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IOM Calls for More Research on Preterm Births : The cost of extra medical care and lost productivity from this rising problem exceeded $26 billion in 2005.


 

More than 500,000 infants or about 12.5% of infants born in 2004 in the United States were preterm and the rate of preterm births has risen by about 30% since 1981, according to a new report from the National Academy of Sciences' Institute of Medicine.

Preterm birth, defined as any birth that occurs at less than 37 completed weeks of gestation, disproportionately affects women in certain racial, ethnic, and socioeconomic groups. For example, in 2003, nearly 18% of African American women had preterm births, compared with 11.9% of Hispanic women and 11.5% of non-Hispanic white women, the Institute of Medicine (IOM) report said.

“This is a growing problem that can result in significant consequences for families and for society as a whole,” Dr. Richard E. Behrman, chair of the IOM committee that produced the report, said during a press conference. “Yet preterm birth is not receiving the attention and funding necessary to fully understand the causes and consequences and to identify ways to reduce the number of preterm deliveries.”

Infants delivered preterm are at greater risk for a variety of health and developmental problems than full-term infants but there are also significant economic costs associated with preterm births. The cost of medical care in infancy, maternal care, early intervention services, special education, and lost productivity from preterm birth added up to more than $26 billion in 2005, according to the IOM report. And this is likely to be a conservative estimate, said Dr. Behrman, who is executive chair of the Pediatric Education Steering Committee for the Federation of Pediatric Organizations Inc., in Menlo Park, Calif.

In addition to defining the scope of the problem, the IOM report outlines a multidisciplinary research agenda aimed at improving information on the causes and treatment of preterm birth. The report calls on the federal government and private institutions to do a better job on collecting preterm birth data and to increase research that will lead to better identification of women at risk for preterm labor.

Although there have been significant improvements in treating preterm infants, there has been comparatively little success in understanding and preventing preterm birth, Dr. Behrman said. In effort to address some of those gaps, the IOM committee made a series of recommendations for public and private researchers. Some of the recommendations include:

Multidisciplinary research centers. The National Institutes of Health and private foundations should establish integrated multidisciplinary research centers to focus on better understanding the causes of preterm birth and health outcomes for women and infants, the IOM committee recommended.

Ultrasound use. Professional societies should encourage the use of ultrasound before 20 weeks' gestation and establish standards of practice for training personnel to improve the reliability of ultrasound data, the IOM committee recommended. These efforts are important to gain accurate measures of gestational age, according to the report.

Infertility treatments. NIH, CDC, and other agencies should support research into how fertility treatments can increase the risk for preterm birth. The report also calls on professional societies to establish guidelines aimed at reducing the number of multiple gestations, such as single embryo transfer and restricted use of superovulation drugs. The Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine, which have already issued guidelines on the number of embryos that should be transferred per cycle, announced that upcoming revisions to their guidelines should help to further reduce the incidence of multiples and preterm births associated with assisted reproductive technology.

Identification and treatment. Researchers should focus on ways to identify and treat women who have an increased risk of preterm labor, such as studying known markers of preterm labor and potential new genetic markers that could lead to the creation of an “individualized composite assessment of risk.” Better methods are needed to diagnose preterm labor, assess fetal health, and arrest labor, the report said.

Perinatal data. National Center for Health Statistics, part of the Centers for Disease Control and Prevention, should collect and report national perinatal data, the IOM committee recommended.

Etiologic and epidemiologic studies. Public and private funding agencies should support research into the etiologies of preterm birth, the report said. The IOM committee also urged agencies to promote research that would simultaneously examine multiple risk factors for preterm birth instead of looking at risk factors individually.

Health disparities. NIH and other agencies should examine the causes of racial, ethnic, and socioeconomic disparities related to preterm birth and devote resources to developing prevention strategies, the IOM committee recommended.

The report is a “call to arms” for the federal government to devote significantly more resources to preterm birth, Dr. Charles Lockwood, professor and chair of the department of obstetrics and gynecology and reproductive sciences at Yale University, said in an interview. Dr. Lockwood, who was one of the reviewers of the IOM report, said a 10-fold increase in current government spending on preterm birth would be a good start.

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