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Interventions could prevent 58,000 premature births a year

Only 5% of premature births globally are preventable, study finds

Adrian O'Dowd

Friday, 16 November 2012

Around 58,000 premature births could be prevented if 39 of the world’s highest income countries made a concerted effort to implement certain interventions, concludes a study published today in The Lancet.

The study, published to tie in with tomorrow’s World Prematurity Day, found that the best available science could only allow for a 5% relative reduction in high-income countries’ preterm birth rates by 2015.

It is estimated that each year, 15 million babies are born preterm worldwide and of these, around 1.1 million die and many survivors are disabled. Preterm rates have been rising in almost all countries with reliable data, but it is not clear why or how best to address the problem.

The new study in The Lancet claims to be the first multi-country study to examine the causes of preterm births and potential reductions that might be possible.

Research was conducted by an international team of researchers, coordinated by Dr Joy Lawn of Save the Children and included experts from the London School of Hygiene and Tropical Medicine and the World Health Organization.

The researchers identified five evidence-based interventions that reduce the rate of preterm births:

  • decreasing non-medically indicated caesarean deliveries and induced labour
  • limiting multiple embryo transfers in assisted reproductive technology
  • smoking cessation
  • progesterone supplementation
  • cervical cerclage (a surgical operation which can prevent a preterm birth in some women).

By analysing data, the researchers estimated that if all 39 high income countries fully implemented the five interventions, an average 5% relative reduction in preterm birth could be achieved by 2015, varying from an 8% reduction in the USA to a much smaller reduction in most European countries, and only 2% in the UK.

In addition, if rates of preterm births were to be reduced in these countries, an 80% relative reduction in the rate of elective caesareans and other non-medically indicated early deliveries would be necessary.

They calculated that, if all 39 high-income countries could achieve this average 5% reduction in preterm births, this would result in around 58,000 preterm births averted annually, amounting to roughly 3 billion US dollars (or £1.89 billion) in total economic cost savings (such as medical costs, economic costs to parents, employers, and other factors).

Dr Lawn said: “Our analysis shows that the current potential for preterm birth prevention is shockingly small - yet 15 million babies are born too soon and this is the leading cause of newborn deaths, and the second leading cause of child deaths globally.

“In addition, the five identified interventions, such as changing smoking habits and caesarean section practices, are not simple to implement.

“Our hope is that the proposed target of a 5% relative reduction in preterm births in high income countries will motivate immediate programme action, and the 95% knowledge gap will motivate immediate, strategic research.”

Writing in an accompanying comment, Jane Norman and Andrew Shennan of Tommy's Centre for Maternal and Fetal Health at the University of Edinburgh, said: “Although any reduction in the rate of preterm births is to be welcomed, the conclusion that 95% of preterm births are intractable to current therapies suggests that substantial further research is needed in this area.”

DOI:10.1016/S0140-6736(12)61856-X
DOI:10.1016/S0140-6736(12)61956-4

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