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date: 17 June 2024

Preterm Birth: Epidemiology, Risk Factors, Pathogenesis, and Preventionlocked

Preterm Birth: Epidemiology, Risk Factors, Pathogenesis, and Preventionlocked

  • Xiaojing Zeng, Xiaojing ZengXinhua Hospital, Shanghai Jiao Tong University School of Medicine
  • Wen Jiang, Wen JiangXinhua Hospital, Shanghai Jiao Tong University School of Medicine
  • Xiaoqing HeXiaoqing HeXinhua Hospital, Shanghai Jiao Tong University School of Medicine
  •  and Jun ZhangJun ZhangShanghai Jiao Tong University School of Medicine

Summary

Preterm birth is a significant global public health issue. It is defined by the World Health Organization as infants born alive before 37 completed weeks of gestation. The preterm birth rate varies significantly across countries and regions. Globally, an estimated 13.4 million babies were born preterm in 2020 (i.e., 1 in 10 babies worldwide was preterm birth). It is the leading cause of under-5 child mortality worldwide, and preterm infants are particularly vulnerable to respiratory complications, feeding difficulty, poor body temperature regulation, and high risk of infection. Both genetic and nongenetic factors (exposome factors) contribute to the risk of preterm birth. Social and behavioral factors, medical and pregnancy conditions, and environmental exposures are common nongenetic risk factors for preterm birth. Individuals from certain ethnic and racial groups, in low- and middle-income countries, or with a low socioeconomic status are at an increased risk of having preterm birth, and social determinants of health are the root causes of these factors. Existing pregnancy complications, history of preterm birth, and other medical conditions are also common risk factors. Environmental exposures such as air pollution, climate change, and endocrine-disrupting chemicals have been increasingly realized as potential risk factors for preterm birth. Various pathological events in different feto-maternal systems have been reported to be involved in the development of preterm birth. Immunopathogenesis plays a pivotal role, and both pathogenic and nonpathogenic inflammation can induce preterm birth. Oxidative stress, decidual hemorrhage and vascular lesions, uterine overdistension, and cervical insufficiency have all been proposed to contribute to the pathophysiology of preterm birth. Prevention strategies for preterm birth include primary prevention aimed at the modifiable risk factors at the individual and societal levels and therapeutic approaches using pharmaceuticals and mechanical interventions, such as progesterone and cervical cerclage. A comprehensive approach is still needed to reduce the global disease burden of preterm birth.

Subjects

  • Sexual and Reproductive Health

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