Five effective strategies for preventing preterm birth
Each year, 1.1 million babies around the globe die from prematurity; furthermore, many survivors suffer from long-term disabilities. Worldwide, 15 million babies are born preterm (less than 37 weeks’ gestation). In addition, in the past two decades, the prematurity rates have risen in all nations with reliable data. Hannah H. Chang, MD, PhD, a consultant at Boston Consulting Group in Massachusetts, and colleagues conducted a study that evaluated methods for reducing preterm births. They published their findings online on November 16 in The Lancet.
The researchers note that implementation of the five most effective preventive interventions could reduce the preterm births in the highest-income nations by 5%. Although that is a relatively small percentage, it would prevent approximately 58,000 preterm births and result in a $3 billion total cost savings each year. They examined trends and estimated the potential reduction in preterm births for nations with a very high human development index (VHHDI). The human development Index (HDI) is a composite statistic of life expectancy, education, and income indices to rank nations into four tiers of human development.
Nations that were included in the study were those in which reliable data on preterm births was available from 2000 through 2010. For the United States, the researchers analyzed drivers of rate increases from 1989 through 2004. For 39 nations with a VHHDI and more than 10 000 births each year, they conducted nation-by-nation analyses based on target population, incremental coverage increase, and intervention efficacy. They estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity.
The researchers found that from 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990 through 2010 (Estonia and Croatia), 2000 through 2010 (Sweden and Netherlands), or 2005 through 2010 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 nations. Their analysis of preterm birth rise from 1989 through 2004 in USA suggested that half the change was unexpected; however, important drivers include non-medically indicated labor induction and caesarean delivery and assisted reproductive technologies.
Significant variability in the absolute benefit of interventions was found across the nations studied; it ranged from 1-9% risk reduction. They found that although reducing non–medically indicated caesarean delivery and labor induction would have the highest effect in the US, its effect would negligible in Sweden. Conversely, performing a cervical cerclage (sewing a strong mesh band around the cervix to prevent it from dilating) for women with previous preterm delivery and a short cervix would have the largest effect in Sweden.
For all 39 nations with a VHHDI, five interventions, which could reduce preterm births by 5% were:
- Smoking cessation
- Decreasing multiple embryo transfers during assisted reproductive technologies (ARTs)
- Cervical cerclage
- Progesterone supplementation (0•01)
- Reduction of non-medically indicated labor induction or caesarean delivery
The researchers note that a conservative estimate of the benefits provided by implementation of the five interventions would be a reduction in preterm birth rates of 5% by 2015. They noted that their findings highlight the urgent need for research into underlying mechanisms of preterm births, and development of innovative interventions. They added that the highest preterm birth rates occur in low-income settings where the causes of prematurity might differ and have simpler solutions such as birth spacing and treatment of infections in pregnancy than in high-income nations. They stressed that urgent focus on these settings is also crucial to reduce preterm births worldwide.
Reference: The Lancet
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