Strategies in the Prevention of Preterm Births During and Before Pregnancy

Abstract

Preterm birth – defined as a childbirth before 259 days of gestation (<37 weeks) – is the major challenge in obstetrics and gynaecology worldwide. Preterm birth is associated with high perinatal mortality and surviving children often suffer higher morbidity throughout their lives. The incidence of preterm birth is very high in developing countries but also in some developed countries. According to a worldwide WHO report, Africa and North America, with rates of 11.9% and 10.6% in 2005, are the regions with the highest rates of incidence (Beck et al., 2010). Preterm birth not only causes much harm but also is associated with high costs. Despite considerable technical and medical improvements in obstetrics over recent decades, in developed countries preterm birth rates are not decreasing. On the contrary, the incidence continues to increase. In relation to possible preventive and epidemiologically well-founded measures, although onset and aetiology are not completely understood, our epidemiological knowledge concerning risk and protective factors of preterm birth is in no way poor. As regards preventive approaches, a distinction has to be made between primary and secondary preventive interventions, with this chapter focusing on the former. After presenting some epidemiological and economic data on preterm birth, we will summarise the scope and results of certain programmes aiming to prevent preterm births. Subsequently, we will introduce the framework and methods of our prevention programme BabyCare. Special attention will be given to the evaluative methods and results achieved by our programme in terms of effectiveness and efficiency. While we can register a considerable and stable reduction in the incidence of preterm birth by at least 25% when comparing participants in the programme with a control data set, epidemiological analysis of our data indicates further that certain persistent risk factors of preterm birth observed in relation to programme participants require additional preventive measures which, ideally, should be implemented at the pre-conceptual stage. Consequently, after releasing the BabyCare Program in 2000, the PlanBaby Program was launched in 2007. In conclusion, interventional as well as evaluative problems and limitations of our programmes will be discussed.