Making sense of preterm birth

Abstract

p w t g t c t t t s s i e fi t Categorization, such as that represented by the taxonomy of Linnaeus and periodic table of Mendeleev, can help us ake sense of and understand the world around us. The sucess of systems such as these underscores the lack of accepted ategories and the corresponding dearth of insight that we have ith regard to preterm birth, despite the fact that it remains ne of our major public health problems. The health and economic burdens of preterm birth are ndeed remarkable. It accounts for 33% of blindness among hildren, nearly 50% of cerebral palsy, and is a leading cause f perinatal death. There is also increased evidence that preterm birth is related to morbid conditions that appear to develop in adulthood, including cardiovascular disease. It has been estimated that the health ramifications of preterm birth cost the health care system $26 billion annually. All he more sobering is the fact that we have made little progess in reducing its frequency, despite intensive basic scince, translational, clinical, and health services research. The reasons for the lack of progress are doubtlessly multifactorial, although one of the simplest reasons may be the way we conceptualize preterm birth as a result of our present classification system (or lack thereof). Kramer et al describe how, given the multiple causes for preterm birth, the dearth of a more nuanced classification system affects our ability to properly understand its multifactorial nature and properly investigate its myriad causes. They point out, for example, how relatively aimless and difficult the interpretation of a genome-wide association study of adult premature death would be, given that the underlying reasons for this death are so many and so fundamentally different. This article by Kramer et al is the first of 3 to be presented in this issue of the American Journal of Obstetrics and Gynecology that seek to rectify the present situation with regard to preterm birth classification and conceptualization. These articles are he product of a working group of international experts formed s a result of the Global Alliance to Prevent Prematurity and tillbirth meeting. They are organized cogently to demontrate: (1) the inadequacy of historic attempts at classification nd the benefits that an adequate classification system would rovide, (2) the issues that must be considered and the deci-