Causes and Prevention of Prematurity
Date: October 14th, 2018
Time: 09:00 – 15:00 including a lunch break
Location: Riocentro – room to be confirmed
Organisers: FIGO Preterm Birth Working Group
Moderators: Mary D’Alton (USA) and Jane Norman (UK)
Preterm birth (< 37 gestational weeks) and especially very preterm birth are a major public health problem in both High-Income countries and Low Middle Income (LMIC) countries. The rate of PTB is 10% in the USA, 9% in Germany and 7-8% in the UK. Yet in Sweden the rate is only 5.5%. In some LMIC the rate is over 15%, as it is in African-American population in inner cities in the USA. The FIGO Working Group on Preterm Birth sought to determine the biological basis of PTB, conducting an Individual Patient Data Meta- Analysis in 4.1 Million births- Sweden, Czech Republic, Slovenia, New Zealand, and California. Among risk factors, less than 10% could be mitigated by health care providers. In 2/3 of risk factors there is no known biological basis. These include male fetus and nulliparity (adjusted for known confounders such as preeclampsia). The clinical significance of these data is that efficacious interventions cannot be devised unless the etiology of labor and preterm labor is elucidated.
This FIGO Working Group will focus systematically on potential explanation for labor in humans. The country or regional specific global incidences of PTB will be discussed by WHO investigators. The most common explanations for PTB- and potential interventions – will be critiqued by Working Group members. These include the role genetic factors play – single nuclear genes and mitochondrial genes; overt infections as traditionally implicated; microbiome encompassing a broader spectrum than typically considered; anatomic predisposition in the cervix that lead to short cervix; electrical stimulation responsible for uterine contractions (pacemakers); chrono-disruption; glycoproteins (glycans) in cervical-vagina fluid that could correlate explicitly with tissue in the vagina or cervix. The biological basis for PTB in multiple gestations will be explored, as well as the role played by nutritional factors.
All providers involved in care of obstetrical patients or administration of services requiring resource allocation will benefit. Increasingly robust studies are directly us to interventions that will require implementation. Yet other studies are showing lack of efficacy, or insufficient benefit. Foundation and governmental support has increased compared to even a decade age, presaging genuine advances. Talk will especially be targeted by obstetricians and midwives functioning in a referral unit., as well as trainees.
Take Home Messages:
The attendees will be expected to state 3-4 specific scientific advances that plausibly can be translated into efficacious interventions. As examples, these data will be able to be cited on microbiomes associated with PTB, genes in high statistical association with preterm birth, and role of disturbed sleep – wake patterns (chrono-disruption).
Pessary, cerclage and combined intervention - Eduardo Fonseca (Brazil)