Unlocking the Cervix: Biological Mechanisms and Research Gaps in Preterm Birth

Area of Science:

• Reproductive Biology
• Obstetrics
• Perinatology

Background:

• Preterm birth (PTB) is a leading cause of neonatal mortality globally.
• Current PTB prevention strategies are limited by incomplete understanding of its pathophysiology.
• The cervix's role in pregnancy maintenance and labor initiation is increasingly recognized but underexplored.

Purpose of the Study:

• To review current knowledge on cervical function and remodelling during pregnancy and labor.
• To identify research gaps in cervical remodelling mechanisms.
• To explore potential intervention strategies for PTB.

Main Methods:

• A comprehensive 50-year literature review using PubMed.
• Inclusion of 114 studies examining cervical function, spontaneous PTB, and molecular mechanisms of cervical remodelling (CR).

Main Results:

• Significant molecular differences exist in cervical remodelling between term and preterm births.
• Extracellular matrix (ECM) remodelling, immune cell activity, and genetic factors vary by labor triggers and gestational age.
• Inflammatory responses, especially infection-driven, are heightened in PTB.

Conclusions:

• Understanding complex molecular mechanisms of cervical remodelling is crucial for PTB prevention.
• Human tissue studies are needed to bridge the gap between animal models and human physiology.
• Targeted interventions for cervical insufficiency are essential to improve pregnancy outcomes and reduce PTB.