The epidemiology of preterm labour—why have advances not equated to reduced incidence?
Article first published online: 19 DEC 2006
BJOG: An International Journal of Obstetrics & Gynaecology
Special Issue: Reducing the Burden of Prematurity: New Advances and Practical Challenges
Volume 113, Issue Supplement s3, pages 1–3, December 2006
How to Cite
Steer, P. (2006), The epidemiology of preterm labour—why have advances not equated to reduced incidence?. BJOG: An International Journal of Obstetrics & Gynaecology, 113: 1–3. doi: 10.1111/j.1471-0528.2006.01116.x
- Issue published online: 19 DEC 2006
- Article first published online: 19 DEC 2006
- Accepted 8 September 2006.
- infectious disease;
The major burden of preterm birth is in the developing world, where most of the increasing death and morbidity is secondary to infectious diseases such as malaria, HIV, tuberculosis, bacterial vaginosis and intestinal parasites. In some developing countries, the growth of medical care has outstripped the growth of preventive public health, with an associated increase in iatrogenic preterm births. In developed countries, more than one-third of preterm births are medically indicated because of conditions such as fulminating pre-eclampsia or severe intrauterine growth restriction. Neither of these conditions is currently preventable. One in five preterm births is associated with multiple pregnancy, and these have been greatly increased by assisted reproduction techniques. The use of tocolytics has proved disappointing perhaps because inflammation rather than spontaneous uterine activity is increasingly recognised as the final common pathway. Inappropriate antibiotics used late in pregnancy are ineffective and may have adverse effects. Currently, the most promising interventions are public health related and include reducing the transmission of communicable diseases, improvements in the management of diabetes and reduction in harmful behaviours such as smoking and drug abuse.