NICHD, global health groups set preterm birth research agenda
I’m happy to report that the NICHD has helped organize a coalition of global health organizations to set a research agenda for tackling the problem of preterm birth.
The brain, lungs, liver and other organs develop rapidly during the final weeks of pregnancy. Infants born before this developmental process is complete are at much higher risk for death or breathing problems, cerebral palsy, problems with vision, and other serious health and developmental problems. When they reach adulthood, individuals who were born at a low birthweight—common for preterm infants—are at increased risk for heart attack, stroke, high blood pressure and diabetes.
“A solution pathway for preterm birth: accelerating a priority research agenda,” appeared in a recent issue of The Lancet Global Health. Together with NICHD, the plan was developed by the Bill and Melinda Gates Foundation, the Global Alliances to Prevent Prematurity and Stillbirth, the March of Dimes, and the World Health Organization.
This document addresses a compelling need. In the United States alone, nearly 1 of every 8 infants is born preterm (before 37 weeks gestation). In 2009, preterm birth accounted for 35 percent of all U.S. infant deaths—more than from any other single cause. Worldwide, an estimated 15 million infants are born preterm, and 1 million die from complications related to their early birth.
Despite intensive efforts by NICHD and other groups around the world, we still do not understand most of the cause of preterm birth and, thus, treatments to prevent preterm delivery remain only modestly effective. Although strides have been made in reducing the risk of preterm birth in certain at risk groups, we still lack the means to keep it from occurring, even among healthy women.
The Solutions Pathway seeks to capitalize on advances in technology that have taken place in the last 10 years. For example, genomics—the study of all an individual’s genes and how they interact with each other—hold great promise for identifying the multitude of gene interactions and, importantly, of gene-environment interactions that lead to term and to preterm delivery. Similarly, advances in information and computation technology will help in understanding these interactions.
The plan calls for research into the biochemical pathways and other physiological phenomenon of pregnancy and preterm birth, ultimately to find ways to prevent preterm birth. Carrying out the research would involve such diverse areas as family history, infections and inflammation in the reproductive tract, maternal nutrition, emotional and physical stress, and genetics. The plan also seeks to speed the pace of research to develop practical and affordable interventions to improve the survival of preterm infants born in low and middle income countries. For instance, such efforts would seek ways to adapt the high-tech medical techniques of newborn intensive care units in the developed world to less developed areas.
The solutions pathway also calls for greater efforts to gather population wide data on preterm birth. Data could be collected during population surveys, at local hospitals and community clinics, and compiled in statistical registries. Epidemiologists could use the data to determine the frequency of preterm birth in various populations and to identify those most at risk.
The final element of the solutions pathway calls for collaboration among medical and scientific specialties involved in preterm birth research. Funding agencies and organizations could help by prioritizing and coordinating support for studies involving multiple disciplines. Standardized databases and repositories of biological samples would provide an important resource for these efforts.
Preterm birth is a difficult problem, and finding better solutions will not come easily. With new scientific tools, we should be able to address the questions we’ve not yet been able to answer. We invite other organizations who share our interest in solving this problem to join with us in this effort. Combining and coordinating our resources could only enhance our chances for success.
Alan E. Guttmacher, M.D.