A program aimed at reducing premature births among Western Australian women, particularly in Aboriginal communities, has lowered the rate by eight per cent, according to researchers.

The WA Preterm Birth Prevention Initiative included a public health program for women and their families, new clinical guidelines for health professionals and a new perinatal centre.

Preterm birth complications are the leading cause of death and disability among children under five years of age in the developed world.

In WA, more than 2900 babies are born preterm each year with rates among Aboriginal women and in disadvantaged communities about double those in the rest of the community.

Professor John Newnham, who headed the program, said the eight percent decline in the program’s first year was the result of researchers, doctors, health professionals, families and the government working together.

“Until recently, preventing preterm birth was an idea limited to the world of research,” he said.

“But the discovery and translation of effective new strategies, coupled with a multi-faceted commitment to educating health care professionals and families, has enabled change on such a scale.

“These results have global implications for safely and effectively lowering the rate of preterm birth, saving countless lives and preventing lifelong disability.”

Professor Newnham said that while progress was made, challenges remained.

“About one in eight WA pregnant women continues to smoke during pregnancy; a significant contributing factor to a range of pregnancy complications including low birth weight and preterm birth,” he said.

WAYS TO AVOID PRETERM BIRTH

* Make sure that the length of your cervix is measured whenever you have an ultrasound scan between 16 and 24 weeks of pregnancy. This is now recommended by the WA Preterm Birth Prevention Initiative as standard practice within WA. The length of your cervix in mid-pregnancy is a strong predictor of your risk of preterm birth. If the cervix is shortened, then your doctor needs to be consulted urgently to prescribe the appropriate treatment.

* In those cases in which the cervix can be imaged clearly on a trans-abdominal scan, a length of 35mm or more is adequate. If the operator cannot image your cervix clearly, or if the measurement is less than 35mm, then an internal scan needs to be performed. The length of the cervix on a trans-vaginal scan below which treatment is required is 25mm. This length is less than required at trans-abdominal scan because trans-abdominal scans have a full bladder which can stretch the length of the cervix, while internal scans are performed with an empty bladder.

* If your cervix is less than 25mm on an internal scan your doctor needs to prescribe natural vaginal progesterone — 200mg given as a pessary. This pessary is inserted into the vagina each night at bedtime. This treatment should continue until 36 weeks gestation and is expected to halve the risk of preterm birth. In cases in which the cervix length is less than 10mm on internal scan, or in some cases where there is a history of previous preterm birth, the cervix may need to be closed surgically.

* Vaginal progesterone, 200mg pessaries, are also to be prescribed for any case in which there is a history of spontaneous preterm birth in a previous pregnancy between 20 and 34 weeks gestation. The treatment is used each night from 16 to 36 weeks’ gestation.

* No pregnancy is to be ended prior to 38 plus weeks’ gestation unless there is medical or obstetric justification. While most babies born in the days and weeks before this time can be expected to survive and live a healthy life, there are risks to the child including learning and behavioural problems at school age. If, however, there are risks to the pregnancy then your doctor may advise earlier birth on safety grounds.

* Women must not smoke, or be exposed to cigarette smoke, during pregnancy. Smoking is a major and totally avoidable cause of preterm labour. Speak to your doctor about ways you can quit.

* In WA, women at very high risk of preterm birth may speak to their doctor about being referred to the Preterm Birth Prevention Clinic at King Edward Memorial Hospital. Typically, a management plan is developed and the woman is then referred back to her referring practitioner when the high risk period has ended. The clinic has Maternal Fetal Medicine specialists, ultrasound imaging facilities for cervix length measurement, and mental health care and midwifery services.

* In vitro fertilisation (IVF) and ovarian stimulation increase the risk of preterm birth. Part of this increased risk results from multiple pregnancies, part results from the cause of the underlying sub-fertility, and part results from other factors that remain unclear. The PTBP Initiative recommends that fertility treatments be used with appropriate caution and applied with a full understanding of the potential to increase the risk of early birth.

* Medical professionals are encouraged to advise women to prepare for a future pregnancy by optimising their health and seeking pre-conception counselling. This is especially important for women who have an increased risk of preterm birth from a personal or family history of early birth, prior surgical intervention on the woman’s cervix, or recurrent miscarriages, older women or where the time between pregnancies is less than 18 months.

* Women are also encouraged to maintain a normal bodyweight, avoid alcohol and recreational substance abuse and to take a daily folate supplement for at least three months before conception. Women with diabetes and hypertension should also stabilise autoimmune conditions or hypertension.

Source: The WA Preterm Birth Prevention Initiative

Wendy Caccetta