Preterm birth: A clinical enigma and a worldwide public health concern

Abstract

Delivery before 37 weeks of gestation is a major worldwide public health concern, occurring in 10% of all births globally. This problem exists both in low-and middle-income countries (LMIC) and in high-income countries. In a 2012 report by WHO, March of Dimes, Save the Children, and The Partnership for Maternal, Newborn and Child Health-'Born Too Soon'-it was stated that in 2010, 15 million babies were born preterm, namely before 37 weeks of gestation. 1 Over 1 million of these preterm babies died. Surviving infants had an increased risk of learning disabilities, as well as visual and auditory problems. The magnitude of the problems is inversely related to gestational age at birth. For example, a linear decline in the need for special education can be shown for births from gestational week 24 to week 41. 2 At the time of the 'Born Too Soon' report, 1 only a few interventions were generally accepted: elimination of early elective deliveries; progesterone or progestational agents if a prior preterm birth had occurred; single embryo transfer in Assisted Reproductive Technologies (ART); cerclage for cervical insufficiency; cessation of smoking. If all of these guidelines were followed, however, the reduction in preterm birth was only a modest 9.6%-9.1%. 3As a result of these realities, the FIGO Working Group on Preterm Birth was initiated in 2014, a collaborative agreement between FIGO and the March of Dimes, both Non-State Actors (NSA) in official relations with WHO. Terms of reference included identification of risk factors, strategies to communicate clinical significance, and preparation of enduring educational material for use by member societies and for presentation at international FIGO meetings and elsewhere. These included FIGO World Congresses in Vancouver in 2015 and in Rio de Janeiro in 2018. Site-specific workshops and presentations were held elsewhere, in particular South America (Costa Rica, Uruguay). The success of these and other ventures have resulted in extension of the activities of Working Group. In 2016 the Working Group completed an exhaustive individual patient data meta-analysis encompassing 4.1 million births in California and four countries (Czech Republic, Sweden, New Zealand, Slovenia). 4 Of preterm birth pregnancies, 2/3 lacked a known biological basis. As result, attention expanded to elucidate the biological basis (etiology) of preterm birth. Enthusiasm for exploring the potential beneficial treatment with vaginal progesterone and 17-alpha OH progesterone caproate continued. Perturbations of the vaginal microbiome as a predisposing factor in preterm birth are perhaps one explanation for the markedly higher risk in African-Americans. Heritable factors have long been known to exist, and in 2017 a genomewide association study of 43 568 women discovered six genes of significance. 5 Work continues in other related fields-regulatory genes, glycobiology, maternal stress, sleep disturbance, and anatomic changes in the cervix and vagina. In this special section of IJGO, Preterm Birth Working Gro...

IJGO: Continuing to advance women’s health research and practice globally

“…One of IJGO’s key aims is to help achieve improvements in the reproductive health status of women globally, and as part of this agenda we aim to disseminate as widely as possible key guidance and successful initiatives from FIGO’s expert committees and working groups. Among recent notable publications are the FIGO Initiative on Pre‐eclampsia guidance 10 ; a supplement on the important work carried out by our Fistula project, 11 and a special section from FIGO’s Preterm Birth Working Group 12 . Over the next 6 months we look forward to expert guidance papers from our Safe Motherhood and Newborn Health Committee, and FIGO’s Pregnancy Obesity and Nutrition Initiative.…”

Factors Influencing the Implementation of Infant Warming Devices Among Healthcare Workers in Malawian Hospitals

“…Globally, preterm births (<37 weeks) occur in 11% of all newborns and are the leading cause of death in children under the age of 5. 1 - 3 Approximately 1 million children die around the world each year due to prematurity complications, with a disproportionate burden in low- and middle-income countries (LMICs). 3 , 4 The rate of preterm births in Malawi has remained alarmingly high, up to 19.3%.…”

“… 1 - 3 Approximately 1 million children die around the world each year due to prematurity complications, with a disproportionate burden in low- and middle-income countries (LMICs). 3 , 4 The rate of preterm births in Malawi has remained alarmingly high, up to 19.3%. 5 Respiratory distress and neonatal sepsis are leading causes of death among preterm infants, though hypothermia is often a neglected contributory cause.…”

The role of vaginal progesterone for preterm birth prevention in women with threatened labor and shortened cervix diagnosed after 24 weeks of pregnancy

“…Therefore, predicting and preventing preterm birth is a major healthcare priority. 1,5,6 Irregular contractions, lower backache, vaginal discharge, or bleeding are indicators of threatened preterm labor that may or may not lead to preterm birth. In addition, threatened preterm labor may appear with or without cervical changes, and a sonographic short cervix is the most powerful method for predicting preterm birth.…”

“…Moreover, preterm birth is a major cause of long‐term morbidity in adult life. Therefore, predicting and preventing preterm birth is a major healthcare priority 1,5,6 . Irregular contractions, lower backache, vaginal discharge, or bleeding are indicators of threatened preterm labor that may or may not lead to preterm birth.…”