Perspectives in the prevention of premature birth

https://doi.org/10.1016/j.ejogrb.2004.07.007Get rights and content

Abstract

Obstetric and neonatal interventions have improved the survival of preterm infants, but there has not been an equivalent reduction in long-term neurological disability. Thus, some effort must be invested in finding ways of preventing preterm birth. Numerous programmes have been promoted to address the matter of how the frequency of preterm birth could be prevented. Most interventions intended to prevent preterm labour do not have the desired effect, except for antibiotic treatment in cases of asymptomatic bacteriuria or bacterial vaginosis and progesterone administered prophylactically in high-risk women. Tocolytic drugs appear to delay delivery long enough for successful administration of corticosteroids in women in preterm labour, but without decreasing the risk of preterm birth. Some authors promote public health approaches that address all risk factors and affect the entire population of pregnant women, given that prevention programmes directed only at high-risk women have had little effect in preventing preterm births. However, the lack of progress in reducing the frequency of preterm births is also due to our limited understanding of the aetiology of preterm delivery. Although there is growing evidence that infection and neuroendocrine processes are involved, progress has remained slow. Recently, the hypothesis of a genetic predisposition to preterm delivery has been set up. Additional research exploring the pathophysiology of preterm labour is obviously needed, which will hopefully lead to the development of new therapeutic approaches.

Section snippets

Preventive strategies and their results

The prevalence of premature birth remains high in many countries, including the United States (11%) [1], Canada (7%) [2] and France (7%) [3]. Furthermore, the frequency of premature birth in these countries has increased by 10–20% in the last few years [2], [3]. This is worrying, because 60% of neonatal deaths and almost half of all cases of cerebral palsy occur in children born before term [1], [4]. Obstetric and neonatal practices have changed. Improvements in screening for fetal distress and

Perspectives in the prevention of premature birth

Some authors have proposed that the relative failure of preventive programmes may be due to the tendency for them to be too highly targeted [2]. These programmes are often designed to reduce preterm birth rate in women at high risk whereas (1) 60% of premature babies are born to women at low risk; (2) a history of adverse pregnancy outcomes has a major effect on the risk of premature birth, but is difficult to target; and (3) many factors may interact in a complex manner [8]. Thus, even if it

Acknowledgements

We owe sincere thanks to Gérard Bréart for helpful advice during the preparation of this review.

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