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Scientists Search For Causes Of Preterm Birth And Better Ways To Test For Risk

Preterm birth comes with significant health risks for the baby and is a leading cause of infant mortality worldwide... "This is something that has plagued humanity for as long as we've been able to observe," says Gary Shaw, an epidemiologist at Stanford University and a co-author on both studies. He's part of a research group at Stanford that includes scientists from several disciplines working together to investigate preterm birth. "What's the trail to being born too soon? We keep looking and looking and looking to see where the trail-head starts," he says.

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 Pre-Eclampsia and Preterm Labor – Time Sensitive Management

Regarding the use of tocolytics, their use in modern obstetrics (since they don’t really work very well) is restricted to transfer situations and in order buy time to get steroids on board. Maximal effect on fetal lung maturity is at 48 hours after the first dose, so we will sometimes use tocolytics in order to achieve this. In this case, the magnesium sulfate itself is a reasonable tocolytic and I would not recommend adding anything else.

 You Can Do Everything ‘Right’ and Still Have a Preterm Birth

Every day, as I rush to preterm deliveries on the labor floor of my safety-net hospital and work beside incubators and clear plastic hospital bassinets, one of my patients’ mothers confides to me her belief that if she had only done that one thing differently during pregnancy, her child might not be in the NICU. Women tell me about catching COVID-19, eating spicy food, working outside the home, exercising, not exercising. I hear from mothers who tripped over that last step off the bus – hidden beneath their pregnant bellies – and ascribe their ultimate pregnancy outcome to that single stumble. A mother picked up her toddler while 26 weeks pregnant because he was crying, arms raised; she started contracting two hours later. I flashed back to my second pregnancy and my older son sobbing on the sidewalk. I couldn’t debunk this association that I knew would gnaw at her forever.

Articles of Interest

Common method of preventing early births may be causing more

New research has found a commonly used method of preventing early or preterm birth (delivery of a baby before 37 weeks) may in fact be causing more to occur, and leading to further problems. The “cervical cerclage” is a surgical procedure involving stitching the neck of the womb (the cervix) closed in pregnancy. The cerclage stitch prevents preterm birth as it provides support to a weakened cervix. This prevents the cervix from opening too early in pregnancy, and also acts a barrier, protecting the baby from vaginal infection.

Diagnosis and Management of Preterm Labor

Around 75% of preterm deliveries occur after preterm labor, which may or may not be preceded by preterm prelabor rupture of membranes (PPROM). Therefore, early diagnosis and management of preterm labor is central to improving health care for mothers and newborns.

Fetal fibronectin testing for reducing the risk of preterm birth

Fetal fibronectin (FFN) is an extracellular matrix glycoprotein localized at the maternal‐fetal interface of the amniotic membranes, between chorion and decidua, where it is concentrated in this area between decidua and trophoblast. In normal conditions, FFN is found at very low levels in cervicovaginal secretions. Levels greater than or equal to 50 ng/mL at or after 22 weeks have been associated with an increased risk of spontaneous preterm birth. In fact, FFN is one of the best predictors of preterm birth in all populations studied so far, and can help in selecting which women are at significant risk for preterm birth

Management of Threatened and Active Preterm Labour

Fetal fibronectin is one of several commercially available vaginal biomarker tests for the prediction of preterm birth in women presenting with symptoms of PTL. To date fFN is the most extensively tested with data on predictive value in several thousand symptomatic women.

More Bad News: Study Suggests Hotter Temperatures Lead to Pre-Term Labor

Climate change is going to kill most things: you, me, the internet, the economy, society, the planet… Humans messed with the planet and the planet is now messing with us back, in the form of a slow and probably very painful death. And a new study published Monday in Nature identifies another potential hazard of climate change: an increase in preterm births. On average, the researchers found that unusually high temperatures cost babies about 6.1 days’ gestation time.

Navigating the Challenges of Preterm Labor: Insights from Maternal Fetal Medicine Experts

On the most recent episode of the Healthful Woman podcast, maternal-fetal medicine specialists, Dr. Nathan Fox and Dr. Jessica Spiegelman recently discussed the intricacies of preterm labor and preterm contractions—two common occurrences that can leave many expecting mothers afraid and in the dark.

Pharmacologic Management of Preterm Labor and Prevention of Preterm Birth

Although several interventions for managing preterm labor and preventing preterm birth are available, most are not universally effective, offering benefits in only a specific group of women or presenting safety concerns for the mother or fetus. Large-scale research is needed to conclusively define the best choices for managing preterm labor and preventing preterm birth.

Prematurity: A riddle wrapped in a mystery inside an enigma

Prematurity looms as one of our greatest public health challenges, yet the average American is almost oblivious to the magnitude of the problem. Equally distressing is the enormous gap between our knowledge of the major pathways to premature birth and their causes and treatments. Why haven't we closed this gap and implemented strategies to make a real impact on prematurity rates? The short answer is that not nearly enough research has been conducted in the right areas. The long answer is that this lack of research reflects a general decline in reproductive scientific research at academic departments of obstetrics and gynecology throughout the United States.

The management of preterm labour

Preterm labour is the onset of regular uterine contractions associated with progressive cervical change between viability and 37 completed weeks of gestation. The incidence is between 5% and 10% in most developed nations. In the US, the incidence has increased from 9% to 12% in the past two decades. Preterm delivery can be associated with immediate and long‐term neonatal complications. Long‐term morbidity includes cerebral palsy, neurodevelopmental delay and chronic lung disease. The neonatal outcome is dependent on the gestational age at delivery and associated features such as infection.

The Problem With What Doctors Call Preterm Labor

A new review, published in the journal Science this month, argues that in order to truly get a handle on what causes preterm birth, and do a better job of preventing it, doctors and researchers must transition away from thinking of it simply as one condition -- labor that happens before a woman reaches 40 weeks -- to a complex syndrome with many causes.

This Blood Test Could Predict When Babies Will Arrive Early

Now, an international team of scientists has debuted a new type of blood test that is nearly as effective as an ultrasound in determining how far along a woman is in her pregnancy and, crucially, how likely she is to give birth ahead of term.

Why can’t more American women access medications for preterm birth?

There are two medications that prevent preterm birth, the most common cause of perinatal death in the U.S. One costs 16 cents a week, one US$285. Poor black women aren’t getting either. Why?

Resources

PreTRM Test

The PreTRM Test is an innovative blood test that your doctor can order during weeks 18 through 20 of your pregnancy.² The test measures proteins in the blood that can indicate if you are at higher risk of delivering early.

StatPearls

Preterm labor is labor occurring between after 20 and before 37 weeks gestation. Preterm labors are subcategorized as early or late preterm. Early preterm labor occurs prior to 33 weeks gestation, and late preterm labor occurs between 34 and 36 weeks gestation.