Page 451 - Encyclopedia of Nursing Research

418 n PReveNTION OF PReTeRM BIRTH, PReTeRM lABOR, AND lOW BIRTH WeIGHT

and availability of neonatal intensive care preeclampsia (Allen, Joseph, Murphy, Magee
have decreased infant deaths and stillbirths & Ohlsson, 2004; Honest et al., 2009; Zhang,
P across time (Goldenberg, 2002; Institute of Neikle, & Trumble, 2003).
Medicine, 2007). This improvement, how- Prevention of preterm birth focuses on
ever, has resulted in more low-birth-weight identifying and reducing risk using perinatal
infants being born at the lower limits of monitoring systems and risk screening tools
viability and exceptionally high mortality so that health care providers can intensively
rates (Institute of Medicine, 2007). Preterm monitor women and initiate interventions
neonates who survive experience serious to reduce adverse outcomes (Andolesk &
immediate and long-term neurological Kelton, 2000; Institute of Medicine, 2007;
and developmental morbidities that affect Honest et al., 2009; Jordan & Murphy, 2009;
the family and society (Ashton et al., 2009; lyerly et al., 2009). Factors indicative of
Crowther, Hiller, & Doyle, 2009; Honest increased risk for preterm birth can be phys-
et al., 2009; Institute of Medicine, 2007). The iological, psychosocial, behavioral, and
annual cost of preterm birth to American sociodemographic in nature (Institute of
society is more than $26 billion (Institute of Medicine, 2007). Major physiological risk fac-
Medicine, 2007). tors include a history of previous preterm
Reducing preterm labor and preterm birth, multiple gestation, vaginal bleeding
birth has been stymied by the lack of under- from a placenta previa or abruption, second
standing of the factors that initiate labor and trimester bleeding, and disease states such
the causes of preterm birth (Ashton et al., as hypertension or diabetes (Goldenberg,
2009; Institute of Medicine, 2007; Muglia 2002; Institute of Medicine, 2007; Society of
& Katz, 2010). Causes of preterm birth are Obstetricians and Gynaecologists of Canada,
believed to be due to complex multiple etiolo- 2008). Psychosocial risk factors include prob-
gies of medical complications, biological and lems such as stress, which is associated with
genetic factors, behavioral and psychosocial preterm birth, lower birth weight, small for
issues, exposure to environmental terato- gestational age, fetal birth defects, and devel-
gens, and infertility treatments (Ashton et al., opmental delay (Anhalt, Telzrow, & Brown,
2009; Institute of Medicine, 2007; Muglia & 2007; Giscombe & lobel, 2005; Krabbendam
Katz, 2010). Preterm birth is categorized as et al., 2005; Nkansah-Amankra, luchok,
either spontaneous or elective. The cause of Hussey, Watkins, & liu, 2010; Wadhwa et al.,
spontaneous preterm birth, which occurs 2002). Behavioral risk factors include sub-
in 60% to 70% of pregnancies, is unknown stance use, particularly smoking, which is
and includes diagnoses such as spontane- associated with increased risk of preterm
ous preterm labor or rupture of membranes birth, low birth weight, and small for gesta-
and cervical weakness, placental abruption, tional age (Agrawal et al., 2010; Institute of
and infection (DiRenzo et al., 2006; Honest Medicine, 2007; Raatikainen, Huurrinainen,
et al., 2009; Muglia & Katz, 2010). Between & Heinonen, 2007).
30% and 50% of these births are caused by Sociodemographic risk factors for pre-
infection of the fetal membranes and mater- term birth include the extremes of maternal
nal systemic system, including periodon- age, low education, socioeconomic status, and
tal disease (Crowther, Thomas, Middleton, maternal race/ethnicity (Institute of Medicine,
Chua, & esposito, 2009; Goldenberg, 2002). 2007; Osterman, Martin, & Menacker2009;
elective preterm birth, which occurs in 30% Whitehead, Callaghan, Johnson, & Williams,
to 40% of women, results from medical inter- 2009; Wise, Heffner, & Rosenberg, 2010). Racial
vention for maternal or fetal complications disparities in preterm birth exist (Institute of
such as sepsis, fetal distress, or fulminating Medicine, 2007). The rate of preterm birth