WASHINGTON, Dec. 18, 2014—Statistics in the United States remain staggering in regard to infant mortality. According to the United Nations, the U.S. ranks 55th in the world. This ranking is behind nations like Cuba and Slovakia. Each year, more than 26,000 infants die before their first birthday. A baby dies of preterm birth every 30 seconds in the world. Preterm birth is the leading cause of infant morbidity and mortality, affecting 11.5 percent of all births in the U.S.—which is also among the worst in the world. Infant mortality disproportionately affects African Americans with a rate that is double that of Caucasians.
Research has proven that expanding preterm birth risk screening to include universal cervical length screening to identify more pregnant women who can benefit from evidence-based progesterone treatment can significantly reduce the nation’s preterm rate. This, in turn, would reduce the overall infant mortality rate.
Recently, physicians with the Society for Maternal-Fetal Medicine (high-risk pregnancy specialists), American Congress of Obstetricians and Gynecologists , and the American College of Nurse-Midwives joined with the March of Dimes and representatives from Medicaid Health Plans of America and the Perinatal Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened on Capitol Hill to brief Congress on the issue. They were also there to seek the support of the U.S. Dept. of Health & Human Services in driving the adoption of progesterone use—a vital strategy in saving the lives of tens of thousands of infants annually.
The U.S. Department of Health and Human Services has identified the reduction of infant mortality as well as preterm birth as priority policy areas. Both the Centers for Medicare and Medicaid Services and Health Resources and Services Administration have supported pilot programs to develop best practices for preterm birth and infant mortality prevention. However, little or no attention has been paid to driving adoption of the progesterone strategies both in women with no prior preterm as well as those with prior preterm birth as recommended by SMFM, ACOG, and ACNM.
“A country ranked number one in GDP should not also be ranked 55th in infant mortality rate. The evidence is clear and we have all of the necessary tools,” explained Dr. Vincenzo Berghella, president of SMFM and director of the Maternal-Fetal Medicine Program, Obstetrics & Gynecology at Thomas Jefferson University in Philadelphia. “A change in practice and emphasis on universal screening for premature cervical shortening and appropriate progesterone treatment, as well as progesterone for all those with prior preterm birth, is fundamental to the health and well-being of U.S. mothers and babies. Moreover, in women with singleton gestations and a prior spontaneous preterm birth, who develop a short cervical length before 24 weeks despite progesterone therapy, a cerclage should be performed.”
In 2012, the SMFM, ACOG,, and the ACNM published practice guidelines for preterm birth prevention. These guidelines emphasized that the use of progesterone treatment is proven to reduce the risk of early preterm births and of neonatal morbidity and mortality by at least 40-50 percent in women with singleton gestations, no prior preterm birth (90 percent of the population), who develop a short cervix on ultrasound screening.
Economic analyses show that universal cervical length screening and appropriate progesterone treatment for those diagnosed with premature cervical shortening is cost saving. The economic toll of preterm birth in the U.S. exceeds $26.2 billion annually. This strategy could save as much as $750 million annually. On-going medical and other costs for preemies continue to be much higher than full-term babies through the first seven years of life. Because Medicaid pays for 45 percent of births in the U.S. and the Children’s Health Insurance Program covers many preemies, the economic impact on government spending is tremendous.
# # #
The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed. For more information visit www.smfm.org.