Pediatricians have long been combating the negative consequences of prematurity with ever-increasing sophistication of clinical care. As a result, a vast majority of premature infants have survived and complications of their early birth have been reduced substantially. These successes have not been matched by successes in the efforts to prevent preterm labor and to ensure that pregnancies at risk are carried to satisfactory full-term conclusions. Even worse, since the 1970s, the rate of preterm birth in the United States and in other countries where records are available actually has shown a steady increase, except perhaps in the last 4 years. Moreover, this increase in rate involved most social strata and all ethnic groups. Regardless of the absolute rate, all countries have experienced a continuous linear increase. The United States now ranks 131st of 184 countries worldwide in its rates of preterm birth.1
The disproportionality between the successes in the clinical care of premature infants and the failures of prevention has not been simple to explain. There has been an increase in risk factors (often dramatic) such as advanced maternal age, diabetes,2 and obesity, as well as in the use of assisted reproductive technology, which has led to preterm deliveries and to lower birth weights.3 Moreover non–medically indicated inductions of labor and cesarean sections have become more common, although their rates have not yet been estimated with precision.
Until about a decade ago, this problem was considered so intractable that it was accepted as unavoidable and major efforts and funding were concentrated on care of the premature infants. In 2003, the March of Dimes, along with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Association of Women’s Health, Obstetric and Neonatal Nurses, initiated a strong push to prevent this problem. These efforts were followed by an Institute of Medicine report “Preterm Birth Causes, Consequences, and Prevention” in 2007 and a Surgeon General’s Conference on Prematurity in 2008. The March of Dimes then decided that the time had come to discover the causes of preterm births. Several research symposia were convened of scientific experts from wide-ranging fields to suggest a course of investigative actions. The time is ripe for a systematic identification of possible biological causes of preterm birth fueled by new investments, new models of research, and heightened collaboration.
Meanwhile, the iatrogenic causes of preterm births, especially those late in pregnancy (34–37 weeks), can be addressed. In January 2012, the March of Dimes organized a national conference in Washington, DC, that brought together national, state, and community constituencies concerned with preterm birth. The gathering encompassed basic scientists, clinical investigators, epidemiologists, medical and nursing clinicians, and social workers. There was an encouraging atmosphere and a remarkable enthusiasm for implementing known solutions. One major intervention that clearly emerged from these deliberations was that if non–medically indicated elective inductions or cesarean sections before 39 weeks of completed gestation were stopped, this could lead to some reduction in late preterm births.
Based on this conclusion, in March 2012, the Association of State and Territorial Health Officials encouraged their health officers to reduce preterm birth in their respective states by 8% within 2 years. To date, 46 state health officers have signed a pledge to work toward this laudable goal. We are confident that through this heightened collaboration, and the encouragement to accelerate discovery research, we will move significantly closer to conquering prematurity.
- Accepted October 2, 2012.
- Address correspondence to Michael Katz, MD, 1275 Mamaroneck Ave, White Plains, NY 10605. E-mail:
Jennifer Howse and Michael Katz contributed equally to the writing of this commentary.
Jennifer L. Howse is president and Michael Katz is senior advisor for transdisciplinary research of the March of Dimes Foundation, White Plains, New York.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
- ↵March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. CP Howson, MV Kinney, JE Lawn, eds. World Health Organization, Geneva, 2012
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- Copyright © 2013 by the American Academy of Pediatrics