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Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very
Hannah H Chang1, Jim Larson, Hannah Blencowe
1Boston Consulting Group, Boston, MA, USA.
Insights
Implementing evidence-based interventions could reduce preterm births by 5%, averting 58,000 infant deaths annually. Key strategies include smoking cessation and reducing non-medically indicated C-sections.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Public Health
Background:
- Preterm birth affects 15 million babies globally each year, with increasing rates and significant disability among survivors.
- Understanding the drivers of preterm birth and effective preventive interventions remains limited.
- This study focuses on countries with very high human development index (VHHDI) to assess potential preterm birth rate reductions.
Purpose of the Study:
- To examine trends in preterm birth rates in VHHDI countries.
- To estimate the potential reduction in preterm births through widespread implementation of evidence-based interventions.
- To inform a rate reduction target for the Born Too Soon initiative.
Main Methods:
- Analysis of preterm birth prevalence data (2000-2010) and trend projections for 39 VHHDI countries.
- Investigation of drivers for preterm birth rate increases in the USA (1989-2004).
- Modeling of five key interventions (smoking cessation, reduced multiple embryo transfers, cervical cerclage, progesterone supplementation, reduced non-medically indicated labor induction/C-section) at high coverage.
Main Results:
- Even with best-performer rates, VHHDI countries would see less than a 5% relative reduction in preterm births by 2015.
- In the USA, half of the preterm birth increase was unexplained, with significant contributions from labor induction, C-sections, and assisted reproductive technologies.
- Modeling predicted a 5% relative reduction in preterm birth rate (from 9.59% to 9.07%) with high coverage of five interventions, averting ~58,000 births and saving ~$3 billion annually.
Conclusions:
- A conservative target of a 5% relative reduction in preterm birth rates by 2015 is recommended.
- Urgent research into preterm birth mechanisms and innovative interventions is needed.
- Focus on low-income settings is crucial, as causes and solutions (e.g., birth spacing, infection treatment) may differ.
Background:
Every year, 1·1 million babies die from prematurity, and many survivors are disabled. Worldwide, 15 million babies are born preterm (<37 weeks' gestation), with two decades of increasing rates in almost all countries with reliable data. The understanding of drivers and potential benefit of preventive interventions for preterm births is poor. We examined trends and estimate the potential reduction in preterm births for countries with very high human development index (VHHDI) if present evidence-based interventions were widely implemented. This analysis is to inform a rate reduction target for Born Too Soon.
Methods:
Countries were assessed for inclusion based on availability and quality of preterm prevalence data (2000-10), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1989-2004. For 39 countries with VHHDI with more than 10,000 births, we did country-by-country analyses based on target population, incremental coverage increase, and intervention efficacy. We estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity.
Findings:
From 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990-2010 (Estonia and Croatia), 2000-10 (Sweden and Netherlands), or 2005-10 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 countries. Our analysis of preterm birth rise 1989-2004 in USA suggests half the change is unexplained, but important drivers include non-medically indicated labour induction and caesarean delivery and assisted reproductive technologies. For all 39 countries with VHHDI, five interventions modelling at high coverage predicted a 5% relative reduction of preterm birth rate from 9·59% to 9·07% of livebirths: smoking cessation (0·01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0·06), cervical cerclage (0·15), progesterone supplementation (0·01), and reduction of non-medically indicated labour induction or caesarean delivery (0·29). These findings translate to roughly 58,000 preterm births averted and total annual economic cost savings of about US$3 billion.
Interpretation:
We recommend a conservative target of a relative reduction in preterm birth rates of 5% by 2015. Our findings highlight the urgent need for research into underlying mechanisms of preterm births, and development of innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity might differ and have simpler solutions such as birth spacing and treatment of infections in pregnancy than in high-income countries. Urgent focus on these settings is also crucial to reduce preterm births worldwide.
Funding:
March of Dimes, USA, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institutes of Health, USA.
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