little or no impact on the rate of preterm births, whereas nutritional supplementation has had mixed results. This may be one area where additional research is needed.

PURPOSE AND TIMING OF THIS WORKSHOP

“Mortality is decreasing primarily because of our ability to intervene, but we’ve really not made much of an impact at all on morbidity,” said Donald R. Mattison of Columbia University. Despite research efforts that are complete or ongoing, we still do not understand the many divergent causes of preterm birth, and therefore we lack the interventions needed to prevent it. Many speakers, however, described research findings suggesting that we may be on the verge of understanding the intervening factors of preterm birth at the molecular, individual, and community levels.

Despite research efforts that are complete or ongoing, we still do not understand the many divergent causes of preterm birth, and therefore we lack the interventions needed to prevent it.

Donald R. Mattison

During this two-day workshop, several speakers suggested that a greater understanding of the factors that constitute normal parturition and labor as well as those that contribute to preterm birth is needed. Chapter 2 of this workshop summary focuses on what is known about the normal mechanisms of labor and delivery that might lead to identification of the causes of preterm birth. Chapter 3 provides an overview of the biological causes of preterm birth. Chapters 4 and 5 explore environmental factors, including the social environment, gene–environment interactions associated with preterm birth, and research protocols used by federal agencies that may detect toxicant effects on gestation length. Finally, Chapter 6 presents workshop participants’ proposals for future research directions that are needed to address this major public health concern.



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