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Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action.

ABSTRACT: Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid-containing multivitamin supplement) and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.

SUBMITTER: Dean SV

PROVIDER: S-EPMC3828587 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action.

Dean Sohni V SV Mason Elizabeth E Howson Christopher P CP Lassi Zohra S ZS Imam Ayesha M AM Bhutta Zulfiqar A ZA

Reproductive health 20131115

Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk fo ...[more]

PMID: 24625189

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Project description:As part of a supplement entitled “Born Too Soon”, this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women’s groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent’s voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries.

Project description:Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies that promote safe motherhood and universal access to care before, during and after pregnancy. The aim of this paper is to present the latest information about available interventions that can be delivered during pregnancy to reduce preterm birth rates and improve the health outcomes of the premature baby, and to identify data gaps. The paper also focuses on promising avenues of research on the pregnancy period that will contribute to a better understanding of the causes of preterm birth and ability to design interventions at the policy, health care system and community levels. At minimum, countries need to ensure equitable access to comprehensive antenatal care, quality childbirth services and emergency obstetric care. Antenatal care services should include screening for and management of women at high risk of preterm birth, screening for and treatment of infections, and nutritional support and counselling. Health workers need to be trained and equipped to provide effective and timely clinical management of women in preterm labour to improve the survival chances of the preterm baby. Implementation strategies must be developed to increase the uptake by providers of proven interventions such as antenatal corticosteroids and to reduce harmful practices such as non-medically indicated inductions of labour and caesarean births before 39 weeks of gestation. Behavioural and community-based interventions that can lead to reductions in smoking and violence against women need to be implemented in conjunction with antenatal care models that promote women's empowerment as a strategy for reducing preterm delivery. The global community needs to support more discovery research on normal and abnormal pregnancies to facilitate the development of preventive interventions for universal application. As new evidence is generated, resources need to be allocated to its translation into new and better screening and diagnostic tools, and other interventions aimed at saving maternal and newborn lives that can be brought to scale in all countries.

Project description:ImportanceCriminalizing immigrant policies, a form of structural racism, are associated with preterm birth; however, to date, few population studies have examined this association by race and nativity status or examined the association of inclusive immigrant policies with preterm birth.ObjectiveTo assess the extent to which variation in preterm birth by race/ethnicity and nativity status is associated with state-level criminalizing vs inclusive immigrant policies.Design, setting, and participantsThis retrospective, cross-sectional study analyzed birth record data from all 50 states and the District of Columbia in 2018, as well as state-level indicators of inclusive and criminalizing immigrant policies. White, Black, Asian, and Latina women who had singleton births were included in the study. Statistical analysis was performed from June 1, 2020, to February 5, 2021. Two continuous variables were created to capture the number of criminalizing vs inclusive immigrant policies in effect as of 2017 in each state.Main outcomes and measuresThe main outcome measure was preterm birth (<37 weeks' gestation).ResultsAmong the 3 455 514 live births that occurred in 2018, 10.0% were preterm, and 23.2% were to mothers born outside the US. Overall, for women born outside the US, each additional state-level inclusive policy was associated with a 2% decrease in preterm birth (adjusted odds ratio [aOR], 0.98 [95% CI, 0.96-1.00]); there were no significant associations between inclusive policies and preterm birth among women born in the US. In models examining the combined associations of criminalizing and inclusive immigrant policies with preterm birth, each additional criminalizing policy was associated with a 5% increase in preterm birth among Black women born outside the US (aOR, 1.05 [95% CI, 1.00-1.10]). Each additional inclusive immigrant policy was associated with a lower likelihood of preterm birth for Asian women born in the US (aOR, 0.95 [95% CI, 0.93-0.98]) and White women born outside the US (aOR, 0.97 [95% CI, 0.95-0.99]). No significant associations were found among other groups.Conclusions and relevanceThis study suggests that criminalizing immigrant policies are associated with an increase in preterm birth specifically for Black women born outside the US. Inclusive immigrant policies are associated with a decrease in preterm birth for immigrants overall, Asian women born in the US, and White women born outside the US. No associations were found between criminalizing or inclusive immigrant policies and preterm birth among Latina women.

Project description:IntroductionBlack African American (B/AA) women have a 2-fold to 3-fold elevated risk compared with non-Hispanic White (W) women for preterm birth. Further, preterm birth is the leading cause of mortality among B/AA infants, and among survivors, preterm infant adverse health outcomes occur disproportionately in B/AA infants. Racial inequities in maternal and infant health continue to pose a public health crisis despite the discovery >100 years ago. The purpose of this study was to expand on reported preterm infant outcome disparities. A life-course approach, accumulation of lifelong stress, including discrimination, may explain social factors causing preterm birth rate and outcome inequities in B/AA mothers.MethodsAnthropometric measures and clinical treatment information for 197 consented participants were milled from electronic health records across 4 years. The Neonatal Infant Stressor Scale was used to tally acute and chronic painful/stressful procedures. Neurobehavioral differences were investigated using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale.ResultsB/AA mothers gave birth to preterm infants earlier than W mothers. NICU hospitalization stays were extended more than 2 weeks for the significantly smaller B/AA preterm infants in comparison to the age-matched W preterm infants. A higher number of chronic lifesaving procedures with demonstrated altered stress response patterns were recorded for B/AA preterm infants.DiscussionThis cross-sectional analysis of preterm birth rates and preterm infant developmental and neurodevelopmental outcomes are presented in the context of NICU stress and pain, with attendant implications for infant mortality and future health disparities. Preterm birth rate and outcome inequities further support the need to develop interventions and policies that will reduce the impact of discrimination and improve social determinants of health for Black, Indigenous, and other People of Color.

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Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action.

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Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action.

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