Multimodal Approach to Reducing Preterm Birth: The Synergistic Effects of Antenatal Corticosteroids, Optimized Prenatal Care, And Targeted Infection Management
Keywords:
preterm birth prevention, antenatal corticosteroids, infection screening, prenatal care, perinatal outcomesAbstract
Background: Preterm birth (PTB) remains a leading global cause of neonatal mortality, affecting 5-18% of pregnancies worldwide. While single interventions like antenatal corticosteroids (ACS) show partial efficacy, the multifactorial etiology of PTB demands integrated approaches. This study evaluated a multimodal strategy combining ACS, optimized prenatal care, and targeted infection management.
Methods: A prospective interventional cohort study was conducted at tertiary care hospitals (N=620 high-risk women; 310 intervention/310 historical controls). Inclusion criteria included prior PTB, short cervix (<25mm), or genitourinary infections at 24-34 weeks' gestation. The intervention comprised: (1) ACS per ACOG guidelines, (2) risk-stratified biweekly/weekly visits with nutritional support, and (3) systematic infection screening/treatment. Primary outcome was spontaneous PTB (<37 weeks); secondary outcomes included neonatal morbidity and maternal complications.
Results: The multimodal approach reduced PTB by 44% (14.2% vs 24.5% controls, RR 0.58, 95% CI 0.42-0.81, p<0.001), with greatest impact on early PTB (<34 weeks; 57% reduction). Neonatal outcomes improved significantly: RDS (31.8% vs 52.6%, p=0.02), NICU admissions (45.5% vs 68.4%, p=0.01), and sepsis (9.1% vs 22.4%, p=0.04). Subgroup analysis revealed 56% PTB reduction in women with short cervix (18.6% vs 40.3% controls, p=0.008). High adherence was achieved (94.8% ACS completion, 89.5% antibiotic compliance).
Conclusions: This three-pronged intervention significantly reduced PTB, particularly in highest-risk groups. Results support routine infection screening, frequent risk-adapted monitoring, and ACS integration within comprehensive care protocols. Future research should validate these findings in multicenter trials and evaluate long-term neurodevelopmental outcomes
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