Interventions to reduce premature births: a review of the evidence

Abstract

BackgroundRisk factors for preterm births include sociodemographic factors and obstetric history. Consequently, preterm births and their consequences can be reduced through antenatal surveillance, implementation of interventions for mothers before and during pregnancy, and interventions targeted at preterm infants after birth. Following the identification of a persistent number of preterm births in the London borough of Southwark, we aimed to review the evidence from high-income countries for interventions to reduce premature births. MethodsWith a narrative review approach, data were synthesised according to the intervention category and strength of effect, and then stratified into primary, secondary, and tertiary level. Key search terms were “preterm birth”, “premature birth”, and “intervention”. The websites and databases of the following institutions and groups were searched systematically: National Institute for Health and Care Excellence, NHS Choices, Tommy's charity, Royal College of Obstetricians and Gynaecologists, WHOLIS, Centers for Disease Control and Prevention, Cochrane Library, Medline, and grey literature, supplemented with expert opinion. Searches were done between Feb 2 and Feb 6, 2018, for articles published in English between Jan 1, 1990, and Jan 31, 2018. Strength of evidence was classified according to the hierarchy of evidence provided by the National Health and Medical Research Council, with findings from randomised control trials (RCTs) given the most weight. Findings16 articles were included, of which 13 different interventions were identified for alleviating preterm births. The evidence reviewed was mixed in quality and reliability; most interventions did not exhibit consistent benefit in RCTs. Identified interventions with strong evidence of benefit were smoking cessation, progesterone supplementation, cervical cerclage, preterm surveillance clinics and screening, diagnosis and preparation, corticosteroids, magnesium sulphate, and tocolysis; moderate evidence was cervical pessaries; weak evidence was weight management services; and mixed evidence included nutritional supplementation and artificial reproduction treatments. InterpretationThe interventions identified have the potential to radically reduce the health and economic burdens associated with preterm births, deaths, and disability. This review therefore provides recommendations for implementation of interventions not only at the local level, within Southwark, but also at the regional and national level. Recommendations include targeting determinants of preterm birth, effective mapping and surveillance of at-risk women ensuring that service provision matches demand, and provision of healthy start vitamins and vitamin D to all pregnant women. FundingNone.