Abstract

Preterm birth (PTB) is one of the major health-care challenges of our time. Being born too early is associated with major risks to the child with potential for serious consequences in terms of life-long disability and health-care costs. Discovering how to prevent PTB needs to be one of our greatest priorities. Recent advances have provided hope that a percentage of cases known to be related to risk factors may be amenable to prevention; but the majority of cases remain of unknown cause, and there is little chance of prevention. Applying the principle of precision public health may offer opportunities previously unavailable. Presented in this article are ideas that may improve our abilities in the fields of studying the effects of migration and of populations in transition, public health programs, tobacco control, routine measurement of length of the cervix in mid-pregnancy by ultrasound imaging, prevention of non-medically indicated late PTB, identification of pregnant women for whom treatment of vaginal infection may be of benefit, and screening by genetics and other “omics.” Opening new research in these fields, and viewing these clinical problems through a prism of precision public health, may produce benefits that will affect the lives of large numbers of people.

Highlights

  • Preterm birth (PTB) is the single major cause of death in children up to 5 years of age in the developed world [1,2,3]

  • Starting in the 1960s, much attention was given to developing and refining tocolytic drugs, which are therapeutic agents aiming to inhibit uterine contractions and prevent early birth. These drugs may have some usefulness in delaying PTB by hours or a few days, but do not extend pregnancies to gestational ages that will lower the rate of PTB [11]

  • What factors associated with migration are operating to decrease and increase PTB rates, and how might this information be exploited in a precision public health approach? Large amounts of data are available in various government agencies on people as they either reside in their country of origin or migrate

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Summary

Applying Precision Public Health to Prevent Preterm Birth

Preterm birth (PTB) is one of the major health-care challenges of our time. Being born too early is associated with major risks to the child with potential for serious consequences in terms of life-long disability and health-care costs. Presented in this article are ideas that may improve our abilities in the fields of studying the effects of migration and of populations in transition, public health programs, tobacco control, routine measurement of length of the cervix in mid-pregnancy by ultrasound imaging, prevention of non-medically indicated late PTB, identification of pregnant women for whom treatment of vaginal infection may be of benefit, and screening by genetics and other “omics.” Opening new research in these fields, and viewing these clinical problems through a prism of precision public health, may produce benefits that will affect the lives of large numbers of people

INTRODUCTION
Precision Public Health to Prevent PTB
SUCCESS SO FAR
PRECISION PUBLIC HEALTH
TOBACCO EXPOSURE AND PTB
Tobacco Use and Pregnancy
Controlling Tobacco Exposure to Prevent
TERM BIRTH
Findings
AUTHOR CONTRIBUTIONS
Full Text
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