Preterm Birth Causes, Consequences, and Prevention (2007) / Chapter Skim
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15 A Research Agenda to Investigate Preterm Birth
15 A Research Agenda to Investigate Preterm Birth
Pages 477-492
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From page 477... ...
The committee evaluated this evidence to identify gaps in knowledge and recommend areas for future research. In its review of the evidence, the committee finds that understanding of the conditions and the mechanisms that lead to preterm labor is limited and that despite the availability of several interventions that are designed to inhibit preterm labor, preterm birth remains a significant barrier to the health of newborns.
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From page 478... ...
Study the economic outcomes for infants born preterm • Conduct clinical and health services research investigations Recommendations in this category pertain to the need to examine and improve the clinical treatment of women who deliver preterm and infants born preterm and the health care systems that care for them.
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From page 479... ...
. Therefore, the committee recommends the establishment of multidisciplinary research centers to study preterm pregnancy and preterm infants.
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From page 480... ...
1. Improve National Data Birth weight is an incomplete surrogate for gestational age for determination of the risk of perinatal morbidity and mortality (Finding 2-1)
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From page 481... ...
• Perinatal mortality and morbidity should be reported by gestational age, birth weight, and birth weight for gestational age. • A categorization or coding scheme that reflects the heterogeneous etiologies of preterm birth should be developed and implemented.
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From page 482... ...
Conduct Clinical and Health Services Research Investigations The committee finds that in addition to improvements in data collection to obtain a better understanding of the scope and the nature of the problem of preterm birth, five clinical and health services areas warrant investigation: the identification and treatment of women at risk for preterm labor, study of acute and long-term outcomes for infants born preterm, study of and guidelines for infertility treatments, improvements in the quality of care for women at risk for preterm labor and infants born preterm, and investigation of the impact of the health care delivery system.
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From page 483... ...
Researchers should investigate ways to improve methods to identify and treat women with an increased risk of preterm labor. Specifically: • The content and structure of prenatal care should include an assessment of the risk of preterm labor.
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From page 484... ...
Few studies report on the outcomes for preterm infants by gestational age. In addition to infants born preterm, studies with samples of infants with birth weights less than 2,500 grams include full-term infants who are small for gestational age (Finding 11-1)
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From page 485... ...
• Follow-up and outcome evaluations for infants involved in maternal trials of prenatal means of prevention or treatment of threatened preterm delivery and infant trials of means of prevention and treatment of organ injury not only should report the infant's gestational age at delivery and any neonatal morbidity but also should include neurological and cognitive outcomes. Specific outcomes should be tailored to answer the study questions.
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From page 486... ...
Specifically, those conducting work in this area should attempt to achieve the following: • Develop comprehensive registries for clinical research, with particular emphasis on obtaining data on gestational age and birth weight, whether the preterm birth was indicated or spontaneous, the outcomes for the newborns, and perinatal mortality and morbidity. These registries must distinguish multiple gestations from singleton gestations and link multiple infants from a single pregnancy.
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From page 487... ...
However, the optimal deployment of resources for specific types of preterm delivery is not yet established (Finding 14-2)
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488 PRETERM BIRTH 5. Investigate the Role of the Health Care Delivery System Recommendation V-3: Conduct research to understand the impact of the health care delivery system on preterm birth.
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From page 489... ...
• Simple genetic and more complex epigenetic causes of preterm birth should be studied. • Gene-environment interactions and environmental factors should be considered broadly to include the physical and social environments.
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From page 490... ...
• Emphasize culturally valid measures in studies of stress and preterm delivery to consider the unique forms of stress that individuals in different racial and ethnic groups experience. Measurement of stress should also include specific constructs such as anxiety.
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From page 491... ...
III. STUDY AND INFORM PUBLIC POLICY Finally, the committee finds that effective public policies that will reduce the rates of preterm birth and improve the outcomes for infants born preterm will require a better understanding of the determinants of preterm birth and the determinants of healthy outcomes for infants born preterm and better information on effective interventions.
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From page 492... ...
492 PRETERM BIRTH ment all of the previous recommendations. Research in the areas of better defining the problem of preterm birth, clinical investigations, and etiologic and epidemiologic investigations is critical to conduct before policy makers can create policies that will successfully ad dress this problem.
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