Research could improve clinical care, help educate women on premature birth

A March of Dimes expert panel has recommended a targeted research agenda designed improve the lives of thousands of babies by preventing premature birth. The agenda has been published in the American Journal of Obstetrics and Gynecology.

"Preterm birth is a complex disorder, like heart disease or diabetes, with no single cause, and it requires a multi-faceted approach," says Nancy S. Green, M.D., medical director of the March of Dimes and the article's lead author. "We need to stimulate more funding for research in six promising areas that may lead to new clinical strategies for identifying who is at greatest risk for premature birth and how to prevent it."

Prematurity is the leading killer of America's newborns, and those who survive often have lifelong health problems, including cerebral palsy, mental retardation, chronic lung disease, blindness, and hearing loss. As much as half of all neuro-developmental problems in children can be ascribed to premature birth, the authors of the paper say.

More than 12 percent of all babies in the United States each year – or nearly 500,000 -- are born prematurely (before 37 weeks completed gestation), and the rate of prematurity has increased by more than 30 percent since 1981. Babies born extremely prematurely (before 32 weeks gestation) suffer the greatest burden of death, complications and disabilities, so more research studies should focus on them, the authors say.

Dr. Green, the paper's lead author, worked with the March of Dimes Scientific Advisory Committee on Prematurity, made up of experts from across the nation in the fields of obstetrics and gynecology, pediatrics, women's health, reproductive biology, nursing, and public health.

The authors of today's paper identify six priority areas for a more targeted prematurity research agenda:

1. New epidemiologic studies focused on the risk of extremely preterm births to identify the factors that predispose women to very early labor and delivery;
2. Genes and their interaction with the environment, that, in concert, lead to preterm birth;
3. Racial and ethnic differences. While prematurity affects all socioeconomic groups, there are significant racial and ethnic disparities. For example, non-Hispanic African-Americans had the highest rate of premature babies at 17.8 percent in 2003, well above the national rate of 12.3 percent;
4. The roles of infection and immune response to those infections;
5. The effects of stress on the mother and fetus;
6. Clinical trials to assess the impact of potential treatments, to whom, and when during the course of pregnancy to be most effective.

Such research could lead to improvements in clinical care, and also help educate women about how to avoid risks that lead to premature birth, the authors said.

In 2005, the March of Dimes awarded the first of its new national Prematurity Research Initiative (PRI) grants at six major research institutions nationwide.

As part of it's comprehensive fight against prematurity, the March of Dimes also is supporting proposed federal legislation that would expand research on prematurity and give states more flexibility to design their Medicaid programs to offer health care coverage to low-income pregnant women and their children as a way to prevent premature birth. The bills are: The "Prevent Prematurity and Improve Child Health Act of 2005" (S 710) and the Prematurity Research Expansion and Education for Mothers Who Deliver Infants Early (PREEMIE) Bill" (S 707).

"Research Agenda for Preterm Birth: Recommendation from the March of Dimes," appears in the September issue of the American Journal of Obstetrics and Gynecology, volume 193, number 3.