Born Too Soon: The global epidemiology of 15 million preterm births

Abstract

This second paper in the Born Too Soon supplement presents a review of the epidemiology of preterm birth, and its burden globally, including priorities for action to improve the data. Worldwide an estimated 11.1% of all livebirths in 2010 were born preterm (14.9 million babies born before 37 weeks of gestation), with preterm birth rates increasing in most countries with reliable trend data. Direct complications of preterm birth account for one million deaths each year, and preterm birth is a risk factor in over 50% of all neonatal deaths. In addition, preterm birth can result in a range of long-term complications in survivors, with the frequency and severity of adverse outcomes rising with decreasing gestational age and decreasing quality of care. The economic costs of preterm birth are large in terms of immediate neonatal intensive care, ongoing long-term complex health needs, as well as lost economic productivity. Preterm birth is a syndrome with a variety of causes and underlying factors usually divided into spontaneous and provider-initiated preterm births. Consistent recording of all pregnancy outcomes, including stillbirths, and standard application of preterm definitions is important in all settings to advance both the understanding and the monitoring of trends. Context specific innovative solutions to prevent preterm birth and hence reduce preterm birth rates all around the world are urgently needed. Strengthened data systems are required to adequately track trends in preterm birth rates and program effectiveness. These efforts must be coupled with action now to implement improved antenatal, obstetric and newborn care to increase survival and reduce disability amongst those born too soon.DeclarationThis article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.

Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

“…The finding of higher odds of ventilation of LBW infants supports the previous finding of a reduced rate of intrapartum stillbirths after training in HBB, as almost half of those stillbirths were LBW infants [8]. The data for gestational age in this study were not complete, but the cases with available information on gestational age confirmed the global estimates of the relatively high proportion of moderately premature infants [25,26]. This study focused on evaluating differences in steps of neonatal resuscitation between LBW and NBW infants; therefore it is difficult to compare with previous observational studies of HBB interventions.…”

Temporal and spatial variation of the human microbiota during pregnancy

“…Normal pregnancy represents a unique, transient, and dynamic state of altered anatomy, physiology, and immune function. Preterm birth, i.e., before 37 wk of gestation, occurs in 11% of pregnancies and is the leading cause of neonatal death (4). In both term and preterm pregnancies, the interplay between the microbiota and the host remains poorly understood.…”

Sterile inflammation and pregnancy complications: a review

“…Evidence shows that impaired inflammatory response is implicated in numerous female reproductive tract pathologies including menstrual disorders (Sales & Jabbour 2003), endometriosis-associated infertility (Gupta et al 2008), recurrent miscarriage (von Wolff et al 2000, Laird et al 2003, intrauterine growth restriction (Heyborne et al 1994), preeclampsia , Rinehart et al 1999) and preterm labor (Romero et al 2006. Infertility has an estimated global prevalence of 9% with >72 million infertile women worldwide (Boivin et al 2007), whereas preterm birth and preeclampsia, the two leading causes of perinatal mortality and morbidity, have an estimated prevalence of >11% (Blencowe et al 2013) and 3-5% (Ananth et al 2013 respectively. Therefore, understanding the mechanisms by which inflammation is untimely triggered in the uterus is fundamental to developing effective therapeutics to improve fertility and decrease poor obstetrical outcomes.…”