Researchers link preterm births to infection
Uterine infection is the cause of many preterm births, according to a recent editorial in the American Journal of Public Health.
As many as 40% of all women in spontaneous labor have bacteria in both the amniotic fluid and the membranes, notes Robert L. Goldberg, MD, of the University of Alabama in Birmingham, who serves as principal investigator of the Low Birthweight Patient Outcomes Research Team sponsored by the Agency for Health Care Policy and Research in Rockville, MD.
The microorganisms cause increased production of inflammation-causing cytokines that can be detected in the amniotic fluid. These cytokines directly and indirectly participate in various reactions that lead to the onset of uterine contractions, changes in cervical consistency, and rupture of membranes that initiate labor.
Bacteria most commonly associated with spontaneous delivery include:
• Ureaplasma urealyticum;
• Mycoplasma hominus;
• Bacteroides organisms;
• Garnerella vaginalis.
Goldberg concludes that treatments aimed at the underlying infection seem far more promising than treatments targeted to symptoms of preterm labor or the psychosocial, behavioral, or nutritional characteristics of the mother. He adds that recently reported randomized antibiotic treatment trials of women at high risk for preterm birth, who also had bacterial vaginosis, showed substantial reduction in spontaneous preterm births.
(See: Goldenbert RL, Andrews WW. Intrauterine infection and why preterm prevention programs have failed. Amer J Public Health 1996; 86:781-782.)
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