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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
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PRETERM BIRTH

CAUSES, CONSEQUENCES, AND PREVENTION

Committee on Understanding Premature Birth and Assuring Healthy Outcomes

Board on Health Sciences Policy

Richard E. Behrman and Adrienne Stith Butler, Editors

INSTITUTE OF MEDICINE OF THE ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

THE NATIONAL ACADEMIES PRESS

500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. N01-OD-4-2139, Task Order No. 145 between the National Academy of Sciences and the National Institute for Child Health and Human Development, Centers for Disease Control and Prevention, Health Resources and Services Administration, Environmental Protection Agency, and NIH Office of Research on Women’s Health; and contracts with the March of Dimes, Burroughs Wellcome Fund, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, and the Society for Maternal-Fetal Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Preterm birth : causes, consequences, and prevention / Committee on Understanding Premature Birth and Assuring Healthy Outcomes, Board on Health Sciences Policy ; Richard E. Behrman, Adrienne Stith Butler, editors.

p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-309-10159-2 (hardback)

ISBN-10: 0-309-10159-X (hardback)

1. Labor, Premature. I. Behrman, Richard E., 1931- . II. Butler, Adrienne Stith. III. Institute of Medicine (U.S.). Committee on Understanding Premature Birth and Assuring Healthy Outcomes. [DNLM: 1. Premature Birth—diagnosis—United States. 2. Premature Birth—economics—United States. 3. Premature Birth—prevention & control—United States. 4. Public Policy—United States.

WQ 330 P9413 2006]

RG649.P744 2006

618.3′97—dc22

2006028538

Additional copies of this report are available from the

National Academies Press,

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Copyright 2007 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

COMMITTEE ON UNDERSTANDING PREMATURE BIRTH AND ASSURING HEALTHY OUTCOMES

RICHARD E. BEHRMAN (Chair), Executive Chair,

Pediatric Education Steering Committee, Federation of Pediatric Organizations, Inc., Menlo Park, CA

ELI Y. ADASHI, Dean of Medicine and Biological Sciences,

Brown University, Providence, RI

MARILEE C. ALLEN, Professor of Pediatrics,

The John Hopkins Hospital, Baltimore, MD

RITA LOCH CARUSO, Professor,

Environmental Health Sciences, Associate Research Scientist, School of Public Health, University of Michigan, Ann Arbor

JENNIFER CULHANE, Associate Professor,

Department of Obstetrics & Gynecology, Drexel University College of Medicine, Philadelphia, PA

CHRISTINE DUNKEL SCHETTER, Professor,

Department of Psychology, Health and Social Psychology, University of California, Los Angeles

MICHEAL G. GRAVETT, Professor and Vice-Chairman,

Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle

JAY D. IAMS, Professor and Vice-Chairman,

Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus

MICHAEL C. LU, Assistant Professor,

Department of Community Health Sciences, School of Public Health, Deparment of Obstetrics and Gynecology, School of Medicine, University of California, Los Angeles

MARIE C. MCCORMICK, Professor,

Department of Society, Human Development and Health, School of Public Health, Harvard University, Boston, MA

LAURA E. RILEY, Director,

Labor and Delivery, Director, Infectious Disease, Massachusetts General Hospital, Boston

JEANNETTE A. ROGOWSKI, University Professor,

Department of Health Systems and Policy, School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick

SAROJ SAIGAL, Professor of Pediatrics, Director,

Neonatal Follow-up Program, Senior Scientist, CIHR, McMaster University, Hamilton, Ontario, Canada

DAVID A. SAVITZ, Professor,

Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York

HYAGRIV N. SIMHAN, Assistant Professor,

Divisions of Maternal-Fetal Medicine and Reproductive Infectious Diseases and Immunology, University of Pittsburgh, Magee-Women’s Hospital, Pittsburgh, PA

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

NORMAN J. WAITZMAN, Associate Professor,

Deparment of Economics, University of Utah, Salt Lake City

XIAOBIN WANG,

Director and Mary Ann and J. Milburn Smith Research Professor, Children’s Memorial Hospital and Children’s Memorial Research Center, Chicago, IL

Health Sciences Policy Board Liaison

GAIL H. CASSELL, Vice President,

Scientific Affairs, Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company, Indianapolis, IN

IOM Project Staff

ADRIENNE STITH BUTLER, Study Director

EILEEN J. SANTA, Research Associate

THELMA L. COX, Senior Program Assistant

Copy Editor

MICHAEL HAYES

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

BOARD ON HEALTH SCIENCES POLICY

FRED H. GAGE (Chair),

The Salk Institute for Biological Studies, La Jolla, CA

GAIL H. CASSELL,

Eli Lilly and Company, Indianapolis, IN

JAMES F. CHILDRESS,

University of Virginia, Charlottesville

ELLEN WRIGHT CLAYTON,

Vanderbilt University Medical School, Nashville, TN

DAVID R. COX,

Perlegen Sciences, Mountain View, CA

LYNN R. GOLDMAN,

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

BERNARD D. GOLDSTEIN,

University of Pittsburgh, Pittsburgh, PA

MARTHA N. HILL,

Johns Hopkins University School of Nursing, Baltimore, MD

ALAN LESHNER,

American Association for the Advancement of Science, Washington, DC

DANIEL MASYS,

Vanderbilt University Medical Center, Nashville, TN

JONATHAN D. MORENO,

University of Virginia, Charlottesville

E. ALBERT REECE,

University of Arkansas, Little Rock

MYRL WEINBERG,

National Health Council, Washington, DC

MICHAEL J. WELCH,

Washington University School of Medicine, St. Louis, MO

OWEN N. WITTE,

University of California, Los Angeles

MARY WOOLLEY,

Research!America, Alexandria, VA

IOM Staff

ANDREW M. POPE, Director

AMY HAAS, Board Assistant

DAVID CODREA, Financial Associate

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

GLEN AYLWARD, Southern Illinois University School of Medicine

PAULA A. BRAVEMAN, University of California, San Francisco School of Medicine

CHRISTOS COUTIFARIS, University of Pennsylvania Medical Center

JANET CURRIE, Columbia University

M. SEAN ESPLIN, University of Utah Health Sciences Center

NEIL FINER, University of California, San Diego

THOMAS J. GARITE, Professor Emeritus, University of California, Irvine

LAURA GLYNN, University of California, Irvine

JOHN GODDEERIS, Michigan State University

MAUREEN HACK, Case Western Reserve University

HOWARD HU, Harvard School of Public Health

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

KATHY S. KATZ, Georgetown University Hospital

CHARLES LOCKWOOD, Yale University School of Medicine

JEROME F. STRAUSS, Virginia Commonwealth University School of Medicine

MICHELLE A. WILLIAMS, University of Washington School of Public Health and Community Medicine

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by NANCY E. ADLER. Appointed by the National Research Council, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
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Preface

Preterm birth and its consequences constitute a major health problem in the United States and worldwide. However, there has been relatively little attention from the public and research community despite the significant impact preterm birth and prematurity have on infant mortality and subsequent disabilities of many survivors, and on societal and economic costs to the nation. This health problem is associated with multiple complex and poorly understood, but interrelated, biologic, psychologic, and social factors that appear to be expressed in the common pathway of preterm birth. Low socioeconomic status alone does not explain the increase in preterm births among African Americans compared to the white non-Hispanic population.

Prenatal care is currently primarily directed at identifying and managing preeclampsia; maternal infections, diabetes, and other major illnesses; birth defects; and intrauterine fetal growth failure. As our knowledge and understanding of preterm birth increase, prenatal care will provide a health infrastructure for women from which it is possible to prevent, diagnose, and treat preterm births.

The nature of this health problem and the charge to the committee required a comprehensive assessment as well as an in depth analysis resulting in a large-volume report. The Committee suggests that readers first review the executive summary for essential ideas and recommendations, then turn to the abstracts of each chapter before reading each of the individual chapters.

Richard E. Behrman, M.D.

Chair

Committee on Understanding Premature Birth and Assuring Healthy Outcomes

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Acknowledgments

Several individuals and organizations made important contributions to the study committee’s process and to this report. The committee wishes to thank these individuals, but recognizes that attempts to identify all and acknowledge their contributions would require more space than is available in this brief section.

To begin, the committee would like to thank the sponsors of this report. Funds for the committee’s work were provided by the National Institute for Child Health and Human Development, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, March of Dimes, Burroughs Wellcome Fund, American College of Obstetricians and Gynecologists, Environmental Protection Agency, National Institutes of Health Office of Research on Women’s Health, American Society for Reproductive Medicine, and the Society for Maternal-Fetal Medicine. The committee thanks Capt. Donald Mattison, Scott Grosse, and Samuel Posner, who served as project officers and who were instrumental in the initiation of this activity. The committee thanks Ann Koontz, Marina Weiss, Nancy Green, Lisa Potetz, Enriqueta Bond, Nancy Sung, Ralph Hale, Nicole Owens, Lanelle Bembenek Wiggins, Vivian Pinn, Loretta Finnegan, Robert Rebar, and Richard Depp for their support and guidance on the committee’s task. Special recognition is also given to Eli Adashi and Gloria Sarto for the fundamental roles they played in the initiation of this activity.

The committee found the perspectives of many individuals and organizations to be valuable in understanding the causes and consequences of preterm birth. The committee thanks the numerous individuals and organizations who generously provided information and assistance during delib

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×

erations. Appendix A of this report contains the names of those who participated in the committee’s meetings by providing important information at its open workshops.

The committee also gratefully acknowledges the contributions of the many individuals who assisted the committee in its work, either by providing data and research support or by assisting in the preparation of draft material. The committee would like to thank Brent James and Intermountain Healthcare (IHC) for data used to generate the cost estimates provided in the chapter, “Societal Costs of Preterm Birth.” In particular, Pascal Briot, Russell Staheli, and Erick Henry performed much of the data generation used for the medical care estimates. C. Jason Wang of the RAND Corporation served as an appointed consultant and assisted the committee in preparation of the chapter, “Public Policies Affected by Preterm Birth.” James Perrin of Massachusetts General Hospital, and Wendy Chavkin and Blair Johnson of Columbia University’s Mailman School of Public Health also served as appointed consultants and provided information on policies related to preterm birth. Stavros Petrou of the University of Oxford, an appointed consultant, provided information and assistance on the economic consequences of preterm birth. Ciaran Phibbs of Stanford University; Wanda Barfield of the Massachusetts Department of Public Health; Charles Mercier of the University of Vermont; Joyce Martin of the Centers for Disease Control and Prevention; Mona Rowe of the National Institutes of Health; Ralph Hale, Albert Strunk, Bernice Rose, Nonda Wilson, Donna Kovacheva of the American College of Obstetricians and Gynecologists; Mario Merialdi of the World Health Organization; and Vipul Mankad of the University of Kentucky provided information, reports, and data. The committee thanks each of these individuals.

Finally, the committee would also like to thank the authors whose paper contributions added to the evidence base that the committee examined. These include John A.F. Zupancic, Harvard Medical School; Gerri R. Baer and Robert M. Nelson, The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine; and Greg R. Alexander, University of South Florida.

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PRETERM BIRTH

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The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups.

While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems.

Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

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