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

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. "Appendix B Prematurity at Birth: Determinents, Consequences, and Geographic Variation ." Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press, 2007.

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Preterm Birth: Causes, Consequences, and Prevention

survival with high-risk intensive care services after they are born (1719). Beyond the elevated health care costs of newborn premature infants, however, those born preterm have an appreciable risk of long-term neurological impairment and developmental delay (2022). The ongoing medical and support service needs of these infants and their families add to the overall health care system cost burden over time and emphasize the continuing health and developmental problems that some preterm infants face. Finally, the high preterm birth rates in the United States have been identified as a major contributor to this nation’s relatively poor ranking in infant mortality among other developed countries (23). Although low birth weight has often received greater attention than preterm birth as the leading factor underlying poor pregnancy outcomes in the United States, it has been recognized that to successfully address these problems, the “key goal is prevention of preterm birth” (23).

Policy makers and the public need to be kept informed of the rapid developments in research and their implications for clinical practice and public programs and policies. Because of the continuing problem that premature birth poses in the United States and other countries, as well as the rapid and ongoing developments in research in this area, there has been a recognized need for periodic forums, reports, and public investigative committees that would increase knowledge and awareness of evolving strategies for the prevention of preterm birth. In 1985, the Institute of Medicine released the report of its Committee to Study the Prevention of Low Birth Weight (24). That report addressed the epidemiology of low birth weight and assessed preventive approaches for cost and effectiveness. That same year, Émile Papiernik, an international French innovator and leader in prematurity research, organized a conference in Evian, France, entitled Prevention of Preterm Birth: New Goals and New Practices in Prenatal Care. That conference focused on reducing the risk of preterm labor and delivery and offered participants an opportunity to disclose their latest research findings (25). A follow-up to the 1985 Evian conference was held in the United States in 1988. That conference, Advances in the Prevention of Low Birth Weight, was hosted by H. Berendes, S. Kessel, and S. Yaffe and focused on the results of clinical trials and community-based interventions aimed at reducing low birth weight (25). Yet another follow-up to those conferences, The International Conference on Preterm Birth: Etiology, Mechanisms and Prevention, was held in 1997 (26). That conference was also developed to provide an overview of studies in preterm birth research, a review of risk factors and potential etiologic pathways, and an assessment of the then current intervention and prevention strategies.

Other reports, conferences, and national efforts, including the current Prematurity Campaign of the National March of Dimes, have been developed over the last 2 decades to address the widely perceived problem of

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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)