Preterm Birth

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

Preterm birth is an increasing challenge in the developed anddeveloping world. As we begin to understand what contributes to the likelihood ofpreterm birth, obstetricians and gynecologists can advise mothersand aspiring mothers on how to minimize the risks. Doctors can alsomonitor those patients who are likely to be at risk to increase thechances of preventing or effectively managing preterm labor. This practical book provides a clinically focused approach tothe prevention and management of premature births, using the bestavailable evidence to provide clear guidance to obstetricians,gynecologists, nurse midwives and family practitioners. Written for an international audience, the author addresses thespecial issues affecting patients in the developing world,including infectious- and poverty-related preterm birth. Each of the 30 chapters follows a wealth of practicalfeatures: Key points and chapter summaries Algorithms, tables and graphs Summary of the evidence-based literature Easy-to-use clinical guidelines

Each year in the United States approximately 440,000 babies are born premature. These infants are at greater risk of death, and are more likely to suffer lifelong medical complications than full-term infants. Clinicians and researchers have made vast improvements in treating preterm birth; however, little success has been attained in understanding and preventing preterm birth. Understanding the complexity of interactions underlying preterm birth will be needed if further gains in outcomes are expected. The Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine sponsored a workshop to understand the biological mechanism of normal labor and delivery, and how environmental influences, as broadly defined, can interact with the processes of normal pregnancy to result in preterm birth. This report is a summary of the main themes presented by the speakers and participants.

This splendid volume presents numerous aspects of preterm labor and delivery, from its fundamental mechanism to clinically focused approaches. The incidence of preterm delivery is 6-7% in Japan, while globally up to 10% of pregnancies with preterm labor result in premature delivery. The rates of overall survival and intact survival of the premature infants are also excellent in Japan. Thus Japan’s approach to preterm labor and delivery has long attracted attention. In each chapter, experts describe specific issues unique to conditions in Japan, including diagnosis, tocolytic agents, definition of clinical chorioamnionitis, treatment of bacterial vaginosis, role of amniocentesis, management of preterm premature membrane rupture and also placental pathology, presenting definitive evidence of the reduced incidence of preterm delivery in Japan. This book benefits not only obstetricians, pediatricians and gynecologist, but also midwives, nurse practitioners, and medical and associated staffs in the field of obstetrics, pediatrics, as well as neonatal and perinatal medicine who are involved in delivery.

Preterm delivery is probably the most important problem in obstetrics, and a major public health concern. Recent developments - such as the preventive use of progesterone, and new data on possible mechanisms of initiation of parturition – have placed the topic at the forefront of the interests and preoccupation of many in maternal-fetal medicine and obstetrics. Recent studies have found that preterm deliveries have increased even amongst low risk women. Also shown is that assisted conceptions, multiple pregnancies and elective deliveries are associated with early birth. The impact on society is considerable. Preterm birth can also have considerable impact on long-term health, including severe mental or physical disability. With all this being currently debated, Obstetricians should re-evaluate the risks and benefits of delivering babies earlier. This book, published in collaboration with the Society for Gynecologic Investigation, is a balanced, authoritative, well-referenced work with a rigorous underpinning of basic science and evidence-based clinical guidelines. The Editors have ensured that there is development of modern ideas throughout regarding understanding, research, prevention and treatment of preterm birth. The book will be essential reading for Specialists in Maternal-Fetal Medicine, Obstetrics and Perinatology. Since the book also highlights definitions, classifications and management algorithms, it will also be useful to general ObGyns, both in practice and training.

A troubling study of the role that medical racism plays in the lives of black women who have given birth to premature and low birth weight infants Black women have higher rates of premature birth than other women in America. This cannot be simply explained by economic factors, with poorer women lacking resources or access to care. Even professional, middle-class black women are at a much higher risk of premature birth than low-income white women in the United States. Dána-Ain Davis looks into this phenomenon, placing racial differences in birth outcomes into a historical context, revealing that ideas about reproduction and race today have been influenced by the legacy of ideas which developed during the era of slavery. While poor and low-income black women are often the “mascots” of premature birth outcomes, this book focuses on professional black women, who are just as likely to give birth prematurely. Drawing on an impressive array of interviews with nearly fifty mothers, fathers, neonatologists, nurses, midwives, and reproductive justice advocates, Dána-Ain Davis argues that events leading up to an infant’s arrival in a neonatal intensive care unit (NICU), and the parents’ experiences while they are in the NICU, reveal subtle but pernicious forms of racism that confound the perceived class dynamics that are frequently understood to be a central factor of premature birth. The book argues not only that medical racism persists and must be considered when examining adverse outcomes—as well as upsetting experiences for parents—but also that NICUs and life-saving technologies should not be the only strategies for improving the outcomes for black pregnant women and their babies. Davis makes the case for other avenues, such as community-based birthing projects, doulas, and midwives, that support women during pregnancy and labor are just as important and effective in avoiding premature births and mortality.

The improved survival of very preterm and very low birth weight infants in recent decades has been associated with an increase in the prevalence of physical and neurodevelopmental problems. Attention is increasingly being focused on the quality of life of survivors, who are at greater risk of brain damage and consequent neurological disorders, and neuropsychological and behavioural impairments. In this volume, leading experts present a comprehensive and up-to-date perspective on research in various aspects of the long-term consequences of very preterm birth. As well as extending existing knowledge of the neurodevelopmental sequelae following very preterm birth, a shared aim of this burgeoning body of research is to identify the mechanisms underlying variations in outcome, and thus recognise subgroups of children who are at increased risk of neurodevelopmental problems, for whom appropriate intervention strategies can be devised. Pediatricians, neurologists, psychiatrists and psychologists will all find this to be essential reading.

Preterm birth is defined by WHO as birth before the 36 weeks and 6 days of gestation or before 259 days, counting from the first day of the last menstrual period. Preterm Birth: Prevalence, Risk Factors and Management presents an overview of the epidemiologic characteristics of women who deliver their neonates prematurely, in order to understand the depth of this major obstetrical problem.Paternal risk factors, including paternal anthropometric and genetic characteristics and life-style habits, are addressed in conjunction with fetal characteristics which may be responsible for increasing the risk of preterm birth.The authors discuss three important omega-3 fatty acids for the prevention of osteopenia of the preterm newborn: alpha-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid.The concluding study explores the mechanisms that link periodontitis with adverse pregnancy outcomes and presents a comprehensive critical review of the current scientific stand regarding this relationship.