Some workshop participants questioned whether the disappointing trend toward an increase in preterm birth rate reflects a failure to prevent preterm delivery, or whether it results from relying on the increased use of early ultrasound for estimating gestational age, early delivery for extreme fetal growth retardation and severe preeclampsia, multiple gestation, inclusion of newborns near the borderline of viability on registries, or changes in sociodemographic or behavioral determinants of preterm birth. These questions can be answered, many participants concluded, by conducting carefully designed interdisciplinary studies that account for the environmental influences and biological mechanisms that cause a pregnancy to end prematurely, placing the fetus, and sometimes the mother, at increased risk.

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