Prevention of Preterm Birth

Jeffrey M. Denney; Jennifer F. Culhane; Robert L. Goldenberg

Disclosures

Women's Health. 2008;4(6):625-638. 

In This Article

Perinatal and Prenatal Care

Women who either seek prenatal care early or have more prenatal visits exhibit a lower incidence of preterm birth than women who seek less care or care later in pregnancy.[32,33,34,35,36,37,38,39] Consequently, a liberal provision of prenatal care has been advocated as a means to reduce preterm birth. Unfortunately, there is no simple cause-effect relationship to be inferred from this association. First, women at lower risk take advantage of receiving prenatal care more often than those women at higher risk. Second, women who deliver early often have fewer prenatal visits, simply because routine prenatal visits are scheduled at shorter intervals in late pregnancy. The association of lower rates of preterm birth with early registry for care has led investigators to study improvement of access to standard prenatal care in areas of need. However, such investigations have generally not demonstrated a positive effect on the rate of preterm births. Enhanced prenatal care (e.g., the March of Dimes Multicenter trial) or early access to care has not generally resulted in a reduction in premature birth.[38] Literature reviews including many of these trials has likewise failed to demonstrate a significant benefit in reducing preterm birth from either strategy.[32,33,34]

Increasing availability of prenatal care to the expectant mother has not proven effective in reducing the incidence of preterm delivery. By the same token, enhancing prenatal care by the addition of nutrition counseling, home visitation, case management and patient education appeared to suggest benefit in some randomized trials but not in the majority. Since the enhancements to prenatal care have varied from study to study and because the associated reductions in preterm birth have been inconsistent, it is not clear which specific additions to prenatal care, if any, will result in a reduction in preterm births.

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