Epidemiology and causes of preterm birth

The Lancet 2008; 371:75-84

DOI:10.1016/S0140-6736(08)60074-4

Series, Preterm birth

Prof Robert L Goldenberg  a ,   Jennifer F Culhane PhD a,   Prof Jay D Iams MD b   and   Prof Roberto Romero MD c d

Summary

This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks’ gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12–13% in the USA and 5–9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM—together called spontaneous preterm births—are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.

Affiliations

a. Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA
b. Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, USA
c. Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI, USA
d. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA

Correspondence to: Prof Robert Goldenberg, Department of Obstetrics and Gynecology, Drexel University College of Medicine, 245 N 15th Street, 17th Floor, Room 17113, Philadelphia, PA 19102, USA

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