The ultimate goal is to help as many women as possible give birth to healthy, full-term babies. But a big step toward reducing the number of preterm births is to find out a woman's risk of preterm birth early in her pregnancy.
Preterm birth rates - babies born before 37 weeks - are on the increase in Canada and around the world. In this country, more than eight per cent of all births are now preterm.
Why the increase? Dr. Deborah Money, Vice-President, Research at BC Women's, explains that the increase in Canada is not fully understood but is partially due to an increase in multiple pregnancies - primarily caused by fertility treatments. Another possible cause is related to women choosing to give birth later in their reproductive lives. In this case, it may be due to higher rates of complications of the pregnancy that puts the health of the fetus or mother at risk, making it safer to deliver the baby by early induction of labour or Caesarean section. Pregnancy complications result in about one third of preterm births.
However, in many cases, preterm birth happens because contractions begin too early or the membranes suddenly rupture. This is thought to be related to infection and inflammation. Tragically, prematurity results in 70 per cent of newborn deaths and approximately half of all long-term health problems in infants.
Although obstetrical specialists are constantly working on strategies and treatments that can help women stay pregnant and healthy as long as possible, identifying a woman at risk of preterm birth early on enables them to keep a close watch on her progress and be ready to take action if needed.
Despite the dramatic impact on child health, there's still much to learn about the causes and risk factors, Money notes: "If a woman has never given birth before, there is currently very little that we can do to categorize a healthy women into high or low risk."
Research underway at BC Women's has the potential to change this situation. Money, along with her team and research partners in the Integrative Genomics group at the Women's Health Institute, are working on a "systems biology" approach to try to come up with predictive biomarkers for preterm birth.
Biomarkers are measurable indicators found in the body that can provide an early warning that the person is more likely to develop a particular disease or biological condition. For example, blood cholesterol test results are a biomarker that can indicate greater risk of developing cardiovascular disease.
Money explains that the research team expects to identify more than one biomarker related to increased risk of preterm birth. "We are trying to look for biomarkers in maternal secretions or maternal blood that would allow us predict the risk of preterm birth and ideally direct intervention to reduce that risk."
Originally focused on studying the bacterial balance in the vagina (the vaginal microbiome), this search for biomarkers now extends to examining the bacteria in the mouth. The thinking is that the "wrong" mix of bacteria present in the vagina, and potentially in the mouth, has the potential to cause an inflammatory response in the placenta and membranes, triggering spontaneous preterm births. In addition, researchers are looking at the placenta and products it produces in situations where preterm birth will be triggered.
The challenge is to identify the correct marker organisms, and the results of some of the research carried out so far are encouraging. For example, a study looking at unexplained preterm rupture of the membranes showed that participants had significant changes in their vaginal microbes.
Once the biomarkers are identified, the next step is to develop a simple test that will use a sample of the mother's blood and/or secretions (either from the vagina or the mouth) to identify women at greater risk of preterm birth.
Money is optimistic that a screening test for preterm labour is on the horizon: "Our team believes that it is achievable - it won't be tomorrow, but we are definitely getting closer and closer."
What can you do to reduce your risk of preterm delivery?
If you can, see your primary health care provider to get pre-pregnancy counselling. It's an important opportunity to discuss your current health, family history and the steps you can take to prepare for pregnancy. This may include getting your vaccinations up-to-date, starting a folic acid supplement or being referred to a specialist to address any existing health concerns that may impact your pregnancy. If you have already had complications with a previous pregnancy, seeking advice before or immediately after you conceive is especially important. There are now some interventions that can be done to reduce your risk of having another preterm birth, but this depends on your doctor or midwife's understanding of your personal health history.
Once you are pregnant, the Society of Obstetricians and Gyneacologists of Canada provides some advice that women can use to try to prevent your baby being born too soon. These include: quitting smoking, eating properly, getting enough rest, reducing your stress and seeking help if you are in an abusive situation at home.
However, Money stresses that women should not feel guilty that something they have done has resulted in giving birth to a premature baby. "In the vast majority of cases, there is nothing that the woman could have done to make a difference."
If you can, consider volunteering to participate in research that can help advance knowledge about preterm birth and other complications of pregnancy. By doing so, you are paving the way for discoveries that will impact the health of women and babies in the future. Talk to your care provider to find out if your are eligible for current studies.
Society of Obstetricians and Gynaecologists of Canada
Women's Health Research Institute
This article was written by Anne McLaughlin and reviewed by BC Women's VP Research, Dr. Deborah Money.
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