Research |  Interventions and Education  |  Information and Support for Affected Families  |  Awareness  |  Professional Education  |  Advocacy

 

RESEARCH
Supporting New Prematurity Research: Nearly half of all premature deliveries have no known cause. The March of Dimes Prematurity Research Initiative funds promising, innovative research into the causes of prematurity. The goal is to translate research findings into actions that will help prevent early births. Since 2004, the March of Dimes hs funded 34 grants for a total of over $11 million. The grants target some of the most crucial questions in prematurity research, including:

  • What role do various genes or gene-environment interactions play in the events that lead to early labor?
  • What role do infection and inflammation play in premature birth?
  • How can we identify women who go into preterm labor and deliver their babies early? Some women go into premature labor, but don't deliver early.
  • What genetic variations may be involved in premature birth among African-American women? For unknown reasons, African-American women are more likely to deliver early than are other women.  

The March of Dimes expects to award additional grants under the Prematurity Research Initiative in the future. To learn more, read about the grants that have been awarded.

Recent Discoveries by March of Dimes Prematurity Research Grantees: March of Dimes research funding has already resulted in promising discoveries.

  • Dr. Jerome Strauss identified a gene variant related to increased risk of premature rupture of the fetal membranes, a common cause of premature birth. The gene variant is much more common among African-American women. (2006)
  • Dr. Xiaobin Wang found a genetic variant associated with preeclampsia, another cause of premature birth. (2006)
  • Dr. Louis Muglia reported on the first mouse model for spontaneous preterm delivery. (2007)
  • Dr. Jeff Murray found a link between prematurity and places on the human gene that are involved in cholesterol metabolism. (2007)

Other Research Support: As we have done for many years, the March of Dimes continues to fund grants related to prematurity as part of our national research program. About 25 percent of those grants pertain to prematurity. Among the topics being studied are spontaneous preterm labor, complications of pregnancy, and the prevention and treatment of the consequences of prematurity.

The Institute of Medicine (IOM) Report: The IOM report "Preterm Birth: Causes, Consequences and Prevention," released in 2006, was cosponsored by the March of Dimes and other national organizations. The report validated and added urgency to the March of Dimes Prematurity Campaign and raised the importance of prematurity on the nation's research agenda. The March of Dimes and its campaign partners are pursuing many of the report's key recommendations.

Identifying National Priorities for Research: The campaign's Scientific Advisory Committee, a group of recognized experts, has identified national priorities for prematurity research in several areas: epidemiology, genetics, racial and ethnic disparities, potential treatments, infection and immune response. The American Journal of Obstetrics and Gynecology published the national priorities in September 2005. Our hope is that this article will inspire a broad range of medical researchers to study both the causes of prematurity and effective ways to prevent it. We also hope the paper will stimulate more funding for research. While the March of Dimes can support some of the needed studies, we cannot do it alone. Members of the Scientific Advisory Committee are leaders in the fields of obstetrics and gynecology, pediatrics, nursing, public health and research.  

Supporting International Collaboration: The March of Dimes is collaborating with the World Health Organization on an international preeclampsia study. Preeclampsia is a serious type of high blood pressure that can prompt preterm delivery. The foundation also participates in the Preterm Birth International Collaborative (PREBIC), an organization that supports and enhances international networking among researchers in preterm birth and works to establish multinational research projects. Within this group, WHO has established a consortium of investigators to carry out an international study of preterm birth. Participating countries include Australia, Denmark, the Republic of Korea and Mexico.


INTERVENTIONS AND EDUCATION
Preconception Education and Risk Reduction: The March of Dimes continues to educate women of childbearing age about how to prepare for pregnancy and reduce the risk of premature birth. Celebrities appear in educational pamphlets and print, radio and television advertising. Materials featuring Latina celebrity Thalia were launched in 2005. In 2006, the March of Dimes produced materials for Black women, featuring singer Heather Headley. Information is available in English and Spanish. To learn more, read 9 Questions to Help You Get Your 9 Months. 

Preconception Leadership: The March of Dimes co-leads the national Preconception Health and Health Care Initiative, along with other national organizations including the U.S. Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. National summits on preconception health were held in 2005 and 2007, and work continues on finance, clinical practice, disparities, special populations and global strategies.

Demonstration Project in Kentucky: In 2006, the March of Dimes, the Johnson & Johnson Pediatric Institute, and the Kentucky Department for Public Health launchd a prematurity prevention initiative, working with six Kentucky hospitals. The program is called Healthy Babies Are Worth the Wait. This effort brings together the most current approaches for preventing preterm birth. Interventions include:

  • Helping women to stop smoking and to gain an appropriate amount of weight during pregnancy
  • Screening women and referring them for treatable and preventable conditions
  • Providing consistent care before, during and between pregnancies
  • Implementing quality improvement programs in hospitals
  • Providing professional education for doctors and nurses
  • Encouraging women and their health care providers to think twice about early cesarean section and induction, unless they are medically necessary
  • Conducting consumer awareness campaigns

Investigating 17P, a Promising Intervention: Studies have suggested that progesterone treatment (also called 17P) can help prevent recurrent premature birth among some women. If all pregnant women who had previously given birth to a premature infant received this treatment, about 10,000 premature births in the United States could be prevented each year. Although progesterone treatment would reduce the overall rate of preterm birth by a modest 2 percent, it would still be important, given the enormity of the prematurity problem and the current challenges in effective prevention. 17P is awaiting approval by the U.S. Food and Drug Administration (FDA). In August 2006, the March of Dimes testified before the FDA Advisory Committee about the importance of licensing the drug so that more women can be helped by treatment. In 2007, a new study suggested that 17P may also help prevent premature birth in women with a short cervix, even if they did not previously have a premature birth.
 
Providing Grants to Communities: March of Dimes chapters award grants to community-based initiatives aimed at preventing premature birth. These efforts include programs that address disparities in preterm birth, preconception and interconception health, professional education on late preterm birth and the use of 17P, smoking cessation, consumer education on late preterm birth, and improved prenatal care. In 2007, these grants totaled over $7 million. 

Supporting CenteringPregnancy: CenteringPregnancy is a group model of prenatal care. In August 2007, the medical journal Obstetrics & Gynecology reported the results of a randomized, controlled trial that assessed this model. Women assigned to group prenatal care were less likely to have preterm births than women who received standard prenatal care (preterm birth rates of 9.8 percent and 13.8 percent, respectively). This study primarily included pregnant women who were young, African American and of low socioeconomic status. The March of Dimes has supported development of CenteringPregnancy in several ways, and many chapters fund local projects.  

Reducing Disparities in Premature Birth: The U.S. Centers for Disease Control and Prevention has funded the March of Dimes to develop model programs aimed at reducing disparities in premature birth. The program has tested a range of interventions in six states. In 2007, two programs were chosen for replication: group prenatal care and interconception care for high-risk women. The project has worked with local health departments, community-baed organizations, faith-based groups and provider organizations.


INFORMATION AND SUPPORT FOR AFFECTED FAMILIES
The March of Dimes NICU Family Support program provides information and comfort to families with newborns in neonatal intensive care units. Working in partnership with local hospitals, the project provides services to parents and staff. Educational materials and direct services assist families throughout the infant's hospitalization, during the transition to home, and in the event of a newborn death. As of March 2008, the program was operating in 60 hospitals across the country.  

For families outside the program's service sites, the March of Dimes provides iinformation, resources and support on the Web and through the online community Share Your Story. By the end of 2007, the community had 22,000 members and 350,000 unique visitors annually. Members tell their stories, seek and give support, keep blogs, and connect to the March of Dimes.


AWARENESS
Raising Awareness and Educating the Public: The March of Dimes reaches out to the general public, women and employers in a number of ways: through pamphlets, posters, fact sheets, videos, public service announcements, news releases, Web sites, community-based programs, and appearances on radio and television and at public meetings. November is Prematurity Awareness Month, with events held throughout the United States. From 2001 to 2007, awareness that premature birth is a very or extremely serious problem increased by 56 percent among women of childbeaing age: rising from 41 percent in 2001 to 64 percent in 2007.

Involving the Business Community: The March of Dimes continues to draw attention to the costs of prematurity and the actions employers can take. Eleven percent of newborns covered by employer health plans are born prematurely. Employers pay over $41,000 in direct health care costs for a premature baby—15 times more than what they pay for a healthy, full-term delivery. Companies are important partners in the March of Dimes prematurity campaign. They can do many things in the workplace to help fight prematurity. Providing health insurance to cover adequate preconception and prenatal care for employees is vital. Companies can also educate their employees about pregnancy and create pregnancy-friendly worksites that reduce physical and environmental stress. More information is available through Healthy Babies, Healthy Business.


PROFESSIONAL EDUCATION
Educating Doctors and Nurses: The Compendium on Preterm Birth, an online curriculum for health professionals, was launched in September 2006. The curriculum helps professionals learn to better identify patients at risk for having a premature baby and offers continuing education credits. It was developed in partnership with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Association of Women's Health, Obstetric and Neonatal Nurses. In 2006 alone, over 14,000 health care professionals attended 130 grand rounds sponsored by the March of Dimes on prematurity. As part of the campaign, the March of Dimes has published continuing education materials for nurses about preterm labor and the premature infant. For more information, visit the March of Dimes Web site for perinatal nurses.

Partnership with Family Medicine Physicians: The Family Medicine Education Consortium (FMEC), with funding from the March of Dimes, has launched a prematurity prevention initiative for family medicine faculty and residents. Utilizing quality improvement techniques, the program stresses clinical interventions that are known to prevent prematurity.  


ADVOCACY
The PREEMIE Act: In 2006, the March of Dimes achieved a major campaign milestone when the PREEMIE Act (P.L. 109-450) was signed into law. The act was cosponsored by 90 Representatives and 43 Senators. The bill set the stage for a 2008 Surgeon-General's conference to establish a public-private premaurity agenda. The agenda provides a comprehensive blueprint for identifying the causes of preterm labor and delivery, the risk factors, and treatment options.

Increased Federal Funding: The March of Dimes has succeeded in gaining increased appropriations to federal agencies for prematurity-related research.

The National Children's Study: Through the efforts of the March of Dimes, the federal government has fully funded the second phase of the National Children's Study. This research will track the health status of 100,000 children, from their mother's pregnancy to age 21.

Children's Health Insurance: The March of Dimes co-led a coalition of more than 300 groups who came together to support the reauthorization and expansion of the State Children's Health Insurance Program (SCHIP). President Bush vetoed the initial bills, but a temporary extension with additional funding was enacted into law.

Crucial Information for Policy Makers: The March of Dimes Data Book for Policy Makers includes national and state information on prematurity, infant mortality, birth defects prevention and health insurance. It also provides talking points, graphs and tables to be used when communicating with federal and state officials, both elected and appointed. To obtain a copy, download the PDF version (4.71 mb).

Health Insurance Status of Women and Children: Using Bureau of the Census tabulations, the March of Dimes collects and provides information on the health insurance status of women of childbearing age and children under the age of 19. Get the 2008 highlights here (pdf, 118 kb).

Advocacy in the States: Since the beginning of the Prematurity Campaign, March of Dimes chapters have had dozens of legislative and regulatory "wins." As a result:

  • Women, infants and children have better access to health insurance.
  • Birth defects programs and research have expanded. 
  • Smoking prevention and cessation programs for pregnant women have increased.   

Contact your local chapter to learn more about March of Dimes advocacy efforts in your state.    

September 2008