Preterm Birth Causes, Consequences, and Prevention (2007) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 31-52
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 31... ...
committee considers low birth weight to be a poor surrogate and has specifically focused its analysis on preterm birth. Compared with infants born at term (37 to 41 weeks of gestation)
|
From page 32... ...
With assistance from the study sponsors, the Committee on Understanding Premature Birth and Assuring Healthy Outcomes was established. The sponsors include the National Institute of Child Health and Human
|
From page 33... ...
In support of these broad goals, the study will: • Review and assess the various factors contributing to the growing inci dence of premature birth, which may include the trend to delay childbearing and racial and ethnic disparities; • Assess the economic costs and other societal burdens associated with premature births; • Address research gaps/needs and priorities for defining the mechanisms by which biological and environmental factors influence premature birth; and • Explore possible changes in public health policy and other policies that may benefit from more research. In order to assess research gaps and needs, the committee will plan an addi tional meeting that will address barriers to clinical research in the area of preterm birth.
|
From page 34... ...
defined the significance of the problem of low birth weight, reviewed data on risk factors and etiology, and examined state and national trends in the incidence of low birth weight among various groups. This report also described approaches to prevent low birth weight and their economic costs and identified research needs.
|
From page 35... ...
The current report makes a novel contribution by recommending directions for action and an organizational structure that will help focus research and policy directives on a variety of dimensions of preterm birth, based on a comprehensive assessment of the status of knowledge and scientific research regarding the causes and the broad short- and long-term consequences of preterm birth. In completing its task, the committee does not, however, provide an exhaustive review of the literature examining the various etiologies of preterm birth or its consequences for infants and children.
|
From page 36... ...
The population of preterm infants is diverse, with preterm births having various etiologies and infants born preterm having various complications and outcomes. A variety of terms have been used to characterize the duration of gestation, fetal growth, and maturation.
|
From page 37... ...
Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or members of minority populations. It is difficult to assess the extent to which each potential factor accounts for the proportion of preterm births.
|
From page 38... ...
First, major trends in preterm birth; that is, the rates or proportions of preterm births by gestational age at birth, geographic location, and maternal age and preterm births resulting from ARTs, are reviewed. Second, the broad costs of preterm birth are briefly described.
|
From page 39... ...
. 10 8 Less than 32 6 weeks 32-36 weeks 4 2 0 1990 1995 2001 2000 FIGURE 1-2 Preterm births as a percentage of live births by gestational age.
|
From page 40... ...
In 2002, approximately 64 percent of all infant deaths were for the 12.1 percent of infants who were born at less than 37 weeks of gestation and 53.7 percent of all infant deaths were for the 2 percent of infants born at less than 32 weeks of gestation. (Also see Appendix B for data reflecting gestational age-specific IMRs and geographic variations in mortality rates.)
|
From page 41... ...
Among southern states, Georgia and Virginia had the lowest percentages of preterm birth: 12.6 and 11.8 percent, respectively. The trends within the four major geographic regions show that the proportion of preterm births in the Northeast increased throughout the 1990s, with a small decline from 1999 to 2000 (MOD, 2005a,b,c,d)
|
From page 42... ...
Nevertheless, such reports emphasize that international comparisons and trends must be interpreted cautiously and typically do not allow conjectures on the range of determinants that may underlie the observed differences in the rates of preterm birth to be made. Table 1-1 displays the incidence of low birth weight in selected developed and developing countries.
|
From page 43... ...
The rate was 20.7 percent of all births in 1996 and 26.1 percent of all births in 2002. While the total rate of cesarean births increased for all gestational ages between 1996 and 2003, the highest increase was for preterm infants born at 32 to 36 weeks and those born full term (37 to 41 weeks gestation)
|
From page 44... ...
The current birth rate among adolescents is the lowest rate recorded for this age group in the United States (CDC, 2005a)
|
From page 45... ...
The rates of triplets or higher-order multiple births increased from 37 to 187.4 per 100,000 live births. Multiple births are much more likely than singletons to be born preterm.
|
From page 46... ...
. Low birth weight infants are also a result of ART treatments, separate from their increased risk of preterm birth.
|
From page 47... ...
Evidence suggests greater stress in families of school-age children who were born with very low birth weights; including perceptions of less parenting competence and more difficulty in parental attachment to the child (Taylor et al., 2001)
|
From page 48... ...
. Although the highest percentages of 20 Black American 15 Indian Hispanic Asian or Pacific Islander 10 White, Non Hispanic 5 2 3 4 5 6 7 8 9 0 1 2 3 9 9 9 9 9 9 9 9 0 0 0 0 19 19 19 19 19 19 19 19 20 20 20 20 FIGURE 1-8 Preterm births as a percent of live births, by race and ethnicity, 1992 to 2003.
|
From page 49... ...
Although the proportion of preterm births among Hispanic and AsianPacific Islander women are the lowest of those among the ethnic and racial minority groups, these are not homogeneous populations. Considerable variation in preterm birth percentages exists among subpopulations of these populations.
|
From page 50... ...
Significant disparities in the mortality rates among infants born preterm also exist (Figure 1-11) (see also Appendix B for an additional discussion of the gestational age-specific IMRs among black and white infants)
|
From page 51... ...
In contrast, the mortality rates were 33.2 deaths per 1,000 live births for white infants and 30.7 deaths per 1,000 live births for Hispanic infants. Many believe that differences in family socioeconomic conditions explain the differences in the risk for preterm birth by race, particularly between African American and white, non-Hispanic women.
|
From page 52... ...
Review and assess the various factors contributing to the growing incidence of premature birth 3 to 8 Assess the economic costs and other societal burdens associated with premature births 10, 12 Address research gaps/needs and priorities for defining the mechanisms by which biological and environmental factors influence premature birth 15 Explore possible changes in public health policy and other policies that may benefit from more research 14 Identify major obstacles to conducting clinical research, which may include 13 • the declining number of residents interested in entering the field of obstetrics and gynecology and the resulting effect on the pipeline of clinical researchers • the impact of rising medical malpractice premiums on the ability of academic programs to provide protected time for physicians to pursue research • the ethical and legal issues involved with conducting research with pregnant women Provide strategies for removing barriers, including those targeting resident career choices, departments of obstetrics and gynecology, agencies and organizations that fund research, and professional organizations 13
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.