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Preterm Birth: Causes, Consequences, and Prevention (2007)
Board on Health Sciences Policy (HSP)

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. "Summary." Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press, 2007.

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Preterm Birth: Causes, Consequences, and Prevention

ing the risk of preterm birth (Alexander and Kotelchuck, 2001; Lu and Halfon, 2003), it too seems an unlikely mediator of socioeconomic disparities in preterm birth. Bacterial vaginosis is more common among women of low SES (Hillier et al., 1995; Meis et al., 1995); however, clinical trials of screening and treatment have yielded conflicting results (Carey et al., 2000; McDonald et al., 2005). Finally, women of low SES women experience more stressful life events and more chronic stress (Lu et al., 2005; Peacock et al., 1995), which are linked to preterm birth.

Other behavioral and social differences between African American and white women have been evaluated as potential causes of the disparity in preterm birth rates. Proportionately fewer African American women smoke cigarettes (Beck et al., 2002; Lu et al., 2005) and their rate of use of drugs and alcohol is no higher than white women’s (Serdula et al., 1991). The effectiveness of prenatal care for preventing prematurity has yet to be conclusively demonstrated (Alexander and Kotelchuck, 2001; Lu and Halfon, 2003; CDC, 2005i). African American women are more likely than white women to experience infections, including bacterial vaginosis and sexually transmitted infections (Fiscella, 1995; Meis et al., 2000). However, the cause of this increased susceptibility to infections among pregnant African American women largely remains unknown, and treatment has yielded modest or no benefits (Carey et al., 2000; King, 2002; McDonald et al., 2005). Insofar as African American women may experience more stress in their daily lives than white women, it has been suggested that maternal stress may contribute to the disparities in the rates of preterm birth between African American and white women (James, 1993; Krieger, 2002; Lu and Chen, 2004). Although a woman’s genetic makeup undoubtedly plays a role in the pathogenesis of preterm birth, the potential genetic contribution to racial disparities in preterm birth is unknown (Cox et al., 2001; Hassan et al., 2003; Hoffman et al., 2002; Varner and Esplin, 2005).


Recommendation II-3: Expand research into the causes and methods for the prevention of the racial-ethnic and socioeconomic disparities in the rates of preterm birth. The National Institutes of Health and other funding agencies should expand current efforts in and expand support for research into the causes and methods for the prevention of the racial-ethnic and socioeconomic disparities in the rates of preterm birth. This research agenda should continue to prioritize efforts to understand factors contributing to the high rates of preterm birth among African American infants and should also encourage investigation into the disparities among other racial-ethnic subgroups.

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Front Matter (R1-R18)
Summary (1-30)
1 Introduction (31-52)
SECTION I Measurement : 2 Measurement of Fetal and Infant Maturity (53-83)
Section I Recommendations (84-86)
SECTION II Causes of Preterm Birth: 3 Behavioral and Psychosocial Contributors to Preterm Birth (87-123)
4 Sociodemographic and Community Factors Contributing to Preterm Birth (124-147)
5 Medical and Pregnancy Conditions Associated with Preterm Birth (148-168)
6 Biological Pathways Leading to Preterm Birth (169-206)
7 Role of Gene-Environment Interactions in Preterm Birth (207-228)
8 Role of Environmental Toxicants in Preterm Birth (229-254)
Section II Recommendations (255-258)
SECTION III Diagnosis and Treatment of Preterm Labor: 9 Diagnosis and Treatment of Conditions Leading to Spontaneous Preterm Birth (259-307)
Section III Recommendations (308-310)
SECTION IV Consequences of Preterm Birth: 10 Mortality and Acute Complications in Preterm Infants (311-345)
11 Neurodevelopmental, Health, and Family Outcomes for Infants Born Preterm (346-397)
12 Societal Costs of Preterm Birth (398-429)
Section IV Recommendations (430-432)
SECTION V Research and Policy: 13 Barriers to Clinical Research on Preterm Birth and Outcomes of Preterm Infants (433-454)
14 Public Policies Affected by Preterm Birth (455-472)
Section V Recommendations (473-476)
15 A Research Agenda to Investigate Preterm Birth (477-492)
References (493-590)
Appendix A Data Sources and Methods (591-603)
Appendix B Prematurity at Birth: Determinents, Consequences, and Geographic Variation (604-643)
Appendix C A Review of Ethical Issues involved in Premature Birth (644-687)
Appendix D A Systematic Review of Costs Associated with Preterm Birth (688-724)
Appendix E Selected Programs Funding Preterm Birth Research (725-731)
Appendix F Committee and Staff Biographies (732-740)
Index (741-772)