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Preterm Birth: Causes, Consequences, and Prevention
A
Data Sources and Methods
The Committee on Understanding Premature Birth and Assuring Healthy Outcomes was asked to evaluate the state of the science on the causes and consequences of preterm birth. The committee assessed the various factors contributing to preterm birth; reviewed the economic, medical, social, psychological, and educational outcomes for children and families; addressed research gaps and needs; and explored changes in health policies.
To provide a comprehensive response to the study charge, the committee examined data from a variety of sources. These data sources included a review of recent scientific literature, public input through a series of workshops, and commissioned papers on selected topics. The study was conducted over a 21-month period.
DESCRIPTION OF THE STUDY COMMITTEE
A study committee composed of 17 members was assembled to assess the available data and make recommendations. The committee membership included individuals with expertise in obstetrics and gynecology, pediatrics, environmental health, epidemiology, psychology, economics, genetics, and public health. The committee convened for six 2-day meetings in March 2005, June 2005, August 2005, October 2005, December 2005, and January 2006.
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LITERATURE REVIEW
Three strategies were combined to identify literature in support of the committee’s charge. First, a search on the EMBASE and Medline databases was conducted to obtain articles from peer-reviewed journals. The searches focused on preterm birth and low birth weight, including their genetic, behavioral, biological, and environmental causes, as well as their economic, educational, health, and family consequences. Second, the reports of federal agencies, such as the National Institutes of Health and the Centers for Disease Control and Prevention, relevant to preterm birth and low birth weight were also gathered. Finally, committee members and workshop participants submitted articles and reports on those topics. The resulting database included more than 800 articles and reports.
COMMISSIONED PAPERS
The study committee commissioned three papers intended to provide in-depth information on selected topics, beyond the independent analysis of the literature conducted by the committee. The topics of these papers included geographic variations in rates of preterm birth, prematurity-related ethical issues, and the economic costs associated with preterm birth. The members of the committee determined the topics and the authors of the papers. These papers were not intended to serve as substitutes for the committee’s own review and analysis of the literature. The committee independently deliberated on these topics before it received the drafts of the papers.
PUBLIC WORKSHOPS
The committee hosted three public workshops to gain additional information on specific aspects of the study charge. These workshops were held in conjunction with the March, June, and August meetings. The study committee determined the topics and the speakers.
The first workshop was intended to provide an overview of key issues in the area of preterm birth and to discuss the committee’s charge. Content focused on the biological pathways associated with preterm birth, as well as the educational, economic, and family consequences. Additionally, representatives from the study’s sponsors were invited to discuss the charge to the committee. The second workshop focused on the role of maternal conditions, such as infection, inflammation, and preeclampsia in preterm birth; the epidemiology of preterm birth; public policies that may address the problem of preterm birth; controversial issues in the care of preterm infants; and racial disparities in the rates of preterm birth. The third and final
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workshop focused on barriers to clinical research. Specifically, presenters addressed issues related to the current state of the workforce, key issues in career development, ethics and liability issues in research, funding of research, drug development research, and the leadership required for the development of research capacity within departments of obstetrics and gynecology. Each workshop was open to the public; and individuals were invited to present information to the committee, discuss their presentations, and address inquiries from the committee. The agendas of these workshops, including the names of the workshop participants, are included in Boxes A-1 through A-3.
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BOX A-1
Institute of Medicine
Committee on Understanding Premature Birth and Assuring Healthy Outcomes
The National Academies Building
2100 C Street, NW
Washington, D.C.
Room 150
AGENDA
Wednesday March 30, 2005
12:30 p.m.
WELCOME AND INTRODUCTIONS
Richard E. Behrman, M.D.
Chair, Committee on Understanding Premature Birth and Assuring Healthy Outcomes
OVERVIEW OF KEY ISSUES
12:45 p.m.
Pathogenesis of Prematurity
Charles J. Lockwood, M.D.
Chair, Department of Obstetrics and Gynecology
Yale School of Medicine
1:15 p.m.
Discussion
1:30 p.m.
Educational and Family Sequelae of Prematurity: Findings from Naturalistic and Experimental Studies
Sharon Landesman Ramey, Ph.D.
Professor, School of Nursing and Health Studies
Georgetown University
1:50 p.m.
Economic Consequences of Prematurity
Scott Grosse, Ph.D.
Senior Health Economist, National Center for Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention
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2:10 p.m.
Impact of Prematurity: A Parent Perspective
Kathy Paz
President and Founder
Preemies Today
2:30 p.m.
Discussion
3:00 p.m.
BREAK
3:15 p.m.
DELIVERY OF STUDY CHARGE
Duane Alexander, M.D.
Director, National Institute of Child Health and Human Development
National Institutes of Health
Scott Grosse, Ph.D.
Senior Health Economist, National Center for Birth Defects and Developmental Disabilities
Eve M. Lackritz, M.D.
Chief, Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
3:45 p.m.
DISCUSSION OF STUDY CHARGE
Richard Schwarz, M.D.
Vice Chair of Obstetrics and Gynecology
Maimonides Medical Center
Michael Katz, M.D.
Senior Vice President for Research and Global Programs
March of Dimes Birth Defects Foundation
Enriqueta C. Bond, Ph.D.
President
The Burroughs Wellcome Fund
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Ann Koontz, C.N.M., Dr.P.H.
Associate Director, Division of Perinatal Systems and Women’s Health
Maternal and Child Health Bureau, Health Resources and Services Administration
Loretta Finnegan, M.D.
Medical Advisor for the Director, Office of Research on Women’s Health
National Institutes of Health
Debra Hawks, M.P.H.
Director, Practice Activities
American College of Obstetricians and Gynecologists
Sean Tipton
Director of Public Affairs
American Society for Reproductive Medicine
Arnold Cohen, M.D.
Chairman, Department of Obstetrics and Gynecology, Albert Einstein Medical Center
Society for Maternal-Fetal Medicine
5:15 p.m.
ADJOURN
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BOX A-2
Institute of Medicine
Committee on Understanding Premature Birth and Assuring Healthy Outcomes
The National Academies Building
2100 C Street, NW
Washington, D.C.
Room 180
AGENDA
Wednesday, June 22, 2005
7:30 a.m.
WELCOME AND INTRODUCTIONS
Richard E. Behrman, M.D.
Chair, Committee on Understanding Premature Birth and Assuring Healthy Outcomes
7:45 a.m.
THE ROLE OF INFECTION AND INFLAMMATION IN PREMATURE BIRTH
Prenatal Infection and Inflammation
Robert Goldenberg, M.D.
Department of Obstetrics and Gynecology
University of Alabama at Birmingham
8:30 a.m.
Discussion
8:45 a.m.
Antenatal and Postnatal Inflammation Effects on the Preterm Lung
Alan Jobe, M.D., Ph.D.
Department of Pediatrics
Cincinnati Children’s Hospital Medical Center
9:05 a.m.
Inflammation and Perinatal Brain Damage
Michael O’Shea, M.D., M.P.H.
Department of Pediatrics
Wake Forest University School of Medicine
9:25 a.m.
Discussion
10:00 a.m.
BREAK
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10:15 a.m.
Preeclampsia: Maternal/Fetal Mortality and Morbidity
John Hauth, M.D.
Department of Obstetrics and Gynecology
University of Alabama School of Medicine
10:45 a.m.
Discussion
11:15 a.m.
EPIDEMIOLOGY OF PRETERM BIRTH
Michael Kramer, M.D.
Departments of Pediatrics and Epidemiology and Biostatistics
McGill University
12:00 a.m.
Discussion
12:30 p.m.
LUNCH
1:30 p.m.
OVERVIEW OF POLICIES RELATING TO PRETERM DELIVERY
Wendy Chavkin, M.D., M.P.H.
Department of Population and Family Health
Columbia University’s Mailman School of Public Health
2:00 p.m.
Discussion
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2:15 p.m.
CONTROVERSIAL ISSUES IN NEONATAL CARE
F. Sessions Cole, M.D.
Department of Pediatrics
Washington University School of Medicine
Jerold F. Lucey, M.D.
Department of Pediatrics
University of Vermont College of Medicine
Robert M. Nelson, M.D., Ph.D.
Department of Anesthesia and Critical Care Medicine
The Children’s Hospital of Philadelphia
4:00 p.m.
ADJOURN—Reception
Thursday, June 23, 2005
Room 180
8:30 a.m.
Racial Disparities in Preterm Delivery: Health Care and Research Issues
Carol Rowland Hogue, Ph.D., M.P.H.
Department of Epidemiology
Emory University School of Public Health
9:30 a.m.
ADJOURN
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BOX A-3
Institute of Medicine
Committee on Understanding Premature Birth and Assuring Healthy Outcomes
Keck Center of the National Academies
500 Fifth Street, NW
Washington, D.C.
Room 100
Public Workshop on Barriers to Clinical Research Related to Premature Birth
Wednesday, August 10, 2005
8:30 a.m.
Welcome and Introductions
Richard Behrman, M.D., J.D.
Chair, Committee on Understanding Premature Birth and Assuring Healthy Outcomes
8:45 a.m.
Nurse-Midwife Workforce
Kerri Durnell Schuiling, Ph.D., C.N.M, F.A.C.N.M.
Professor and Associate Dean for Nursing Education
Northern Michigan University
Senior Staff Researcher, American College of Nurse-Midwives
9:00 a.m.
Discussion
9:15 a.m.
Career Development
Jerome F. Strauss III, M.D., Ph.D.
Professor and Director, Center for Research on Reproduction and Women’s Health
University of Pennsylvania Medical Center
9:30 a.m.
Diane Magrane, M.D.
Associate Vice President, Faculty Development and Leadership Programs
Association of American Medical Colleges
9:45 a.m.
Discussion
10:15 a.m.
BREAK
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10:30 a.m.
Funding of Research on Premature Birth
John V. Ilekis, Ph.D.
Health Scientist Administrator, Pregnancy and Perinatology Branch
Center for Developmental Biology and Perinatal Medicine
National Institutes of Health
National Institute of Child Health and Development
10:50 a.m.
William Callaghan, M.D., M.P.H.
Senior Scientist, Maternal and Infant Health Branch
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
11:05 a.m.
Enriqueta C. Bond, Ph.D.
President
Burroughs Wellcome Fund
11:20 a.m.
Nancy Green, M.D.
Medical Director
March of Dimes
11:35 a.m.
Discussion
1:00 p.m.
Ethical and Liability Issues in Reproductive Research
Robert M. Nelson, M.D., Ph.D.
Associate Professor of Anesthesiology and Critical Care
University of Pennsylvania School of Medicine
The Children’s Hospital of Philadelphia
1:10 p.m.
Robert Goldenberg, M.D.
Professor of Obstetrics and Gynecology
University of Alabama at Birmingham
1:20 p.m.
John M. Gibbons, Jr., M.D.
Professor of Obstetrics and Gynecology
University of Connecticut School of Medicine
Past President, American College of Obstetricians and Gynecologist
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1:30 p.m.
Discussion
2:00 p.m.
Training Required for Future Reproductive Research
Sudhansu K. Dey, Ph.D.
Professor, Department of Pediatrics, Departments of Cell and Developmental Biology and Pharmacology
Vanderbilt University
2:15 p.m.
Jeff Reese, M.D.
Associate Professor, Department of Pediatrics
Vanderbilt University
2:30 p.m.
Discussion
3:00 p.m.
Theodore M. Danoff, M.D., Ph.D
Director, Discovery Medicine
Hypertension, PTL, Renal and Thrombosis Disease Area Glaxo Smith Kline
3:15 p.m.
Discussion
3:35 p.m.
BREAK
3:50 p.m.
Robert Goldenberg, M.D.
Professor, Department of Obstetrics and Gynecology
University of Alabama at Birmingham
Jerome F. Strauss III, M.D., Ph.D.
Professor and Director, Center for Research on Reproduction and Women’s Health
University of Pennsylvania Medical Center
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Linda J. Heffner, M.D., Ph.D.
Professor and Chair, Department of Obstetrics and Gynecology
Boston University Medical Center
David Eschenbach, M.D.
Professor and Chair, Department of Obstetrics and Gynecology
University of Washington
Garland D. Anderson, M.D.
Professor and Chair, Department of Obstetrics and Gynecology
University of Texas Medical Branch
Katherine E. Hartmann, M.D., Ph.D.
Director, Center for Women’s Health Research
University of North Carolina
4:45 p.m.
Discussion
5:30 p.m.
Adjourn
Thursday, August 11, 2005
Room 110
9:00 a.m.
Economic Costs of Premature Birth
Stavros Petrou, M.Phil., Ph.D.
National Perinatal Epidemiology Unit
University of Oxford
10:30 a.m.
Adjourn
Representative terms from entire chapter:
premature birth
