WHITE PLAINS, N.Y., JAN. 24 – Hopes of finding a reliable way to predict a woman’s risk of having a premature baby were dashed today by the findings of a randomized clinical trial published in The New England Journal of Medicine, the March of Dimes says.
In the study, women used a home monitor to measure their uterine contractions. However, the testing failed to distinguish between those women who eventually had a preterm birth (before 37 weeks of gestation) and those who had a full-term delivery. The authors also note that other current tests, such as ultrasound and fetal fibronectin, also have low predictive value.
“Once again, we see that it’s nearly impossible with the technology we have today to accurately predict who is going to give birth to a premature baby,” says Nancy S. Green, M.D., acting medical director of the March of Dimes. “And the problem is only getting worse, because prematurity in America is on the rise -- the rate of premature birth has increased by 23 percent since the 1980s.”
Dr. Green points out that a separate study published in last week’s issue of NEJM showed that many babies born prematurely or at low birthweight (less than 5-1/2 pounds) had lower IQs, more serious problems with learning, and more chronic health problems that persisted into young adulthood. Prematurity and low birthweight account for more than 90 percent of all newborn deaths in the United States.
“If we truly want to help more babies be born healthy and lead healthy lives, we need more research aimed at preventing prematurity from occurring in the first place,” Dr. Green says.
Dr. Green said that since 1998, the March of Dimes has awarded nearly $8 million in grants to investigate biological and environmental factors that may contribute to the more than 450,000 preterm or low birthweight births each year in the United States. As part of this unique research program, the organization has selected six of the foremost research teams in the world in the area of preterm birth to receive March of Dimes Perinatal Epidemiological Research Initiative (PERI) grants. Among these is a team led by Charles J. Lockwood, M.D., chairman of the Department of Obstetrics and Gynecology at New York University School of Medicine and author of an accompanying editorial in today’s NEJM, “Predicting Premature Delivery – No Easy Task.”
“Although several biomarkers are associated with premature delivery, the findings of Iams et al. reinforce the conclusion that the practical usefulness of these markers in the case of an individual woman is limited. Although we have come a long way in understanding the mechanisms involved in the pathogenesis of prematurity, we have a long way to go,” Dr. Lockwood writes.
In his March of Dimes PERI grant, Dr. Lockwood is following 3,000 women throughout their pregnancies, tracing 26 different clues that have been linked to prematurity. Dr. Lockwood suggests that there are several main “routes” to preterm birth, including infection and hormone changes. Furthermore, he proposes that these routes may come together into one final pathway to preterm labor and delivery involving uterine contractions as well as softening of the cervix and fetal membranes. Finding which route or routes in any individual pregnancy lead to this final pathway may lead to the design of efficient, focused interventions to prevent or stop the initial steps toward premature birth early enough to be effective.
“Frequency of Uterine Contractions and the Risk of Spontaneous Preterm Delivery,” by Jay D. Iams, M.D., of Ohio State University, Columbus, and colleagues in the National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units appeared in NEJM, volume 346, number 4, January 24, 2002.
The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy to save babies. For more information, visit the March of Dimes Web site at http://www.marchofdimes.com, its Spanish Web site at http://www.nacersano.org, or call 1-888-MODIMES.
Materials provided by March Of Dimes Birth Defects Foundation. Note: Content may be edited for style and length.
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