Download a copy of Prematurity Campaign: 2008 Progress Report (pdf, 4.4 mb)

Meeting Campaign Goals
Goal 1: Raising public awareness of the problems of prematurity: Since 2001, awareness that prematurity is a very serious problem has increased:

• From 41 percent to 60 percent among women of childbearing age
• From 35 percent to 46 percent among the general public

This growth was achieved through public service advertising, media relations activities, online marketing, advocacy, and events conducted by March of Dimes chapters. The annual Prematurity Awareness Month and Day, conducted in November, has been a key driver.

Goal 2: Decreasing the rate of preterm birth in the United States: Over 10 years, the preterm birth rate in the United States increased 15 percent: from 11 percent to 12.8 percent in 2006. This trend and the dynamics underlying it underscore the critical importance and timeliness of the March of Dimes Prematurity Campaign. In 2007, a small but statistically significant decrease occurred: to 12.7 percent.

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Mobilizing Public Support and Action
The Institute of Medicine report: An important early milestone in the Prematurity Campaign was the publication in 2005 of the Institute of Medicine (IOM) report titled Preterm Birth: Causes, Consequences and Prevention. Funded in part by the March of Dimes, this report thoroughly documented the impact of premature birth on families, the health care system and business; it also provided the first cost estimates. According to the IOM, “The annual societal economic burden associated with preterm birth in the United States was at least $26.2 billion in 2005, or $51,600 per infant born preterm.” The report laid out an agenda for research and action for health care providers, researchers and government.

The PREEMIE Act: To further galvanize action in the field, the March of Dimes worked with Congress to introduce the PREEMIE Act in 2005. (The abbreviation stands for the Prematurity Research Expansion and Education for Mothers Who Deliver Infants Early Act.) Through March of Dimes advocacy efforts, this act became law in 2006, leading to the first Surgeon General’s Conference on the Prevention of Preterm Birth.

The Surgeon-General’s Conference: Held June 16-17, 2008, in Rockville, Maryland, the conference brought together experts from the public and private sectors. March of Dimes staff and volunteers were key participants in developing the conference action plan. Achieving the goals of this plan will require both private and public resources for research, capacity building, data systems, interventions, quality initiatives and communications. The March of Dimes played an important role in disseminating the findings of the conference, through online efforts, publicity and preparation of a journal article published in 2009 (Obstetrics and Gynecology, April 2009).

The March of Dimes Action Agenda: After the Surgeon-General’s conference, the March of Dimes prepared its own action agenda consistent with the key findings of that event.

• Advocate for funding and/or authority for the National Center for Health Statistics (NCHS) to implement changes in state and national vital statistics regarding prematurity.
• Enhance the accuracy of gestational dating by implementing the Institute of Medicine’s recommendation for routine first trimester ultrasound.
• Develop a blueprint and cost estimate for research centers dedicated to the study and prevention of preterm birth.
• Pursue an advocacy agenda to gain new funding for the research centers. Gain funding for the PREEMIE Act and other federal programs. Advocate to reestablish the Interagency Council on Low Birthweight and Preterm Birth.
• Create a quality improvement initiative to decrease inductions and cesarean sections, which can contribute to preterm birth. Conduct a 2009 National Symposium on Quality Improvement to Prevent Prematurity.

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Supporting Medical and Epidemiological Research
Funding for research: The March of Dimes has continued to expand funding for the Prematurity Research Initiative, which funds promising, innovative research into the causes of prematurity. The goal is to translate research findings into actions that will help prevent early births. Nearly $11 million has been awarded to 30 grantees. In addition, the March of Dimes continues to fund grants related to prematurity as part of our national research program. About 25 percent of those grants pertain to prematurity.

Promising discoveries: March of Dimes research funding has already resulted in promising discoveries:

• March of Dimes-funded research demonstrated an important pathway of preeclampsia and a potential new approach for diagnosis and treatment. Preeclampsia is a serious form of high blood pressure in pregnant women that can lead to preterm birth. The study was published in the journal Nature Medicine. (2008)
• Dr. Jerome Strauss identified a gene variant related to increased risk of premature rupture of the fetal membranes, a common cause of premature birth. The gene variant is much more common among African-American women. (2006)
• Dr. Xiaobin Wang found a genetic variant associated with preeclampsia, another cause of premature birth. (2006)
• Dr. Louis Muglia reported on the first mouse model for spontaneous preterm delivery. (2007)
• Dr. Jeff Murray found a link between prematurity and places on the human gene that are involved in cholesterol metabolism. (2007)

Networking for research: In December 2008, the March of Dimes and the Burroughs Wellcome Fund cosponsored the conference Preventing Prematurity: Establishing a Network for Innovation and Discovery. This meeting brought together about 200 researchers from around the world to establish new partnerships and to inspire other scientists to pursue studies in this area.

The Perinatal Data Center: The March of Dimes Perinatal Data Center works collaboratively with professional colleagues to conduct epidemiologic analyses and to translate findings into new insights. Key findings from Perinatal Data Center studies published in 2008 include the following:

• Increased Risk of Adverse Neurological Development for Late Preterm Infants, Journal of Pediatrics: This study found that prematurity is associated with long-term neurodevelopmental consequences. Risks increase as gestation decreases, even in infants born at 34 to 36 weeks. This research adds urgency to the need to reduce the number of infants born just a few weeks early.
• The Relationship Between Cesarean Delivery and Gestational Age Among U.S. Singleton Births, Clinics in Perinatology: This study found that cesarean sections account for nearly all of the increase in U.S. singleton preterm births between 1996 and 2004.

The c-section research suggests that more scrutiny is needed to ensure that cesarean sections are medically indicated. C-sections performed before 39 weeks for the convenience of the mother or the physician do not comply with guidance from the American College of Obstetricians and Gynecologists (ACOG); they may significantly contribute to the growth of premature birth in the United States.

Based on the study’s findings, the March of Dimes has called for hospitals and providers to voluntarily assess c-sections performed before 39 weeks to ensure that professional guidelines are being followed. This message supports the quality improvement initiatives now under way in many hospitals and has the potential to reduce the prematurity rate within those institutions.

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Serving Families
NICU Family Support: The March of Dimes NICU Family Support program provides information and comfort to families with newborns in neonatal intensive care units (NICUs). In 2008, the program served 84 NICUs and more than 50,000 families.

Healthy Babies Are Worth the Wait: This 3-year, multifaceted initiative in Kentucky focuses on preventing “preventable” preterm births. Three hospitals deliver evidence-based interventions, with the goal of reducing singleton preterm births by 15 percent.

The March of Dimes and Johnson & Johnson jointly fund and implement the project. If it succeeds in preventing preterm birth, the March of Dimes plans to implement the approach in more states.

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Educating Key Target Audiences
In 2008, the March of Dimes completed and disseminated two new consumer booklets about prematurity:

• Why the Last Weeks of Pregnancy Count includes questions for women to ask providers about labor induction and c-sections, as well as information about late-preterm birth and the developing baby’s brain.
• Thinking About Fertility Treatment includes information on the risks of premature birth and multiples in fertility treatment.

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Delivering Prevention Services
In 2008, March of Dimes chapters conducted a wide array of activities aimed at reaching women with modifiable risk factors. Community grants supported most of these activities; in 2008, chapters funded 659 grants totaling $7.7 million. These efforts included:

• CenteringPregnancy, a group model of prenatal care
• Smoking cessation for pregnant women
• Preconception/interconception education
• Disparities in preterm birth
• Quality improvement

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Educating Health Professionals
In 2008, the March of Dimes conducted continuing education programs in 30 states and 44 cities, touching urban, suburban and rural populations. These efforts included traditional grand rounds in hospital and health care settings, educational conferences, symposia, Webinars and podcasts.

During the year, 61 events took place, attended by approximately 7,600 professionals. Seventy-eight percent of session topics focused on prevention and intervention; 22 percent, on managing the consequences of preterm birth. New funding from Hologic, Inc., and an anonymous donor supported these efforts.

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Protecting and Expanding Public Programs
During 2008, March of Dimes chapters successfully advocated for:

• Improved access to health coverage (16 chapters)
• New funding for smoking prevention and cessation (10 chapters)
• Expanded birth defects surveillance (6 chapters)

At the national level, the March of Dimes helped block a Medicaid regulation that would have narrowed services for women with high-risk pregnancies and for infants and children with special needs.

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Raising Public Awareness
In 2008, the March of Dimes produced Premature Birth Report Cards for every state and the nation. The cards highighted prematurity in individual states, specific contributing factors, and opportunities for action. Positive news stories appeared in every state, Washington, D.C., and Puerto Rico. More than 1,500 stories nationwide were generated.

In the fourth quarter, the March of Dimes encouraged the public to sign the Petition for Preemies, which called for:

• Expanded federal funding for prematurity research
• Increased access to health care and smoking cessation programs for pregnant women
• Voluntary assessment of early c-sections by hospitals
• Enhanced support for healthy pregnancies in the workplace

More than 119,000 people signed the petition, with about two-thirds being new constituents for the March of Dimes.

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July 2009