Prevention of preterm birth

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Reproductive Endocrinology

Background:

• Preterm labor and delivery are significant causes of perinatal morbidity, mortality, and adverse neurodevelopmental outcomes.
• Current primary prevention strategies for preterm birth are largely ineffective.
• Understanding the etiology of preterm labor is advancing with the recognition of subclinical infections and hormonal influences.

Purpose of the Study:

• To review the current understanding of preterm labor etiology, focusing on hormonal influences and subclinical infections.
• To discuss the limitations of current secondary prevention methods like tocolysis.
• To highlight the benefits of antenatal corticosteroids in reducing preterm birth morbidity.

Main Methods:

• Literature review of studies investigating the causes of preterm labor.
• Analysis of hormonal factors, including relaxin and gravidin, in relation to preterm delivery.
• Examination of the role of subclinical infections in preterm labor onset.

Main Results:

• Raised serum relaxin concentrations are associated with preterm delivery.
• Reduced concentrations of the phospholipase A2-inhibitor gravidin are found in women delivering preterm.
• The precise relationship between hormonal levels, socio-economic factors, and subclinical infection in preterm labor requires further establishment.

Conclusions:

• Effective primary prevention of preterm labor remains a significant challenge.
• Secondary prevention with tocolysis is unsatisfactory due to limited efficacy and adverse effects.
• Antenatal corticosteroids are beneficial in reducing preterm birth morbidity, and research into fetal maturation acceleration is ongoing.