” In the meantime, experts hope that the encouraging trends in lowering preterm birth rates around the world continue.

MOREThe Cost of Premature Birth: For One Family, More than $2 Million

3 comments
cualquier8
cualquier8

@DrDanSindelar You call yourself a Doctor? How about a little intellectual curiosity rather than shameless self interest and the perpetuation of myths. There is ZERO relevant evidence to support your argument. The links are there for anyone to read for themselves. "Doctor" dan sindelar should perhaps re-acquaint himself also.From the BMJ study:CLINICAL IMPLICATIONS:Pooled results from the highest-quality RCTs do not support the hypothesis of a reduction of PTB (preterm birth) or LBW (low birth weight) in women who are treated for periodontal disease during pregnancy.From the J Am Dent Assoc study:CONCLUSION:Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.Polyzos NP, Polyzos IP, Zavos A, et al. Obstetric outcomes after treatment of periodontal disease during pregnancy: Systematic review and meta-analysis. BMJ, 2010;341:c7017.Uppal A, Uppal S, Pinto A, et al. The effectiveness of periodontal disease treatment during pregnancy in reducing the risk of experiencing preterm birth and low birth weight. A meta-analysis. J Am Dent Assoc 2010;141:1423-34.

DrDanSindelar
DrDanSindelar

@cualquier8 The research you cite discusses periodontal treatment after the woman becomes pregnant. There is likewise research that going into pregnancy with good oral health improves pregnancy outcomes. The idea is to approach all aspects of healthcare from a prevention viewpoint instead of waiting for people to get sick. 

DrDanSindelar
DrDanSindelar

Most people don't know that the oral health of a pregnant mother can have an affect on her unborn child. In fact, studies have shown that if an expectant mother has gum disease, she only has a 1 in 7 chance of having a full-term baby of normal weight. Considering that at least 50% of the U.S. population has periodontal disease and nearly 80% have some form of gum disease, this may very well be a contributing factor to the high numbers of pre-term births. Oral pathogens (bad bacteria) that cause the gums to bleed and become inflamed can and do travel throughout the body, and in the case of a pregnant woman, can even cross the placental barrier and infect the child. Just a couple years ago, there was a case documented in which a specific oral bacteria (Fusobacterium nucleatum, if you were wondering) caused the stillbirth of a child. And the scary thing is, research is showing that gum therapy during pregnancy doesn't affect the outcome. You've got to get yourself to a healthy mouth before you become pregnant and see your dentist regularly if you develop pregnancy-associated gingivitis (a common problem due to hormones).