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Published on: November 20, 2015
Infection and preterm birth
W W Andrews1, J C Hauth, R L Goldenberg
1Department of Obstetrics & Gynecology and The Center for Research in Women's Health, University of Alabama at Birmingham, 35249-7333, USA.
Insights
Genital tract infections are linked to spontaneous preterm birth, a major cause of infant mortality and handicap. Antibiotic trials show promise but require further research for effective prevention strategies.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Diseases
Background:
- Preterm birth affects 11% of US pregnancies, leading to infant mortality and long-term neurological handicap, particularly in infants born before 32 weeks' gestation.
- Despite improved survival rates for preterm infants, long-term handicap rates remain unchanged, and preterm birth rates are increasing.
- Clinically silent upper genital tract infections are implicated in the pathophysiology of spontaneous preterm births, especially early-term births.
Purpose of the Study:
- To review the current understanding of the relationship between genital tract microbial infections and spontaneous preterm birth.
- To evaluate the availability and utility of markers for identifying women with genital tract infections.
- To analyze the results of recent randomized clinical trials of antibiotic therapy for preterm birth prevention.
Main Methods:
- Review of current literature on genital tract infections and preterm birth.
- Assessment of diagnostic markers for genital tract infections.
- Analysis of prospective randomized clinical trials evaluating antibiotic therapy.
Main Results:
- Genital tract infections are a significant factor in spontaneous preterm birth.
- Diagnostic markers for these infections have varying degrees of usefulness.
- Antibiotic therapy trials have yielded mixed results, with specific strengths and limitations.
Conclusions:
- Further research is needed to refine diagnostic markers and optimize antibiotic treatment strategies.
- Clinical management strategies require careful consideration of trial evidence and future research directions.
- Understanding the role of genital tract infections is crucial for reducing preterm birth and associated handicaps.
Abstract:
Preterm birth complicates 11% of all pregnancies in the United States and remains a leading cause of infant mortality and long-term neurological handicap. The majority of this morbidity and mortality is concentrated among the small subset of infants born before 32 weeks' gestational age and that have birth weights < 1500 g. Although the survival of these preterm infants has improved over the last 20 years, the rate of long-term handicap has not. Despite widespread use of preventive strategies, the rate of preterm birth is increasing. Therefore, the prevalence of long-term handicap attributed to preterm birth also is increasing. Considerable data implicate a clinically silent upper genital tract infection as a key component of the pathophysiology of a majority of early spontaneous preterm births, but a minority of preterm births that occur near term. This report reviews the current status of our understanding of the relationship between genital tract microbial infection and spontaneous preterm birth, the availability and usefulness of markers to identify women with such infections, and the results of recent prospective randomized clinical trials of antibiotic therapy to prevent preterm birth. Strengths and limitations of the trials are reviewed in relationship to their value for guidance in clinical management strategies and directions for future research are discussed.
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