No progress on lowering preterm birth rate in past decade: WHO

Matt Woodley

19/05/2023 2:55:26 PM

More than 150 million babies were born early between 2010–20, a new report highlighting the global ‘silent emergency’ shows.

Preterm baby.
There are a number of ways GPs can support parents and babies after a preterm birth.

An estimated 13.4 million preterm babies were born in 2020, resulting in nearly one million infant deaths, according to a new World Health Organization (WHO) report.
Born too soon: decade of action on preterm birth’ also confirmed that it is now the leading cause of paediatric fatality, accounting for more than one in five of all deaths in children aged five and under.
Meanwhile, those who survive can face lifelong health consequences, with an increased likelihood of disability and developmental delays. 
The report’s co-lead author, Professor Joy Lawn from the London School of Hygiene and Tropical Medicine, said the findings show that no region of the world was able to improve preterm birth rates from 2010–20 and lay bare the ‘cost of inaction’ over the past decade.
‘Preterm birth threatens health progress in every country,’ she said. ‘Greater investment in the care of vulnerable newborns can save millions of families from heartbreak.
‘More work is also needed to prevent preterm birth, which will also improve progress in reducing stillbirths and maternal deaths. Together these twin tracks of preterm prevention and care will produce healthier individuals and societies to deliver on economic and social development.
‘Our next generation depends on us all acting now – the investment may not be small but the returns on this investment will be major for every country.’
More than 26,000 preterm births occur in Australia each year, with the 8.6% rate slightly lower than the global average of one in 10 babies being born early.
Despite the lack of progress in recent years, Dr Wendy Burton, Chair of RACGP Specific Interests Antenatal and Postnatal Care, told newsGP ‘a lot of work’ is being dedicated to reducing preterm birth rates and improving outcomes among those born before the 37-week mark.
‘Stillbirth and prematurity are of significant ongoing concern,’ she said.
‘The reasons a multifactorial … [but] those of us working in the maternity field are trying to raise the profile of some specific factors.’
The strategies cited by Dr Burton, which are featured on The Australian Preterm Birth Prevention Alliance website include:

  • measuring the length of the cervix at all mid-pregnancy scans
  • using natural progesterone (200 mg each evening) if the length of the cervix is less than 25 mm
  • considering surgical cerclage if the length of the cervix continues to shorten despite progesterone treatment
  • using vaginal progesterone in pregnant people with a prior history of spontaneous preterm birth
  • identifying women who smoke and offering Quitline support
  • providing access to continuity of care from a known midwife during pregnancy, where possible.
Dr Burton also says there are a number of ways GPs can support parents and babies after a preterm birth.
‘Be kind, supportive and inform them of options for future pregnancy planning, eg use of vaginal progesterone and perhaps Omega 3 supplementation,’ she said.
On a broader scale, various WHO and United Nations organisations are calling for the following actions to improve care for women and newborns and mitigate risks from preterm births: 
  • Mobilising international and domestic resources to optimise maternal and newborn health, ensuring high-quality care is provided when and where it is needed
  • Meeting country targets for progress through implementing established national policies for maternal and newborn care
  • Promoting education through the lifecycle; supporting smarter economic investments, with co-financing across sectors; strengthening climate adaptation responses; advancing the coordination and resilience of emergency systems
  • Investing in locally led innovation and research to support improvements in quality of care and equity in access
Survival gaps by region, income, race
The global report indicates that where babies are born often determines if they survive.
The report notes that only one in 10 extremely preterm babies (<28 weeks) survive in low-income countries, compared to more than nine in 10 in high-income countries. Gaping inequalities related to race, ethnicity, income, and access to quality care also determine the likelihood of preterm birth, death, and disability, even in high-income countries like Australia. 
Southern Asia and sub-Saharan Africa have the highest rates of preterm birth, and preterm babies in these regions face the highest mortality risk. Together, these two regions account for more than 65% of preterm births globally.
Air pollution is estimated to contribute to six million preterm births each year, while nearly one in 10 preterm babies are born in the 10 most fragile countries affected by humanitarian crises, according to a new analysis in the report.
Maternal health risks, such as adolescent pregnancy and pre-eclampsia, are also closely linked to preterm births, which the authors say reinforces the need to ensure access to sexual and reproductive health services, including effective family planning, with high-quality care in pregnancy and around the time of birth. 
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