Being born too early is now the leading cause of death in children around the world. Preterm deliveries were responsible for 1 million out of the 6.3 million deaths of children under 5 in 2013. Its negative impacts stretch further when taking into account the health of mothers and the lives of the children who manage to survive.
While the greatest burden is felt in developing countries, it is a problem everywhere. Nearly 500,000 babies are born early each year in the United States.
But that might not be the worst part. Roughly half of all preterm births occur spontaneously, and doctors are largely unable to predict whether a mother will give birth too early.
“If you stood 100 women up in a room and asked me to pick who would have a preterm episode, I couldn’t tell you,” said Dr. Craig Rubens, executive director of the Seattle Children’s Hospital-based Global Alliance to Prevent Prematurity and Stillbirth, to Humanosphere.
“This cause of mortality needs to be studied much more specifically and in a much more focused way. Because if we don’t have the causes – if we don’t have the factors – pregnancy is going to end in a premature birth. And this needs to be the focus of intensive research,” said Dr. Andres de Francisco, interim executive director of the Partnership for Maternal Newborn and Child Health.
Efforts are under way to improve health systems so preterm babies and their mothers get needed care, but prevention and identification those at risk remains as a major gap.
Most research and investment focuses on mother-baby care after a baby is born too early. While essential, said Rubens, this is expensive and requires strong health systems. That makes for a difficult circumstance in resource-strapped developing countries. Lowering death rates will mean looking at all the components that contribute to these deaths.
“Preterm birth is almost like saying cancer,” said Rubens. “We need to refine our scientific thinking about what happens at the various stages of pregnancy and what might put a women at risk of preterm birth. The big hole is in prevention.”
Research, published in the British medical journal The Lancet, released to mark World Prematurity Day on Monday, provided an overall analysis of the causes for the 6.3 million child deaths. Pneumonia and “intrapartum-related complication” were the second and third leading causes. Half of the 3.6 million reduction in child deaths from 2000 to 2013 were due to gains against pneumonia, diarrhea and measles.
The authors hope that their findings can set out a way forward for further reducing child deaths after the Millennium Development Goals expire at the end of 2015. As always, significant gaps in available data lead them to say that more research and information is needed. They recommend targeted interventions to address each of the diseases, as well as improving access to family planning in order to reduce the risk of complications during birth.
“Although great progress has been made in child survival in the past two decades, with most of this progress in the past decade, it has not been enough. Millions of children are still dying of preventable causes at a time when we have the means to deliver cost-effective interventions,” they conclude.
“We now have the evidence to develop this momentum to achieve not only the unfinished child health agenda of the MDGs, but to further accelerate progress to end preventable child deaths in a generation, and count and account for every newborn and every child.”
Addressing preterm births will be the place where significant change can happen. The challenge is how. Rubens hopes that new research can identify women at risk and also develop new ways to prolong or prevent early labor.
Right now, the tools available can extend things by a few days, but when the difference in a child’s chance for survival and ability to thrive is measured in weeks, it is not enough. A paper co-written by Rubens and published in Science this month describes the gaps in prevention and a possible way forward.
He suggests learning more about what happens when everything goes right. Surprisingly, successful and healthy pregnancy is not well documented. Research that documents minute changes in mothers and babies over healthy pregnancies could yield important information. Health officials know what can contribute to problems, but knowing exactly what happens for things to go right is unknown. More knowledge about successful pregnancies will help researchers learn what might cause a mother to go into labor early.
“One of the biggest challenges is that when we say preterm birth, we are talking about a time point. It is like hitting this health issue with a sledgehammer, rather than a surgical incision tool,” he said.
