Applying Precision Public Health to Prevent Preterm Birth

Abstract

Preterm birth (PTB) is one of the major health-care challenges of our time. Being born too early is associated with major risks to the child with potential for serious consequences in terms of life-long disability and health-care costs. Discovering how to prevent PTB needs to be one of our greatest priorities. Recent advances have provided hope that a percentage of cases known to be related to risk factors may be amenable to prevention; but the majority of cases remain of unknown cause, and there is little chance of prevention. Applying the principle of precision public health may offer opportunities previously unavailable. Presented in this article are ideas that may improve our abilities in the fields of studying the effects of migration and of populations in transition, public health programs, tobacco control, routine measurement of length of the cervix in mid-pregnancy by ultrasound imaging, prevention of non-medically indicated late PTB, identification of pregnant women for whom treatment of vaginal infection may be of benefit, and screening by genetics and other “omics.” Opening new research in these fields, and viewing these clinical problems through a prism of precision public health, may produce benefits that will affect the lives of large numbers of people.

Gestational age and socioeconomic status as mediators for the impact of prenatal alcohol exposure on development at 6 months

“…Due to its many negative consequences for infant health and development, reducing preterm birth is a major public health objective and one that has been challenging to achieve (Newnham et al, ). In 2010, during the time these data were collected, the March of Dimes (http://www.marchofdimes.org/mission/global-preterm.aspx#) reported that that the global average for preterm birth was 11%, the United States average was 12% and the Ukrainian average overall was 6.5%.…”

Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action!

“…Two adequately sized real-world studies have been published recently based on a universal cervical length screening program compared with historical controls. Son et al 80 from Chicago, IL, and Newnham et al 81 from Western Australia in well-conducted and planned studies both reported significant reductions in spontaneous PTB after the implementation of universal cervical screening despite a low overall incidence of PTB in their populations.…”

“…In the study of Newnham et al, 81 the implementation of a multifaceted program in 2014 that included universal cervical length screening and treatment with vaginal progesterone to women with a cervical length 25 mm was followed by a statistically significant 7.6% reduction in the rate of preterm birth in 2015. The effect extended from the 28e31 week gestational age group onward.…”

BRAzil magnesium (BRAMAG) trial: a double-masked randomized clinical trial of oral magnesium supplementation in pregnancy

“…The World Health Organization (WHO) estimates that each year 15 million children are born preterm before 37 weeks' gestation [1]. Prematurity is a leading cause of death in the neonatal period, and the second most common cause in children under age five years [1][2][3][4]. Preterm has immediate and long-term implications for the child, including cerebral palsy, learning difficulties and visual and hearing impairment [5][6][7][8].…”