Preterm Birth: Causes, Consequences, and Prevention

Excerpt

In 2004, 12.5 percent of births in the United States were preterm; that is, born at less than 37 completed weeks of gestation. This rate has increased steadily in the past decade. There are significant, persistent, and very troubling racial, ethnic, and socioeconomic disparities in the rates of preterm birth. The highest rates are for non-Hispanic African Americans, and the lowest are for Asians or Pacific Islanders. In 2003, the rate for African-American women was 17.8 percent, whereas the rates were 10.5 percent for Asian and Pacific Islander women and 11.5 percent for white women. The most notable increases from 2001 to 2003 were for white non-Hispanic, American Indian, and Hispanic groups.

Infants born preterm are at greater risk than infants born at term for mortality and a variety of health and developmental problems. Complications include acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-term motor, cognitive, visual, hearing, behavioral, social-emotional, health, and growth problems. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. The annual societal economic burden associated with preterm birth in the United States was at least $26.2 billion in 2005. The greatest risk of mortality and morbidity is for those infants born at the earliest gestational ages. However, those infants born nearer to term represent the greatest number of infants born preterm and also experience more complications than infants born at term.

Preterm birth is a complex cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, neighborhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors, and genetics. Many of these factors occur in combination, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups.

The current methods for the diagnosis and treatment of preterm labor are currently based on an inadequate literature, and little is know about how preterm birth can be prevented. Treatment has been focused on inhibiting contractions. This has not reduced the incidence of preterm birth but has delayed delivery long enough to allow the administration of antenatal steroids and transfer of the mother and fetus to a hospital where they may receive appropriate care. These interventions have reduced the rates of perinatal mortality and morbidity. Although improvements in perinatal and neonatal care have significantly improved the rates of survival for infants born preterm, these infants remain at risk for a host of acute and chronic health problems. Therapies and interventions for the prediction and the prevention of preterm birth are thus needed.

Upon review of the literature assessing the causes and consequences of preterm birth, the diagnosis and treatment of women at risk for preterm labor, and treatments for infants born preterm, the committee proposes a research agenda for investigating the problem of preterm birth that is intended to help focus and direct research efforts. Priority areas are: (1) the establishment of multidisciplinary research centers; (2) improved research in three areas including better definition of the problem of preterm birth with improved data, clinical and health services research investigations, and etiologic and epidemiologic investigations; and (3) the study and informing of public policy. The committee hopes that its efforts will help provide a framework for working toward improved outcomes for children born preterm and their families.

Copyright © 2007, National Academy of Sciences.