Study Charge

The persistent and troubling problem of preterm birth prompted the Institute of Medicine (IOM) to convene a committee, the Committee on Understanding Premature Birth and Assuring Healthy Outcomes, to assess the current state of the science on the causes and broad consequences of preterm birth. Specifically, the charge to the committee was as follows:

An IOM committee will define and address the health related and economic consequences of premature birth. The broad goals are to (1) describe the current state of the science and clinical research with respect to the causes of premature birth; (2) address the broad costs—economic, medical, social, psychological, and educational—for children and their families; and (3) establish a framework for action in addressing the range of priority issues, including a research and policy agenda for the future. In support of these broad goals, the study will:


• Review and assess the various factors contributing to the growing incidence of premature birth, which may include the trend to delay childbearing and racial and ethnic disparities;

• Assess the economic costs and other societal burdens associated with premature births;

• Address research gaps/needs and priorities for defining the mechanisms by which biological and environmental factors influence premature birth; and

• Explore possible changes in public health policy and other policies that may benefit from more research.

In order to assess research gaps and needs, the committee will plan an additional meeting that will address barriers to clinical research in the area of preterm birth. A workshop hosted by the committee will seek to

• Identify major obstacles to conducting clinical research, which may include the declining number of residents interested in entering the field of obstetrics and gynecol-ogy and the resulting effect on the pipeline of clinical researchers; the impact of rising medical malpractice premiums on the ability of academic programs to provide protected time for physicians to pursue research; and ethical and legal issues in conducting research on pregnant women (for example, the consideration of safety issues and informed consent); and

• Provide strategies for removing barriers—including those targeting resident career choices, departments of obstetrics and gynecology, agencies and organizations that fund research, and professional organizations.

Through this process the committee learned four key lessons. The first is that preterm birth is a complex expression of many conditions. Second, little is known about how preterm birth can be prevented. Great strides have been made in treating infants born preterm and improving survival. However, any significant gains to be made in the study of preterm birth will be in the area of preventing its occurrence. Third, racial-ethnic and socioeconomic disparities are striking and largely unexplained. Fourth, infants who are born near term (at 32 to 36 weeks of gestation) are at increased risk for adverse health and developmental outcomes that should not be ignored.

This summary presents an overview of the committee's recommendations. Below, these recommendations are preceded by text summarizing the evidence base from which they are drawn. For full findings and justification of each recommendation, the reader is referred to the full committee report.

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