New hope for preventing pre-term births

It's one of the great frustrations of obstetric medicine: humans have been reproducing for hundreds of thousands of years, and yet doctors still haven't unraveled the mystery of why some women give birth well before their babies have fully developed in the womb.

Despite researchers' and physicians' best efforts, the rate of preterm births - defined as babies born before 37 weeks of gestation - climbed 30 percent from 1981 through 2006. Since then, it has fallen slightly; in 2008, the most recent year for which figures are available, 12.3 percent of women delivered babies before 37 weeks, the time when a fetus's lungs typically reach maturity. That's down from 12.8 percent in 2006. Though the causes of this overall increase are not fully known, the high rate of multiple births, the fact that more women are having children later in life, and an uptick in the number of induced labors and voluntary scheduled C-sections are partly to blame.

A new study published online in Ultrasound in Obstetrics and Gynecology offers ob/gyns some new options in caring for mothers-to-be. The research, conducted by the National Institutes of Health in conjunction with a pharmaceutical company, shows that a progesterone gel can help women at risk of premature birth extend their pregnancies and boost the health of their newborns.

"This is a major breakthrough in maternal and child health," said Roberto Romero, chief of the perinatology research branch of the National Institute of Child Health and Human Development and a co-author of the paper. "The prevention of preterm birth has been the most difficult challenge facing obstetrics and prenatal care and has been a goal of NICHD of the last 50 years." The study followed 458 pregnant women who had been diagnosed via intravaginal ultrasound during their second trimester as having a short cervix, a major predictor of preterm delivery. Of those women, 235 were treated with a vaginal progesterone gel developed by Columbia Laboratories, a pharmaceutical company that collaborated on the study with the NIH, and 223 volunteers were treated with a placebo gel. In the progesterone group, 8.9 percent delivered babies prior to 33 weeks of gestation vs. 16 percent in the placebo group. By 37 weeks of gestation, 30 percent of women in the progesterone group had given birth, as compared to 33 percent in the placebo group. The babies born to the progesterone group were also less likely to suffer complications such as respiratory distress syndrome, a breathing problem caused by underdeveloped lungs.

New clues to preventing miscarriage or pre-term births MISCARRIAGE and pre-term birth are the two things all parents-to-be worry about. Two studies published this week could help establish why some pregnancies go wrong, and offer hope for new treatments to prevent pregnancies ending this way.

One in five pregnancies end in miscarriage, and the risk increases with the age of the mother. Patricia Hunt and colleagues at Washington State University in Pullman have now identified a surprising contributing factor: a lack of quality control during egg-making.