Premature birth: preventing early labour and protecting babies from brain damage

Published on 29 October 2010

What's the problem and who does it affect?

The earlier the birth, the greater the danger

The rate of premature births has risen in many industrialised countries.^3,4 In the UK, premature birth is the biggest killer of babies under one.^5-8,b,c Sadly around 1,500 babies die here every year after being born too soon.^5-8,b,c

Many babies who survive an early birth develop lifelong disabilities, such as cerebral palsy, blindness, hearing loss and learning difficulties. They might also have an increased susceptibility to some diseases in adulthood, including heart disease and diabetes.⁹

In total, over 50,000 babies are born prematurely – more than three weeks early – each year in the UK.^1,2.a The earlier a premature baby is born, the lower their chances of surviving and escaping disability. A shocking eight of every ten babies develop disabilities if they survive after being born more than 14 weeks early.¹⁰

Many premature births happen because the mother goes into labour too soon. Tests can identify women who are at high risk of having an extremely early delivery, but little can be done to help the women or their babies.

What is the project trying to achieve?

Benefiting both mother and child

In the past, many of the attempts to delay premature birth have focused on stopping contractions in women who have already gone into labour. Drugs called tocolytics can slow down labour, but they can normally delay a baby’s birth by only 48 hours or so.

The researchers believe that a key to better, preventative treatment could involve a molecule called cAMP. Preliminary data suggests drugs that target cAMP might both decrease a woman’s chances of going into labour early and protect her baby from the harmful effects of infection. Infection is thought to play a major role in the onset of preterm labour and it can cause brain damage in the unborn child.

The researchers are investigating the potential of drugs that increase cAMP levels, and whether they work better alone or in combination with a natural hormone, called progesterone. Currently, most women at risk of preterm labour receive progesterone alone and this reduces their risk, but does not prevent premature labour completely. More importantly, we do not know if it improves the baby's chances of surviving or escaping disability. The researchers are finding out how cAMP works to stop contractions and protect the fetal brain.

What are the researchers' credentials?

The three researchers in the project team are leading experts in premature birth. They have all dedicated their careers to improving the care of women who are at risk of going into labour too soon, and finding ways to improve the health of their babies. They are highly regarded worldwide and have impressive publications records.

The researchers have cutting-edge expertise in laboratory research, and have focused in particular on investigating the molecular mechanisms involved in the onset of labour. They have also been involved in several clinical trials, looking for ways to predict which women are at risk of going into labour prematurely and to prevent early births.

Collectively, the researchers have been responsible for several seminal findings relating to premature birth. They revealed, for example, how stretching of the womb contributes to the onset of preterm labour in women who are expecting twins or triplets. They also uncovered the central role played by proteins called ion channels and hormone-like substances called prostaglandins in the onset of preterm and term labour.

The research is taking place in the Institute of Reproductive and Developmental Biology, Imperial College, London, a state-of-the-art research building equipped with the very latest scientific apparatus.

Who stands to benefit from this research and how?

Protecting babies from life-long disability

The researchers aim to help pregnant women who are at high risk of having their baby very early. Evidence suggests that tests can identify up to eighty per cent of women who are at risk of having their baby more than 12 weeks too soon.¹¹

The researchers are in the early stages of their work. Ultimately, they hope to develop a treatment that brings dual benefits – cutting a woman’s chances of having her baby too soon and protecting the baby from harm.

More specifically, they hope to protect babies from brain damage, so stopping them from developing life-long disabilities, such as cerebral palsy, and sparing them from a lifetime of dependency on others.

The parents, siblings and other close relatives of premature babies can be deeply affected by the stress of caring for them. The economic costs are staggering, with major cost implications for the families themselves, the NHS, the education system and social care.

Treatments that can prevent premature birth, and protect babies from developing life-long disabilities, could bring profound benefits to the babies, their families and society as a whole.

References

1. Office for National Statistics. Health Statistics Quarterly 43 (Autumn 2009), Table 2.1 http://www.statistics.gov.uk/downloads/theme_health/HSQ43.pdf
2. The Information Centre, Community Health Statistics. NHS Maternity Statistics, England: 2006-07, 2007-08, 2008-09 http://www.ic.nhs.uk/statistics-and-data-collections/hospital-care/maternity/nhs-maternity-statistics-2008-09
3. Goldenberg RL et al. Epidemiology and causes of preterm birth. The Lancet 2008; 371:75-84.
4. US Institute of Medicine. Preterm Birth: Causes, Consequences and Prevention. July 13, 2006. http://www.iom.edu/Reports/2006/Preterm-Birth-Causes-Consequences-and-Prevention.aspx
5. Office for National Statistics. Health Statistics Quarterly 28 (Winter 2005), 32 (Winter 2006), 36 (Winter 2007)
6. Office for National Statistics. Infant and perinatal mortality in England and Wales by social and biological factors. Statistical Bulletin. 24 November 2009. http://www.statistics.gov.uk/pdfdir/ipm1109.pdf
7. General Register Office for Scotland, Vital Events Reference Tables 2009
8. Northern Ireland Statistics and Research Agency. Registrar General Annual Report 2008
9. Saigal S, Doyle LW. Preterm Birth 3. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371:261-69.
10. Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and Developmental Disability at Six Years of Age after Extremely Preterm Birth. N Engl J Med 2005; 352:9-19.
11. Celik E et al. Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet Gynecol 2008; 31(5) 549-54.