The researchers reviewed the medical records of 1440 mothers of VLBW infants born in five U.S. locations and retrospecitively applied three different sets of eligibility criteria for home uterine activity monitoring. The theory behind the intervention is that the device is supposed to pick up signs of labor as yet unrecognized by the mother, and give her time to get to a hospital where she can receive treatment to stop the labor and thus prolong the length of gestation.
However the researchers found that the majortiy of deliveries of VLBW infants were precipitated by conditions that would not have have qualified the pregnant mothers for use of home uterine activitiy monitoring or the early labors had indications for immediate delivery of the infant rather than attempts to prolong pregnancy. Additionally, only women who receive early prenatal care have the chance to benefit from monitoring, and, as the researchers data indicate, a sizable number of women did not receive early care.
The findings, combined with those of previous studies may explain why, despite the widespread use of drugs to stop labor and the growth of home uterine monitoring programs, there has been only a slight decline in low birth weight (<2500 gm) births and no change in the number of VLBW births.
The authors write that "effective approaches to the reduction of prematurity and VLBW will depend on linking therapeutic clinical interventions with more comprehensive prevention strategies to improve women's health."
CONTACT: Allison Kempe, MD MPH, Assistant Professor of Pediatrics and Preventive Medicine and Biometrics at the University of Colorado Health Sciences Center; tel. 303-837-2744; fax 303-764-8072; e-mail firstname.lastname@example.org.
Other authors: Bejamin P. Sachs, MBBS DPH; Hope Ricciotti, MD; Arthur M. Sobol, MA; Paul H. Wise, MD MPH.