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the earliest gestational ages. However, those infants born nearer to term represent the greatest number of infants born preterm and also experience more complications than infants born at term.

Preterm birth is a complex cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, neighborhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors, and genetics. Many of these factors occur in combination, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups.

The current methods for the diagnosis and treatment of preterm labor are currently based on an inadequate literature, and little is know about how preterm birth can be prevented. Treatment has been focused on inhibiting contractions. This has not reduced the incidence of preterm birth but has delayed delivery long enough to allow the administration of antenatal steroids and transfer of the mother and fetus to a hospital where they may receive appropriate care. These interventions have reduced the rates of perinatal mortality and morbidity. Although improvements in perinatal and neonatal care have significantly improved the rates of survival for infants born preterm, these infants remain at risk for a host of acute and chronic health problems. Therapies and interventions for the prediction and the prevention of preterm birth are thus needed.

Upon review of the literature assessing the causes and consequences of preterm birth, the diagnosis and treatment of women at risk for preterm labor, and treatments for infants born preterm, the committee proposes a research agenda for investigating the problem of preterm birth that is intended to help focus and direct research efforts. Priority areas are: (1) the establishment of multidisciplinary research centers; (2) improved research in three areas including better definition of the problem of preterm birth with improved data, clinical and health services research investigations, and etiologic and epidemiologic investigations; and (3) the study and informing of public policy. The committee hopes that its efforts will help provide a framework for working toward improved outcomes for children born preterm and their families.

The prevalence of preterm birth in the United States constitutes a public health problem, but unlike many health problems, the rate of preterm birth has increased in the last decade. In 2004, 12.5 percent of births were



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