New scientific review reveals huge gaps in understanding preterm birth

November 12, 2014, Seattle Children's Research Institute

Preterm birth is now the leading cause of death for children under 5 worldwide, and a new scientific paper reveals a startling lack of knowledge about what causes it and how to prevent it.

Published in the November issue of Science Translational Medicine, "Prevention of Preterm Birth: Harnessing Science to Address the Global Epidemic" shines a light on the urgent need for a larger, coordinated research effort to discover how to identify women at risk of preterm birth and develop prevention interventions.

"There are not enough resources dedicated to researching the complex problem of preterm birth and its prevention," said lead author Craig Rubens, MD, PhD, executive director of the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children's. "This paper is a clarion call to the scientific community, that investing in preterm birth research will pay dividends with millions of lives saved and also save billions of dollars in healthcare expenses associated with preterm birth."

The paper provides an analysis of nine pathways that can contribute to preterm birth, including genetics, psychological and environmental stress, and infection and inflammation. It notes that approximately 70 percent of preterm births are spontaneous, and there are few known interventions that can delay labor once it has begun.

"It's easy to look at preterm birth and view it as a single endpoint," Rubens said. "In reality, preterm birth can have many causes and pathways. Although the end result is the same, we need to understand the different pathways so we can develop ways to prevent them."

The authors note that there are many factors that increase a woman's likelihood of a preterm birth - such as periodontal disease, poor pregnancy weight gain, and cigarette use - but there is not much understanding of why different factors increase risk. For example, in the United States, babies of non-Hispanic black women have preterm birth rates that are 40 percent greater than those of Hispanic and non-Hispanic white women, and this difference persists even after adjustment for maternal socioeconomic status and education. Unfortunately, even less is understood about the risk factors, disparities, and causes of preterm birth in high-burden, low-resource countries.

There is a need for more research "to better understand the biology of pregnancy and how [different] risk factors contribute to preterm birth in order to develop effective strategies for early detection and prevention," the authors write.

The paper distills the state of preterm birth research into a central analysis, while conveying the tremendous burden of preterm birth and the urgent need for more research to understand its causes. The authors point out some major challenges, including the fact that pregnancy research involves studying two individuals - the mother and the fetus - at the same time, as well as the influence of the genetics of the father. They also pose a number of questions that can help lay the foundation for what future research should seek to address and how research can be translated into practical interventions. Additionally, the paper identifies barriers to pregnancy research, including the perception of risk and liability, which deters scientists and pharmaceutical companies from testing diagnostics and therapeutics during pregnancy.

The authors note, "The gaps in knowledge about the basic biology of both term and preterm pregnancy, including what constitutes normal gestational length in any given population, leave clinicians with few tools to prevent [preterm birth]. This is the fundamental reason that most prematurity intervention efforts are actually aimed at care of the woman in and care of the preterm neonate, rather than prolonging gestation or stopping labor."

Every year, more than 15 million babies are born too soon around the world, and more than one million of them don't survive infancy. Even in high-income countries with advanced medical technology, preterm birth remains the leading cause of infant mortality. In the U.S., 1 in 9 babies is born too soon, and studies have found that costs society more than $26 billion a year in the U.S. alone.

Explore further: Cervical component protects against infection and preterm birth in mice

More information: Sci Transl Med 12 November 2014: Vol. 6, Issue 262, p. 262sr5 Sci. Transl. Med. DOI: 10.1126/scitranslmed.3009871

Related Stories

Cervical component protects against infection and preterm birth in mice

November 11, 2014
Preterm birth is the leading cause of newborn deaths worldwide. Maternal infection is one known cause of preterm birth; however, preventative antibiotic treatment has not lowered preterm birth rates. The cervix provides structural ...

March of Dimes calls for 50 percent reduction in preterm births by 2030

November 3, 2014
The March of Dimes is calling for a nationwide effort to reduce U.S. preterm births to 5.5 percent of all live births by 2030. Seven other developed countries already have preterm birth rates below 6 percent, and 15 have ...

PTSD, major depressive episode appears to increase risk of preterm birth

June 11, 2014
Diagnoses of both posttraumatic stress disorder (PTSD) and a major depressive episode appear to be associated with a sizable increase in risk for preterm birth that seems to be independent of antidepressant and benzodiazepine ...

Halving the risk of preterm birth for some twin pregnancies

September 10, 2014
International research involving the University of Adelaide has found that the risk of preterm birth could be halved for a specific group of "super high-risk" twin pregnancies.

Study finds residence in US a risk factor for preterm birth

February 9, 2012
In a study to be presented today at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, in Dallas, Texas, researchers will report findings that indicate that duration of stay in the United States ...

Understanding the mystery of preterm birth

November 12, 2013
Researchers at the University of Adelaide's Robinson Institute say there is still a lack of knowledge about the causes of preterm birth and what can be done to prevent it.

Recommended for you

Weight flux alters molecular profile, study finds

January 17, 2018
The human body undergoes dramatic changes during even short periods of weight gain and loss, according to a study led by researchers at the Stanford University School of Medicine.

Secrets of longevity protein revealed in new study

January 17, 2018
Named after the Greek goddess who spun the thread of life, Klotho proteins play an important role in the regulation of longevity and metabolism. In a recent Yale-led study, researchers revealed the three-dimensional structure ...

The HLF gene protects blood stem cells by maintaining them in a resting state

January 17, 2018
The HLF gene is necessary for maintaining blood stem cells in a resting state, which is crucial for ensuring normal blood production. This has been shown by a new research study from Lund University in Sweden published in ...

Magnetically applied MicroRNAs could one day help relieve constipation

January 17, 2018
Constipation is an underestimated and debilitating medical issue related to the opioid epidemic. As a growing concern, researchers look to new tools to help patients with this side effect of opioid use and aging.

Researchers devise decoy molecule to block pain where it starts

January 16, 2018
For anyone who has accidentally injured themselves, Dr. Zachary Campbell not only sympathizes, he's developing new ways to blunt pain.

Scientists unleash power of genetic data to identify disease risk

January 16, 2018
Massive banks of genetic information are being harnessed to shed new light on modifiable health risks that underlie common diseases.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.