Research published this week in the open access journal PLoS Medicine shows that the rising rate of preterm birth in Scotland is as much a result of an increase in spontaneous preterm birth as it is of preterm birth that is medically-induced to avoid risking the lives of the mother and child. The results emphasize that preterm birth, which remains the single biggest cause of infant death in many developed countries, continues to be a major obstetric and neonatal problem despite the reductions that there have been in stillbirths and perinatal deaths as a result of improved maternal medical care.
Jane Norman, of the University of Edinburgh, and colleagues from NHS National Services in Scotland, researched a population-wide database of linked maternity records, infant health and death records in Scotland. They identified 1.49 million singleton births between 1980 and 2004, of which 90,000 were preterm births – babies born before they reach 37 weeks of gestation. Both spontaneous preterm births and medically-induced preterm births increased between 1980 and 2004; in absolute terms the rates of increase in each type of preterm birth were similar. Examining the database, the researchers found that maternal complications including pre-eclampsia (a condition causing high blood pressure) and placenta previa (the covering of the opening of the cervix by the placenta) played a decreasing role in preterm births over the period, whilst gestational and pre-existing diabetes played an increasing role. The researchers also found that there was an overall decline in stillbirth and in neonatal and perinatal deaths amongst preterm babies in the period covered – although at 28 weeks gestation and beyond, stillbirths and perinatal deaths reduced amongst medically-induced preterm babies, but were not reduced in babies who were spontaneously preterm.
These findings are important because rates of preterm birth are rising worldwide. Studies conducted in populations in the United States and in Latin America have suggested that this is mainly due to an increase in medically-induced labor, and therefore could be associated with reduced neonatal deaths, whilst studies conducted in Europe and Australia have shown an increase in spontaneous preterm births. The results of this study show that in Scotland at least, methods will have to be found to reduce the rates of both spontaneous and medically-induced preterm births to both reduce the considerable suffering and better identify those sick babies who need to be delivered early to give them the best chance of survival.
Citation: Norman JE, Morris C, Chalmers J (2009) The Effect of Changing Patterns of Obstetric Care in Scotland (1980�) on Rates of Preterm Birth and Its Neonatal Consequences: Perinatal Database Study. PLoS Med 6(9): e1000153. doi:10.1371/journal.pmed.1000153
Funding: This project was funded by grant no CZG/2/285 from the Chief Scientist Office, Scottish Government (http://www.sehd.scot.nhs.uk/cso) and the baby charity, Tommy's (http://www.tommys.org). The funders had no role in study design, data collection or analysis, decision to publish, or preparation of the manuscript
Competing Interests: JN has received grants from government (Medical Research Council, UK; Chief Scientist's Office, Scottish Executive) and charitable organizations for research into understanding the mechanism of term and preterm labor and investigating treatments (charities currently include Tommy's, Piggy Bank Kids, and Action Medical Research, and formerly include Wellbeing of Women), has acted as a consultant to a small drug company (Preglem, Geneva) that was considering developing treatments for preterm labor, and is named as an inventor on patent applications for a compound (a prokineticin antagonist) potentially useful in preterm labor prevention. CM and JC have read this journal's policy and have no competing interests.
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=1000153
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-06-09-norman.pdf
EDITORS' SUMMARY: http://www.plos.org/press/plme-06-09-norman-summary.pdf
CONTACT:
Jane Norman
University of Edinburgh
Obstetrics and Gynaecology
Edinburgh, EH16 4TY
United Kingdom
+ 44 131 242 2694
jane.norman@ed.ac.uk
FROM THE PLOS MEDICINE MAGAZINE SECTION:
Estimating the need for surgical services worldwide
There is growing interest within the global health community in the role of surgery as a tool for improving the health of the world's poorest people. In an essay in this week's PLoS Medicine, Theo Vos (University of Queensland, Australia) urges researchers to better quantify both the global burden of diseases requiring surgery and the health benefits that could be brought about from surgical services.
Citation: Vos T (2009) Improving the Quantitative Basis of the Surgical Burden in Low-Income Countries. PLoS Med 6(9): e1000149. doi:10.1371/journal.pmed.1000149
Funding: The author received no specific funding for the writing of this paper.
Competing Interests: The author has declared that no competing interests exist.
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=1000149
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-06-09-vos.pdf
CONTACT:
Theo Vos
University of Queensland
School of Population Health
Herston Road
Herston, QLD 4006
Australia
+61-7-3365 5508
t.vos@sph.uq.edu.au
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
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