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Why the United States preterm birth rate is declining
Corina N Schoen1, Sammy Tabbah2, Jay D Iams3
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
Insights
The US preterm birth rate fell to 11.4% in 2013, its lowest since 1997. Continued efforts in prevention and intervention are crucial for further reducing infant mortality and improving neonatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Public Health Policy
Background:
- The United States faces a high preterm birth rate compared to other developed nations.
- Preterm birth remains a significant contributor to infant mortality and morbidity.
Purpose of the Study:
- To analyze trends in preterm birth rates in the United States.
- To identify factors contributing to the observed decline in preterm births.
- To highlight areas for future intervention and research in preterm birth prevention.
Main Methods:
- Analysis of national birth statistics and demographic trends.
- Review of public health policies and smoking cessation initiatives.
- Evaluation of the impact of specific medical interventions for preterm birth prevention.
Main Results:
- The US preterm birth rate decreased to 11.4% in 2013, the lowest recorded since 1997.
- Demographic shifts, policy changes (e.g., preventing early elective deliveries, smoking bans), and medical interventions (17 hydroxyprogesterone caproate, vaginal progesterone, cerclage) are associated with this decline.
- Despite progress, a substantial number of preterm births remain preventable.
Conclusions:
- Multiple factors, including demographic changes, policy shifts, and medical interventions, have contributed to the reduction in preterm birth rates.
- Enhanced access to current interventions and addressing modifiable risk factors are essential for further prevention.
- Expanded outcome and risk factor reporting are needed to advance research in preterm birth prevention and treatment.
Abstract:
The preterm birth rate in the United States declined to 11.4% in 2013, the lowest level since 1997. Although the United States has one of the highest preterm birth rates in the developed world, we are improving this outcome and therefore improving the lives of thousands of infants. Demographic changes that may be responsible include a reduced teenage birth rate and fewer higher-order multiple births. Additionally, a public policy shift to prevent nonmedically indicated births at <39 weeks' gestation and smoking bans in several states have been associated with the reduced rate of preterm births. Last, interventions such as 17 hydroxyprogesterone caproate, vaginal progesterone, and the use of cerclage in selected populations probably are contributing to the reduction in preterm deliveries. However, a large portion of these births could still be prevented with greater access and implementation of our current interventions, the reduction of modifiable risk factors for preterm birth, and expanded reporting of outcomes and risk factors to facilitate research for both prevention and treatment.
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