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