The rising preterm birth rate in China: a cause for concern

Globally, one in ten babies are born preterm, and the preterm birth rate has been increasing.1Chawanpaiboon S Vogel JP Moller A-B et al.Global, regional, national estimates of levels 2014: a systematic review modelling analysis.Lancet Glob Health. 2019; 7: e37-e46Summary Full Text PDF PubMed Scopus (811) Google Scholar The second highest number births reported China, with more than 1 million every year. Our meta-analysis showed an increase by 1·1% per year from 1990 to 2016.2Jing Chen C Gan Y J Zhang Incidence trend 1990-2016: meta-analysis.BMJ Open. 2020; 10e039303Crossref (6) In Lancet Global Health, Kui Deng colleagues3Deng K Liang Mu al.Preterm China between 2012 2018: observational study 9 women.Lancet 2021; 9: e1226-e1241Summary (4) estimated 1·3% 2018. Their data also suggested that increasing might have accelerated after introduction universal two child policy China. Very (born 28 31 weeks gestation) increase, followed late 34 36 gestation). short-term long-term sequalae well recognised;4Crump Sundquist Winkleby MA Gestational age at mortality infancy into mid-adulthood: cohort study.Lancet Child Adolesc 3: 408-417Summary (48) as result, large annual combined rising is cause for concern. Underlying complex matrix causes, risk factors, protectors, confounders. Probably most prominent consistent causes rise maternal childbearing age, resulting pregnancy complications, multiple pregnancies due increased use assistant reproductive technologies. very appeared come singleton whereas gestations contributed proportion births. These factors explain why rates early Low socioeconomic status factor birth. no exception. includes low education, being unmarried while pregnant, attending inadequate prenatal visits (<8 visits), residing lower income regions, suboptimal quality care (eg, poor capability ultrasound scan assess gestational age).3Deng Scholar, 5Chen JW Xia HW china 2015 2016.Am Public 109: 1597-1604Crossref (35) Because these often tightly intertwined, ascertaining whether alone can effectively prevent cross-sectional survey challenging. More evidence needed support idea decrease caesareans over past decade mitigated because reductions caesarean delivery came full term pregnancies. Nonetheless, rapid economic development government Targeted Poverty Alleviation programmes counterbalanced decade. There wide range precursors But still unknown cause. For example, our Labor Delivery Survey5Chen spontaneous labour accounted 159 393 (29·5%) 540 317 premature rupture fetal membranes 150 208 (27·8%) births; 187 035 (34·2%) all had known all. diverse obscure made prevention some strategies found be effective previous randomised trials.6Matei A Saccone G Armson AB Primary secondary birth: reviews ongoing randomized controlled trials.Eur Obstet Gynecol Reprod Biol. 236: 224-239Summary (29) instance, lifestyle behavioural changes diet exercise) reduce when applied general obstetric population primary prevention. targeting individuals high-risk birth, low-dose aspirin, progesterone supplementation, cervical length screening placement cerclage pessary those short cervix useful interventions, although recommendation on supplementation debated.7Medley N Poljak B Mammarella Alfirevic Z Clinical guidelines management review.BJOG. 2018; 125: 1361-1369Crossref (38) Several studies iatrogenic approximately 40% births,5Chen 8Henderson JJ McWilliam OA Newnham Pennell CE Preterm aetiology 2004-2008. Maternal associated three phenotypes: labour, pre-labour medically indicated birth.J Matern Fetal Neonatal Med. 2012; 25: 642-647Crossref (61) which was attributable 20–30 years.8Henderson perinatal childhood outcomes,4Crump should avoided much possible; reducing another potential area reduction goal tertiary minimise adverse infants. Steroids lung maturation magnesium sulphate neuroprotection established prophylactics. It important realise infants not only shorter gestation but already growth developmental problems utero. Some utero damage reversible through appropriate postnatal nurturing rehabilitation during first 1000 days life.9Lei X Ye Ouyang F Jiang optimal trajectory small babies: prospective study.J Pediatr. 2015; 166: 54-58Summary (45) From life-course perspective, it beneficial involve neonatologists paediatricians deciding time making treatment plan together obstetricians. fetuses congenital anomalies or special conditions, paediatric before paediatrics, could helpful provide specialised, continuous treatment, follow future health become healthy adults. achieved great advances neonatal survival extreme reached respectable level neonates 26 exceeds 80%),10Qiao Wang Li al.A Commission 70 years women's reproductive, maternal, newborn, child, adolescent China.Lancet. 397: 2497-2536Summary (28) consider redefining 24 (instead weeks) gestation, make definition comparable high-income countries. We declare competing interests. womenAn noted both 2018 China's strategic investment crucial Due sociodemographic related birth—particularly within context policy—such advanced delivery, pregnancies, greater efforts burden urgently needed. Full-Text Open Access