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The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth
John P Newnham1,2, Scott W White1,2, Han-Shin Lee1
1Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.
Insights
A comprehensive preterm birth prevention program in Western Australia successfully reduced preterm birth rates, particularly in the tertiary center and remote regions. Continued targeted efforts are crucial for sustained effectiveness.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Perinatal Medicine
Background:
- A multi-faceted, whole-of-population preterm birth prevention program was implemented in Western Australia in 2014.
- The program incorporated new clinical guidelines, public awareness campaigns, and a specialized clinic.
- Initial results showed a 7.6% reduction in preterm birth rates in the first year, primarily from 28 weeks gestation onwards.
Purpose of the Study:
- To conduct an in-depth evaluation of perinatal outcomes associated with the preterm birth prevention program.
- To assess the program's effectiveness over the first three years of its implementation.
Main Methods:
- A prospective, population-based cohort study design was employed.
- Perinatal outcomes were analyzed for singleton pregnancies before and after the program's commencement.
- Data was collected and analyzed to compare outcomes across different healthcare settings and risk groups.
Main Results:
- A sustained reduction in preterm birth was observed in the tertiary center from 28 weeks gestation.
- Non-tertiary centers experienced an initial reduction, but this was not sustained beyond the first year.
- The most significant reductions were seen in low-risk pregnancies and in the remote Kimberley region, where free vaginal progesterone was provided.
Conclusions:
- Multi-faceted, population-wide programs can effectively reduce preterm birth rates.
- Sustained effectiveness requires ongoing effort and targeted strategies.
- Program success is greatest when interventions are precisely targeted to specific populations and risk factors.
Background:
In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28-31 week gestational age group upwards.
Objective:
The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program.
Study Design:
This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program.
Results:
There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge.
Conclusion:
Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.
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