Preterm Labor and

Premature Birth
Health care providers consider labor to be preterm if it
starts before 37 weeks of pregnancy. Because a fetus is not
fully grown at 37 weeks, and it may not be able to survive
outside the womb, health care providers will often take
steps to stop labor if it starts before this time. Common
methods for trying to stop labor include bed rest and
medications that relax the muscles in the uterus involved
with labor and delivery.
However, the American College of Obstetricians and
Gynecologists (ACOG) recently reported that many of
the methods used to stop preterm labor are ineffective.
The ACOG announcement confirms NICHD-supported
research (National Institute of Child Health and Human
Development), which found that home uterine
monitors were not effective for predicting or
preventing preterm labor.
If efforts to stop labor fail, then the baby could be born
prematurely. Premature infants face a number of health
challenges, including low birth weight, breathing problems,
and underdeveloped organs and organ systems. Many
infants that are born prematurely need to stay in the
hospital until their health is stable, sometimes several
weeks or more.

NICHD Research on Preterm Labor

and Premature Birth
Despite attempts to stop labor, many cases of preterm
labor end in premature birth. Premature birth occurs in
between 8 percent to 10 percent of all pregnancies in the
United States; it remains one of the top causes of infant
death in this country. Infants who survive being born
prematurely are at increased risk for certain life-long
health effects, such as cerebral palsy, blindness,
lung diseases, learning disabilities, and developmental
disabilities.
Current NICHD-supported research is trying to identify
markers and predictors of preterm labor and premature
birth. In one study, researchers are investigating premature rupture of membranes (PROM), a situation in which
the membranes that support the fetus in the womb break
(sometimes referred to as when a womans water breaks)
before the fetus is fully developed. PROM can lead to preterm labor and premature birth. Researchers found that,
in some cases, the womb and the fetus produce enzymes,

proteins that speed up certain chemical reactions, which

can cause the membranes to break apart. Further research
is now underway to figure out whether other features may
make some women more likely to experience PROM.
The findings of this research may lead to new methods of
preventing PROM and some premature births.
Past research revealed that certain infections can make a
woman more likely to experience preterm labor and give
birth early. For instance, women who have bacterial
vaginosis, the most common vaginal infection for women
of reproductive age, are more likely than other women to
experience preterm labor and give birth prematurely.
Similarly, women who have trichomoniasis, a sexually
transmitted infection, are also more likely to give birth
prematurely than women who dont have the infection.
It would stand to reason, then, that treating these infections
would prevent premature births in these cases. But, NICHDsupported studies have shown that treating these infections
is not an effective way to prevent premature birth. Further
research is now underway to find other options for

treating these infections that may reduce the risk of premature birth. For more information on this research, read
the news release on the bacterial vaginosis and the news
release on trichomoniasis.
One effective way to understand preterm labor and
premature delivery is to study the characteristics of women
who have given birth prematurely. One group of NICHDsupported researchers found that, among women who
had given birth prematurely in the past, a shortened cervix
could be a warning sign in preterm labor for a current
pregnancy. With this knowledge, scientists can work to
develop ways of preventing this shortening of the cervix,
which may help to prevent preterm labor and premature
delivery. For more information on this research, read the
news release about shortened cervix and premature birth.
In addition, research on preterm labor and premature birth
is ongoing through the NICHDs Maternal-Fetal Medicine
Units (MFMU) Network, a research program that uses 14
sites around the country to conduct studies related to the
mechanisms of pregnancy and birth. Researchers in the
MFMU Network recently completed a clinical trial, which
showed that the hormone progesterone may prevent
repeated premature birth in a specific group of women,
those who were carrying a single fetus, and who
previously gave birth prematurely, between 20 and 26
weeks of pregnancy. In this trial, the progesterone
treatment started between the 16th and 20th week of
pregnancy, and continued through the 36th week of
pregnancy. This finding may help to reduce future
premature births among women who have a history of
preterm labor and premature delivery.
NICHD-supported researchers were also working to see
whether having more uterine contractions during pregnancy
could be a warning sign of premature birth. Many pregnant
women have uterine contractions throughout their
pregnancies. These contractions are often mild and usually
occur after the mid-way point of pregnancy. But, this
research showed that, even though how often a woman
had contractions was significantly related to premature
birth, it wasnt an effective way to predict which mothers
would give birth prematurely.
The NICHD and other NIH Institutes are currently conducting
a number of clinical trials related to premature birth.

Infant Problems Related to Premature Birth

Babies that are born prematurely face a number of problems,
including low birth weight, respiratory and breathing

difficulties, and underdeveloped organs and organ systems.

Some research also suggests that babies born prematurely
are at higher risk for certain health problems as they get
older. To find ways to minimize the impact of premature
birth on the health of infants, the NICHD supports and
conducts observational and interventional studies on
these topics.
Low Birth Weight (LBW) and Very Low Birth Weight (VLBW)
LBW refers to any baby that weighs less than 2,500 grams
(about 5 pounds, 8 ounces). VLBW describes an infant that
weighs less than 1,500 grams (about 3 pounds, 5 ounces).
LBW and VLBW infants are at higher risk than other infants
for a variety of problems, including cerebral palsy, sepsis
(a type of blood infection), chronic lung disease, and death.
These infants are also at higher risk for hypothermia
(high-poh-THERM-ee-uh), low body temperature, which can
be dangerous.
Research is now underway to learn how to increase the level
of nutrition for these infants, to improve their survival rates,
and find out what, if any, long-term effects these
conditions have on overall health.
The NICHD and other Institutes are currently conducting a
number of clinical trials related to LBW and VLBW.
Respiratory Distress Syndrome (RDS)
In RDS, the baby has trouble breathing. RDS can result from
various situations, such as:
The babys lungs arent fully developed. Health care
professionals can give these infants certain types of
steroids, called corticosteroids (CORE-tick-oh-stair-oids),
to help the lungs mature more quickly. These steroids may
also lower the risk of brain injury. Sometimes, giving the
lungs a little extra push in their development can help the
baby breathe easier, which allows the infant to get stronger.
Health care providers may also give corticosteroids to a
woman who is at risk of delivering her baby before 34
weeks of pregnancy, to try to prevent the infant from
developing RDS.
The lungs are missing an important material. For the
lungs to work properly, their lining has to be completely
covered with a slick, soapy coating called surfactant. A
growing fetus doesnt make enough surfactant to breathe
outside of the womb until a certain point in development.
Babies born prematurely have about 5 percent of the total
surfactant that they need, which puts them at high risk for
RDS. Through research conducted and supported by the
NICHD, premature babies can now receive replacement
surfactant to coat their lungs and allow for easier breathing.

In some cases, getting replacement surfactant can prevent

RDS from occurring at all; in other cases, the replacement
surfactant saves the babys lungs from long-term damage.
In addition to the treatments for these situations, premature
infants may also benefit from being placed on a respirator,
a machine that helps them breathe by inflating and deflating
their lungs. Oxygen treatments or treatments using nitric
oxide may also improve the breathing.
Through this and other NICHD-supported research into
the problems faced by premature infants, survival rates
for premature infants with RDS are nearly 95 percent.
The NICHD and other Institutes are also conducting clinical
trials related to RDS.
The NICHD is currently conducting and sponsoring a
number of clinical trials involving infants born prematurely.
The Institutes Neonatal Research Network, established
in 1986, strives to improve the care of and outcomes for
infants, especially LBW and VLBW infants. The Neonatal
Research Network follows thousands of infants, through
its 16 clinical centers throughout the country, to conduct
clinical trials and observational studies for preventing
and treating problems related to pregnancy, premature
birth, and the newborn period. The Institutes MaternalFetal Medicine Unit Network also conducts clinical trials
on these topics. Among the trials currently underway
are: the BEAM (Beneficial Effects of Antenatal Magnesium
Sulfate) trial, to try and prevent cerebral palsy; and the
FOX (Fetal pulse OXimetry) trial, to learn more about the
effects of cesarean delivery.
Source: National Institute of Child Health and Human Development
National Institutes of Health
Medical Illustrations & Medical Animations Copyright 2009 Nucleus
Medical Art. All Rights Reserved.
All material 1999 - 2009 Nucleus Medical Art Inc. All rights reserved.

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