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CDC outlines five public health strategies to prevent preterm birth

Researchers from the CDC, Ohio State University and the March of Dimes Foundation have published a report discussing five public health strategies that can help prevent preterm birth, a leading cause of infant morbidity and mortality in the United States.

Published in Morbidity and Mortality Weekly Report, the CDC Grand Round report states that the U.S. preterm birth rate increased 21%, from 10.6% in 1990 to 12.8% in 2006. The rate has decreased since then, dropping to 10.4% in 2007 before falling to 9.6% in 2014. However, these declines have been disproportionate across racial and ethnic groups, with non-Hispanic black women having a preterm birth rate of 13.2% in 2014. That same year, preterm birth rates among Native Americans was 10.2%.

“Reducing preterm birth, a national public health priority, can be accomplished by implementing and monitoring strategies that target modifiable risk factors and populations at highest risk, and by providing improved quality and access to preconception, prenatal, and interconception care through implementation of strategies with potentially high impact,” Carrie K. Shapiro-Mendoza, PhD, of the CDC National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote.

According to the researchers, five strategies to reduce preterm birth, and its associated complications, are:

• Women of childbearing age need access to preconception care services

  This includes screening, health promotion and interventions enabling mothers to enter a pregnancy in optimal health.

  “Modifiable risk factors, including obesity, tobacco use and substance abuse, also should be addressed,” Shapiro-Mendoza and colleagues wrote. “… Since 2010, state Medicaid programs are required to cover tobacco cessation counseling and drug therapy for pregnant women without cost sharing. In 2012, most obstetricians were unaware of this coverage; however, one third indicated they would offer services if they received Medicaid reimbursement."

• Women at risk for preterm delivery need to be identified and offered access to preventive treatments

  “For example, for women who have had a spontaneous preterm delivery, the risk for preterm delivery in subsequent pregnancies is 1.5 to 2 times higher,” Shapiro-Mendoza and colleagues wrote. “Among women with a singleton pregnancy and history of spontaneous preterm delivery, 17 alpha-hydroxyprogesterone caproate can reduce the risk of preterm birth by approximately 30%.”

  In addition, as infants born preterm from 24 to 34 weeks are at higher risk for respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis and perinatal mortality, the American College of Obstetricians and Gynecologists (ACOG) recommends that at-risk mothers should be offered antenatal corticosteroids to improve fetal lung maturity.

• Discourage nonmedically indicated deliveries

  This is particularly true before 39 0/7 weeks, and is consistent with ACOG recommendations.

  “Efforts to reduce nonindicated deliveries before 39 weeks have largely succeeded: During 2010 to 2014, the national average declined from 17% to 3.4%,” Shapiro-Mendoza and colleagues wrote. “Approaches to reducing nonmedically indicated deliveries before 39 weeks include clinical leadership, public advocacy (eg, March of Dimes’ Healthy Babies Are Worth the Wait campaign); quality improvement initiatives (eg, state Perinatal Quality Collaboratives, Collaboration on Innovation and Improvement Network, CMS’s Strong Start for Mothers and Newborns Initiative); public reporting (eg, the Joint Commission); and payment reform.”

• Prevent unintended pregnancies and promote optimal birth spacing

  According to the researchers, three quarters of teen births are unintended, and unintended pregnancies are at 17% higher risk for preterm delivery. In addition, teen mothers are more likely to have a second child within 2 years of the first birth, in turn increasing the likelihood that the second baby will also be born preterm.

  “Although the U.S. teen birth rate has declined, efforts to reduce teen pregnancy need to continue, especially in minority communities where teen and preterm birth rates are highest,” Shapiro-Mendoza and colleagues wrote. “Women who become pregnant after age 35 years are also at increased risk for preterm delivery, and they are also more likely to have a chronic medical condition.”

• Be aware that multiple gestations have a higher risk for preterm birth

In 2013, assisted reproductive technology contributed to an estimated 18.7% of multiple births, 4.6% of preterm births and 5% of very preterm births, according to the researchers.

“Electing to transfer a single embryo for pregnancies achieved by assisted reproductive technology can reduce multiple births and the risk for preterm birth,” Shapiro-Mendoza and colleagues wrote.

According to the researchers, high-quality surveillance systems to monitor preterm births and the associated risk factors and outcomes are needed to effectively implement and evaluate the above prevention strategies. In addition, timely available administrative data and surveys are important for informing strategy evaluation at the local, state and national levels.

“During the past decade, considerable advances have been made in medical care for preterm infants, along with corresponding reductions in infant mortality,” Shapiro-Mendoza and colleagues wrote. “Continued efforts to reduce preterm birth and its associated racial and ethnic disparities are critical for further reduction of the U.S. infant mortality rate.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.