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

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. "Appendix C A Review of Ethical Issues involved in Premature Birth ." Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press, 2007.

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Preterm Birth: Causes, Consequences, and Prevention

pregnancy resulted from rape or incest.” Otherwise, the consent of the pregnant woman is sufficient. “For children as defined in §46.402(a) who are pregnant, assent and permission are obtained in accord with the provisions of subpart D of this part.”

Children are defined as “persons who have not attained the legal age for consent to treatments or procedures involved in the research, under the applicable law of the jurisdiction in which the research will be conducted.” There must be an independent assessment of the viability of the neonate. In addition, “individuals engaged in the research will have no part in any decisions as to the timing, method, or procedures used to terminate a pregnancy.”

Neonates of uncertain viability and nonviable neonates may be involved in research (§46.205) if the following conditions are met: Neonates of uncertain viability may not be involved in research unless the research holds out the prospect of enhancing the probability of survival of the neonate to the point of viability, and any risk is the least possible for achieving that objective, or the purpose of the research is the development of important biomedical knowledge which cannot be obtained by other means and there will be no added risk to the neonate resulting from the research. If neither parent is able to consent because of unavailability, incompetence, or temporary incapacity, the legally effective informed consent of either parent’s legally authorized representative can be obtained.

After delivery a nonviable neonate may not be involved in research covered by this subpart unless all of the following additional conditions are met: (a) vital functions of the neonate will not be artificially maintained; (b) the research will not terminate the heartbeat or respiration of the neonate; (c) there will be no added risk to the neonate resulting from the research; (d) the purpose of the research is the development of important biomedical knowledge that cannot be obtained by other means; and (e) the legally effective informed consent of both parents of the neonate is obtained (unless either parent is unable to consent because of unavailability, incompetence, or temporary incapacity, or the consent of the father need not be obtained if the pregnancy resulted from rape or incest). The consent of a legally authorized representative of either or both of the parents of a nonviable neonate will not suffice.

A neonate, after delivery, that has been determined to be viable may be included in research only to the extent permitted by and in accord with the requirements of subparts A and D of this part.

Research Involving Pregnant Adolescents

Although the National Commission intended that the state consent laws for the treatment of minors apply in the research setting, this has been a point of contention and debate. For example, in adopting Subpart D, the

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681
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)