The problem of preterm birth: effective primary prevention

Preterm birth is an increasingly large public health problem, exacting a high societal cost. Reducing the rate of preterm birth is a priority. An inability to predict preterm delivery with any accuracy, or incomplete understanding of the etiologies of preterm birth, does not preclude effective preventive intervention. There is strong scientific evidence supporting the relationship between the physiologic stress response and pathologic pathways and cascades preceding preterm birth. A large, modifiable set of conditions facing the population of pregnant women can potentially activate this pathway. In the past 30 years, France has decreased its rate of preterm birth through a prevention program extended to the entire population of pregnant women. It is based on education, improvement of the social and working conditions of pregnant women, careful self-monitoring during pregnancy, and short-term lifestyle changes. A broad and unified approach to the problem of preterm birth in the United States, with changes in the culture surrounding pregnancy, including prenatal care, public attitude, and healthcare policy, is warranted.