Managing and Preventing Preterm Birth: How Findings From the INTERGROWTH-21st Project Can Improve Both

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By: Alison Chatfield, Project Manager, Maternal Health Task Force, Women and Health Initiative

Every year, 15 million babies are born too soon – that’s 1 in every 10 births.  Preterm birth is the leading cause of newborn deaths globally, affecting every country; it’s the leading cause of newborn deaths in the U.S. and many other high-income countries, but the burden disproportionately affects Africa and South Asia, where 60% of the world’s preterm births occur.

On World Prematurity Day, it is important to highlight areas where important progress has been made for preterm babies and identify some emerging priorities for improving the quality and effectiveness of their care, especially for the parts of the world most affected by preterm death and disability.

An important progress point is an improved definition of prematurity that shifted from a weight-based, to a gestational-age based, focus.  Earlier definitions of prematurity used weight (i.e. if a baby weighed under 2500 grams) as the measure of whether a baby was premature or not, which fails to capture developmental progress achieved through gestational age.  Now, by defining preterm birth as a birth before 37 weeks, an important distinction is made between small babies and premature babies.

There has also been progress in developing interventions for preterm babies, such as antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth, appropriate use of antibiotics, and Kangaroo Mother Care, to provide low-cost and effective care for babies born prematurely.  Sustained conversations around scaling up the implementation reflect a growing consensus that these interventions improve preterm health outcomes in a diversity of settings.  Recent commitments from Malawi, Uganda and India to prioritize preterm and essential newborn care are all promising developments.

In addition to innovations in managing preterm birth, increasing attention is being paid to preventing preterm birth through investment in maternal and preconception health, particularly through attention to risk factors such as birth spacing, infections like HIV and syphilis, and maternal weight.

Yet, rates of preterm birth continue to rise.

More progress is needed to effectively manage and prevent preterm births across the globe.  Many groups and organizations are engaging with this agenda – amongst them is the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st), an international network of researchers that has studied fetal and newborn growth in eight global study sites.  With improved understandings of growth and development central to the mission of the Consortium, this group has gathered evidence that will inform a series of new tools, guidelines and standards that will support clinical decision-making when it matters most to preterm babies.

These tools will include:

  • A new, international equation for estimating gestational age through ultrasound
  • An evidence-based phenotypic classification system that will include a more nuanced definition of prematurity and better management guidelines for preventing preterm birth
  • New fetal and pre-term specific growth charts for more accurate monitoring and improved decision-making

These innovations will contribute to the range of international collective efforts being made to improve the management and prevention of preterm birth around the world.  More information about the INTERGROWTH-21st Project can be found in a special BJOG supplement on the study’s methodology.  You can also read more about developing these universally-applicable standards and what went into managing such a large-scale research project.