The second situation would be a perfectly healthy fetus that for some reason is subjected to the natural events of delivery too soon. A number of presenters speculated that perhaps not all preterm birth is bad, and in fact, it may serve as a protective mechanism in some cases for the fetus or the mother. Yet, overall, the reason for the health burden from preterm birth is summarized as increased mortality and morbidity.

RESEARCH OPPORTUNITIES

This workshop represented a unique opportunity for the Roundtable and participants to look at the field of premature birth and the research opportunities that intersect with environmental health. The insight provided by bringing together investigators from diverse disciplines, including social and behavioral sciences, toxicology, and reproductive biology, clearly points out the heterogeneous and complex nature of the factors associated with preterm birth. While planning for future research, some participants suggested that we need to look at the complexity of the process and that preterm birth will have to be treated as a chronic disease—one might see this as being similar to our approach to studying hypertension, cardiovascular disease, or diabetes.

Many speakers alluded to the idea that we are on the verge of understanding the factors underlying preterm birth at the molecular, individual, and community levels. Armed with this knowledge, we will be in a better position to develop intervention strategies to address many types of preterm birth (see Box 6.1). However, the real questions that need to be asked, according to one panelist, are how are we going to get there and how are we going to get there with great dispatch? We must bring together biological, psychological, and social research to form a partnership for science—similar to the 1960s National Aeronautics and Space Administration (NASA) project to put a man on the moon. This would require a commitment of resources to make a significant impact. Box 6.1 is a compilation of the strategies identified during these discussions.

Improving National Surveillance and Registration

Terminology

Many speakers pointed out the variety of ways to classify premature delivery. They suggested that the criteria for defining term and preterm labor should be reassessed because they can alter the interpretation of the data as well as of the risks. For example, the current data are blurred by a lack of distinction between indicated preterm labor and spontaneous preterm labor. Determinations of gestation length could be improved by the use of an additional measurement beyond calculations based on the last menstrual period. Several speakers questioned whether the appropriate measure might be preterm birth or gestational



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