Prevention of preterm birth: a renewed national priority

To summarize some recent major epidemiological changes, evidence-based interventions, shifting paradigms, and national initiatives targeting the prevention of preterm birth in the United States.

Noteworthy epidemiological changes in preterm births include a shift from 40 to 39 weeks as the most common length of gestation for singleton births in the United States; significant jumps in late preterm births, which is the major contributor to increasing preterm rates: more multiple births with rates highest for non-Hispanic whites; dramatic increases in births to women of advanced maternal age; and substantial increases in cesarean births. Key paradigm shifts have also occurred such as considering most spontaneous preterm birth as a common complex disorder highlighting the importance of interactions of biological predispositions and environment; support for the fetal origins hypothesis requiring a life course perspective, including preconception health promotion to improve perinatal health and enhance equity; and a renewed focus on preventing recurrence. The March of Dimes National Prematurity Campaign, the National Institute of Child Health and Human Development leadership on late preterm birth, the 2006 Institute of Medicine's report on preterm birth, and passage of the Prematurity Research Expansion and Education for Mothers who Deliver Infants Early Bill with the resultant 2008 Surgeon General's Conference underscore the national resolve to prevent preterm births.

Despite the complex changing environment of perinatal care, shrinking resources and higher risk pregnancies, innovative strategies, expanded, interdisciplinary partnerships, a focus on perinatal quality initiatives, more evidence-based interventions, tools to better predict preterm labor/birth, dissemination of effective community-based programs, a commitment to enhance equity, promoting preconception health, translation of research findings from the bench to bedside to curbside, effective continuing education for busy clinicians and culturally sensitive, health literacy appropriate patient education materials can collectively help to reverse the increasing rates of preterm births.