Preventing premature birth

Premature birth is a complex problem with no single solution. More than half a million babies are born prematurely each year in the United States. In up to 40 percent of cases, the cause is unknown. March of Dimes researchers are seeking the causes of prematurity as a step toward developing ways to prevent it.

Prematurity research initiative

In 2005, the March of Dimes began the Prematurity Research Initiative (PRI), which funds research into the causes of prematurity. More than $15 million has been awarded to 43 grantees over the past 6 years. Some PRI grantees are exploring how genetics or a combination of genetic and environmental factors may influence a woman’s chances of going into labor prematurely. Others are examining how infections may trigger early labor. One of every three premature births can be attributed an infection in a woman’s uterus, which may have presented with no symptoms.

Treating preterm labor

PRI grantees also are exploring new ways to treat preterm labor. Some are studying how the body normally suppresses uterine contractions until a baby reaches full term, so that new drugs can be developed to prevent or stop preterm labor.

Saving preemies’ lives

In addition to PRI support, the March of Dimes funds prematurity research through its national research program. Grantees are improving the care of premature babies by developing new ways to help prevent or treat common complications of prematurity. For example, researchers helped develop surfactant treatment, which has saved tens of thousands of premature babies with breathing problems.

Transdisciplinary research centers
A novel approach to address the complex problem of preterm birth and the resulting prematurity is a transdisciplinary effort within which many diverse disciplines work together by integrating research. By working together, they can examine this problem from new perspectives in ways that individual studies do not allow. The March of Dimes has established the first transdisciplinary research center and plans to promote the establishment of several more.

Sample prematurity research grants

Richard Lambert Auten, MD, Duke University Medical Center in Durham, North Carolina, is seeking to devise better ways to deliver nitric oxide (NO) to the lungs of premature infants who are at high risk of bronchopulmonary dysplasia (BPD). This chronic lung disease is common in premature babies who have been treated for breathing difficulties. Inhaled NO treatment helps prevent inflammation, which contributes to BPD, but has not yet proven successful in preventing BPD.

Iain L. Buxton, PharmD, University of Nevada School of Medicine in Reno, is studying variant versions of a protein structure in uterine muscle cells to see if any of these variants are linked with preterm labor. These structures appear to help keep the uterus relaxed during pregnancy. This study could improve identification of women at high risk of premature delivery and, ultimately, allow early treatment to prevent it.

Erika Chiong Claud, MD, University of Chicago, is investigating whether use of certain antibiotics in premature infants may alter gut bacteria and increase susceptibility to necrotizing enterocolitis (NEC), a life-threatening intestinal complication that is most common in babies born very prematurely. This study could possibly lead to changes in the care of premature babies to help prevent NEC.

Kip Connor, PhD, Children’s Hospital, Boston, is studying the role of omega-3 fatty acids (nutrients found in certain fatty fish) in preventing abnormal growth of blood vessels in the eye that can lead to retinopathy of prematurity (ROP). ROP is a common complication of very premature birth and can lead to blindness. This study could possibly lead to nutritional treatments that could help prevent ROP.

Stephen Lye, PhD, Mount Sinai Hospital, University of Toronto, Canada, is investigating how inflammatory proteins (cytokines) produced by the uterus may contribute to the chain of events that results in term or preterm labor. Because these events occur early in labor, they may be targets for new drugs to prevent preterm labor.
 
Sam Mesiano, PhD, Case Western Reserve University in Cleveland, Ohio, is seeking to identify genes and other factors that help trigger labor, at term or prematurely. A better understanding of biological events that normally start labor may lead to development of novel drugs to prevent premature delivery.

Deborah McColl Money, MD, University of British Columbia, Canada, is using new genetic technologies to detect and analyze vaginal microbes that contribute to preterm premature rupture of the membranes (PPROM), a leading cause of spontaneous premature delivery. This could lead to more accurate identification of women at risk of PPROM, as well as new treatments to prevent it.

Anne M. Moon, MD, PhD, University of Utah in Salt Lake City, is studying how a protein regulates the development of the alveoli, the tiny air sacs in the lungs where gas exchange occurs. Babies born prematurely may have fewer and less mature alveoli than babies born at term, often contributing to a breathing problem called respiratory distress syndrome (RDS). This study could improve treatment for premature babies with RDS and for babies with lung underdevelopment due to other causes.

Jeffrey Murray, MD, University of Iowa, Iowa City, is conducting a comprehensive search of the entire human genome for gene variants that contribute to spontaneous preterm delivery. He also is seeking to identify environmental factors that may interact with such variants to cause prematurity. Identifying the complex causes of spontaneous prematurity is essential to learning how to predict it reliably and prevent it.

Kristina M. Adams Waldorf, MD, University of Washington in Seattle, is studying how uterine stretching may trigger preterm labor, as a step toward developing drug treatments to prevent stretch-induced labor. Uterine stretching appears to be an important stimulus of preterm labor in pregnancies with twins and other multiples and in pregnancies with excess amniotic fluid.