The growing problem of preterm birth is not receiving the attention it deserves. A half million (about 12.5%) babies born in the United States each year are premature, a rate that has risen 30% during the past 2 decades.1 This prevalence constitutes a serious public health crisis in our country and throughout the world. There are significant, persistent, and troubling racial, ethnic, and socioeconomic disparities in the rates of preterm birth, with the highest rates (17.8%) for non-Hispanic African Americans.1 Last year, the economic burden of preterm births in the United States was more than $26 billion, or about $51,600 per infant.

A new report from the Institute of Medicine's Committee on Understanding Premature Birth and Assuring Healthy Outcomes takes a comprehensive look at the problem of preterm birth, from what we know about the complex, overlapping causes of preterm birth, to its varied consequences involving infants, families, and society. Despite decades of attempts to prevent preterm birth, efforts primarily have succeeded only in delaying delivery long enough to allow administration of antenatal steroids and transfer of mother and fetus to a hospital where they can receive appropriate care.1

The report considers the role that assisted reproductive technology, including superovulation drugs and multiple embryo transfer, play in the preterm birth rate, particularly the high rate of multiple births. The Committee determined that fertility treatments were a significant contributor to preterm birth among both singleton and multiple pregnancies.1 Stricter guidelines regarding the number of embryos that may be transferred in a single cycle are recommended.

The Committee advocates the use of early prenatal ultrasound to reliably determine gestational age. In addition, the report proposes a research agenda to investigate the problem of preterm birth, including the establishment of multidisciplinary research centers. The full text of the report is available online at http://www.nap.edu.

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