Thursday, November 29, 2012

Preventing preterm births - Lancet 2012

Preventing preterm births

Wider implementation of evidence-based interventions could reduce preterm birth rates by 5% by 2015, say researchers.
Every year, 1·1 million babies die from prematurity, and many survivors are disabled. Worldwide, 15 million babies are born preterm (<37 a="a" all="all" almost="almost" analysis="analysis" and="and" benefit="benefit" births="births" born="born" countries="countries" data.="data." decades="decades" development="development" drivers="drivers" estimate="estimate" evidence-based="evidence-based" examined="examined" font="font" for="for" gestation="gestation" high="high" human="human" if="if" implemented.="implemented." in="in" increasing="increasing" index="index" inform="inform" interventions="interventions" is="is" of="of" poor.="poor." potential="potential" present="present" preterm="preterm" preventive="preventive" rate="rate" rates="rates" reduction="reduction" reliable="reliable" soon.="soon." target="target" the="the" this="this" to="to" too="too" trends="trends" two="two" understanding="understanding" very="very" we="we" weeks="weeks" were="were" widely="widely" with="with">

Countries were assessed for inclusion based on availability and quality of preterm prevalence data (2000—10), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1989—2004. For 39 countries with VHHDI with more than 10 000 births, we did country-by-country analyses based on target population, incremental coverage increase, and intervention efficacy. We estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity.

From 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990—2010 (Estonia and Croatia), 2000—10 (Sweden and Netherlands), or 2005—10 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 countries. Our analysis of preterm birth rise 1989—2004 in USA suggests half the change is unexplained, but important drivers include non-medically indicated labour induction and caesarean delivery and assisted reproductive technologies. 
For all 39 countries with VHHDI, five interventions modelling at high coverage predicted a 5% relative reduction of preterm birth rate from 9·59% to 9·07% of live births: 
smoking cessation (0·01 rate reduction), 
decreasing multiple embryo transfers during assisted reproductive technologies (0·06), 
cervical cerclage (0·15),
progesterone supplementation (0·01), 
and reduction of non-medically indicated labour induction or caesarean delivery (0·29).
These findings translate to roughly 58,000 preterm births averted and total annual economic cost savings of about US$3 billion.

We recommend a conservative target of a relative reduction in preterm birth rates of 5% by 2015. Our findings highlight the urgent need for research into underlying mechanisms of preterm births, and development of innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity might differ and have simpler solutions such as birth spacing and treatment of infections in pregnancy than in high-income countries. Urgent focus on these settings is also crucial to reduce preterm births worldwide.
Chang HH, Larson J, Blencowe H, et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. The Lancet. 2012;doi:10.1016/S0140-6736(12)61856-X.

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