Potential to reduce preterm births ‘shockingly small’

If developed countries were to successfully implement five preventive interventions, only a 5% relative reduction in the preterm birth rate could be achieved by 2015, shows a study published by The Lancet.

This translates to the prevention of only 58,000 preterm births in the world's 39 richest countries.

"Surely this shocking and humbling finding must lead to strategic prioritisation of research into prevention of preterm births in countries with VHHDI [very high human development index]," say Joy Lawn (Save the Children, London, UK) and colleagues.

The authors used data from 39 countries that fell under the United Nation's classification of VHHDI and had at least 10,000 live births per year.

They identified five interventions that had strong evidence for reducing preterm births: smoking cessation, progesterone, cervical cerclage, decreasing use of nonmedically indicated labor or cesarean induction, and decreasing multiple births from assisted reproduction technologies.

Lawn and colleagues estimate that if all these interventions were applied in the 39 countries, the absolute preterm birth rate would decrease from 9.6% to 9.1%. However, the relative reduction varied significantly across countries. For example, an 8% relative reduction could be achieved in the USA, but only a 2% reduction in Sweden.

The analysis stems from a World Health Organization report by the same authors, Born Too Soon, which was published earlier this year and estimated that by 2025, low-income countries could reduce preterm mortality by 50%.

The authors say that their findings on preterm birth contrast with the potential to prevent deaths due to prematurity, and should motivate high-income countries to take action against preterm births. They add that further research into preterm birth prevention is needed, particularly in low-income countries.

Writing in an accompanying editorial, Jane Norman (University of Edinburgh, UK) and Andrew Shennan (King's College London, UK), agree.

"The conclusion that 95% of preterm births are intractable to current therapies suggests that substantial further research is needed in this area," they write.

"Until considerable strides have been made in our understanding of how, why and when preterm births occur, and the effects that this has on both mother and baby, preterm births will remain a major public health problem, from which no country in the world is immune."

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