Personalized medicine: new approaches to managing prematurity
Delayed motherhood, increasing numbers of amniocenteses and assisted reproductive treatments are some of the causes that explain the jump in preterm births
Prematurity is one of the most significant perinatal health problems in developed countries and, in half of all cases, the causes are unknown. International experts in gynecology, obstetrics and neonatology participated in the scientific debate Extremely Preterm Babies. Improving Perinatal Care, held by B·Debate, Hospital Sant Joan de Déu and Sant Joan de Déu Foundation on 16 and 17 January in Barcelona to debate how to reduce the number of preterm births and how to best treat health complications that often plague these infants in the short, middle and long term.
Dr. Josep Maria Lailla, head of Gynecology and Obstetrics at Hospital Sant Joan de Déu and one of the scientific directors of B·Debate, pointed out that “the most important thing is to delay the birth of extremely preterm babies, those born between week 22 and 27.”
The trend towards having children later in life, the increasing number of amniocenteses, and assisted reproductive treatments are some of the causes that have been connected with prematurity, although “the risk factors are different in each country,” according to the studies presented by professor Gian Carlo di Renzo of the University of Perugia (Italy). Professor di Renzo presented new tools to measure cervix length and biochemical markers (fetal fibronectin) that can be indicators of preterm births.
Dr. Eduard Gratacós of Hospital Clínic in Barcelona discussed some strategies based on published studies that suggest the use of vaginal progesterone and screening for cervix length in all pregnancies could cut preterm births by 100,000 per year in the United States alone. However, the scientific proof isn’t clear and the costs that universal screening would entail must be assessed.
Another breakthrough that was discussed by the experts has come out of Hospital Vall d'Hebron in Barcelona. Dr. Elena Carreras presented a silicon ring designed at Vall d'Hebron that delays preterm birth in approximately 75% of all cases.
In Japan, survival rates for infants born at 23 weeks are currently above 75%, and approximately 45% for those born at 22 weeks. Temperature and humidity in the incubators, monitoring systems, respirators and the drugs administered to these infants are some of the elements that affect their chances for survival, explained Dr. Naoto Takahashi of the Tokyo University Hospital.
If one of the problems in treating preterm babies lies in their response to drugs as compared to adults, “predictive medicine should allow us to identify which drugs are most fitting for each individual case presenting with the same condition,” said Dr. Matthias Schwab of the Tubingen University Hospital (Germany). There are many drugs that must be metabolized by specific enzymes that infants don’t have in order to be effective. Likewise, “having the genomic, proteomic, transcriptomic and metabolomic profiles of the preterm baby helps us improve our therapeutic strategy,” according to Schwab.
Participants also debated on postnatal and intrauterine inflammatory processes, the former having an impact on preterm birth and the latter being strongly linked to alterations in the white matter of the infant’s brain, which could lead to permanent alterations. Dr. Hugh O'Brodovich of the Stanford School of Medicine (United States) shared some of the most interesting lines of research he is working on regarding the study of the maternal microbiome and its role in preterm births and how vitamin D can boost the immune system to fight infection and help prevent preterm birth.
The following reports include the most noteworthy declarations from the speakers:
You can also follow the debate on Twitter @BDebate with the tag #BDebate