The Role of Environmental Hazards in Premature Birth Workshop Summary (2003) / Chapter Skim
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6. Future Directions
6. Future Directions
Pages 68-76
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From page 68... ...
Similarly, researchers are recognizing that preterm birth is a "catch-all" phrase for the multiple pathways leading to a clinical presentation. At the fundamental level, Allen Wilcox, National Institute of Environmental Health Sciences, suggested that we may be looking at two different types of prematurity.
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From page 69... ...
The insight provided by bringing together investigators from diverse disciplines, including social and behavioral sciences, toxicology, and reproductive biology, clearly points out the heterogeneous and complex nature of the factors associated with preterm birth. While planning for future research, some participants suggested that we need to look at the complexity of the process and that preterm birth will have to be treated as a chronic disease one might see this as being similar to our approach to studying hypertension, cardiovascular disease, or diabetes.
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From page 70... ...
They noted that current attempts have looked at short-term outcomes and that the full spectrum of the impact of preterm birth over the life of the individuals has not been fully studied with respect to disabilities of all types, including neurodevelopmental disabilities. For this reason, some individuals suggested that it would be important to describe more completely the impact of preterm delivery on the life course, including individual, family, and social impact.
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From page 71... ...
Better definitions and fully characterizing the interactions between birth weight and gestational age, the interactions of genetic factors and the environment, and differential mechanisms of preterm birth as a function of gestational age provide some direction to tease apart the complexity alluded to during the course of the workshop. Genetics, Environment, and Gene-Environment Interactions The study of genetics, environmental agents (including chemical, physical, and biological exposures)
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From page 72... ...
Some areas that might help to shape the field include the following: · reframing research questions about the etiology and mechanisms of preterm delivery to take advantage of new knowledge about community, family, individual, social, economic, and environmental factors on the organism, as well as cellular, molecular, and genetic mechanisms of preterm delivery, · understanding the impact of social factors on the biological mechanism of preterm delivery, · understanding the impact of stress on maternal physiology on premature delivery, · encouraging cross-disciplinary approaches that would allow more critical evaluation of the role of stress and of the biological mechanisms produced by stress as they influence preterm delivery, and · exploring the role of stress on androgen and estrogen levels in pregnancy and their influence on gestational length, especially given the growing knowledge concerning environmental endocrine disrupters. Gene-Environment Interactions Participants discussed the tremendous opportunities for future research.
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From page 73... ...
Molecular and Biological Considerations Molecular classifications of exposure have much to offer since true prospective studies that begin prior to or early in pregnancy allow for assessment during the etiologically relevant time interval, according to some panelists. Biological markers of nutritional status (e.g., serum folate, ferritin, transferrin receptor saturation)
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From page 74... ...
Risk Assessment Exposure studies have methodological limitations that must be addressed before useful interpretations can be made about how exposure affects preterm labor, noted participants. Some participants suggested that we must increase our basic knowledge of risk assessment and toxicology as they relate to preterm birth, including exposure (e.g., quantity, timing, and dosage)
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From page 75... ...
For example, consistent findings have emerged that identify an association between cocaine use and preterm birth, a reduced risk associated with leisure time physical activity during pregnancy, a reduced risk associated with favorable nutritional status and the use of prenatal vitamins, and an increased risk associated with physically demanding occupations. However, none of these associations is necessarily causal, and distinguishing a true etiologic effect from a spurious association due to other unmeasured or unknown factors has been unsuccessful thus far.
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