A retrospective assessment of Canadian preterm birth prevention efforts: 1979-1999

To assess the achievements and effectiveness of efforts to reduce preterm deliveries through the collaborative efforts of funding agencies, scientists, obstetricians, pediatricians, and health care providers in Canada.

Chronological review of studies carried out in Canada within the past two decades using several methodological approaches, including randomized clinical trials, surveys of women and physicians, and prospective cohort studies.

Tertiary prevention by treatment of spontaneous preterm labor with beta-agonists was effective in delaying delivery by 48 hr compared with placebo. Ongoing studies tested the comparative efficacy of oxytocin antagonists to beta-adrenergic agents. Recently, nitric oxide donors have been tested. Secondary prevention using various approaches showed that high-risk factors could not be modified by these interventions. Before applying primary prevention approaches, surveys disclosed the lack of knowledge among both physicians and pregnant women.

A recent Canadian consensus meeting emphasized the potential for success by using multidiscplinary, community-based health promotion approaches to prevent preterm labor; enhancing basic research in predictive markers such as cervical change, infection/inflammation, and psychosocial stress; and increasing political involvement of health decision makers.