CDC scientists are collaborating with many partners, including state health departments, university researchers, and other health care professionals to understand why preterm births occur and what can be done to help prevent them. CDC’s Division of Reproductive Health is engaged in the following activities:
Perinatal Quality Collaboratives
State Perinatal Quality Collaboratives (PQCs) are networks of perinatal care providers and public health professionals working to improve pregnancy outcomes for women and newborns by advancing evidence-based clinical practices and processes. In September 2014, CDC awarded six states for the State-Based Perinatal Quality Collaboratives (PQCs) Cooperative Agreement (California, New York, Ohio, Illinois*, Massachusetts*, and North Carolina*). Funding will enhance the capabilities of PQCs to improve perinatal outcomes by improving the quality of perinatal care in their states. These PQCs will improve the quality of perinatal care in these states by reducing maternal morbidity and mortality, reducing scheduled deliveries without a medical indication (also known as elective deliveries) before 39 weeks gestation, increasing use and documentation of use of antenatal steroids for impending preterm births, increasing breastfeeding rates, and reducing hospital-acquired neonatal infections.*New states.
CDC worked with statewide PQCs in California, New York, and Ohio to sponsor a series of Webinars from October 2012 through August 2013. These Webinars were intended to help PQCs share knowledge and experiences, and teach other states how to start, maintain, and grow their own collaboratives. Due to an overwhelming response, a second series of Webinars about specific perinatal quality improvement initiatives occurred in 2013–2014. Webinars are available to participants in all states.
Vitamin D Studies
Vitamin D deficiency is estimated to affect 38% of U.S. reproductive-aged women and 28% of U.S. pregnant women. Among pregnant women, vitamin D deficiency varies significantly by racial and ethnic groups, ranging from 13% of non-Hispanic white women to 80% of non-Hispanic black women. Women who have low levels of vitamin D may be at higher risk for problems during pregnancy, including preterm birth. Because this is a new idea, research is needed to clarify this association. CDC conducted a study in Michigan, North Carolina, and Washington State to examine vitamin D levels in stored blood samples of women who had a preterm birth. An additional analysis confirmed seasonal changes in levels of 25-hydroxyvitamin D (a substance used to measure vitamin D status), with peak levels in summer and the lowest levels in winter. However, there are smaller seasonal changes among black mothers. CDC also funded researchers at the University of Pittsburgh to conduct a study examining whether vitamin D deficiency and variations in vitamin D receptor genes are associated with risk of preterm birth in pregnant women.
Smoking in Pregnancy
Despite decreases in smoking prevalence over recent years, almost 22% of women of reproductive age are smokers (2006 data), and 12% of women reported smoking during pregnancy in 2010 (40 sites). In addition to a variety of negative pregnancy outcomes, in 2002, smoking during pregnancy was associated with 5%-8% of the cases of preterm birth. CDC is actively working to improve reproductive health outcomes through the reduction of smoking among women before, during, and after pregnancy in the United States and globally. Learn more about CDC’s work on tobacco use in pregnancy.
Surveillance, Data Quality, and Data Linkages
Much of CDC’s maternal and infant health surveillance, data quality improvement, and data linkage efforts revolve around birth certificates, the primary resource for learning about preterm birth rates in the United States. CDC partners with the National Center for Health Statistics (NCHS) and the National Association for Public Health Statistics and Information Systems (NAPHSIS) to promote the accurate recording of gestational age on birth certificates, that is critical to calculate the rate of preterm birth, better understand the impact of preterm birth, follow trends, and make recommendations about preventing preterm birth. CDC is also involved in data linkage projects for the jurisdictions of NYC and Kansas that link together birth certificate data with other administrative or survey data, including fetal death certificates, hospital discharge records, and Pregnancy Risk Assessment Monitoring System survey data.
CDC collaborates with national partners in the text4baby program. Text4baby is a free mobile health service that provides health and safety tips to mothers about pregnancy and a baby’s first year of life. Since its national launch in February 2010, text4baby has reached more than 700,000 people. The program reduces barriers to accessing services and increases knowledge and positive behaviors related to pregnancy and infant health and safety. Women can sign up by texting BABY or BEBE (for Spanish) to 511411. The program sends approximately 3 free text messages per week timed to due dates and birth dates. Text4baby is a public-private partnership with the National Healthy Mothers, Healthy Babies Coalition, Voxiva, CTIA—The Wireless Foundation, the U.S. Department of Health and Human Services (HHS), and Johnson & Johnson.
Additional Sources of CDC Preterm Birth Data
The CDC National ART Surveillance System (NASS) is a nationwide system for monitoring ART use and outcomes. Analysis of NASS data has supported the evidence suggesting a higher risk for certain adverse outcomes, including preterm birth, among women who use ART.
The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the CDC and state health departments. PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. PRAMS data have been used to analyze the characteristics of women who experienced preterm delivery.
CDC’s NCHS is the principal health statistics agency of the U.S. Through its relationship with vital registration systems throughout the U.S., NCHS collects, analyzes, and publishes data on a wide range of health indicators, including preterm birth. For more information, visit the NCHS birth data page.
MCH Epidemiology Assignees
The Maternal and Child Health Epidemiology Program (MCHEP) assigns senior CDC epidemiologists and graduate-level fellows to state health departments and other public health agencies and organizations, where they focus on MCH epidemiology capacity building and applied research. The MCHEP has assigned more than 35 senior CDC epidemiologists focused on MCH epidemiology capacity building and applied research to 20 states since 1987. Assignees provide direct assistance to public health agencies on a variety of topics, including preterm birth.
Strong Start Initiative
The Department of Health and Human Services launched the Strong Start Initiative to increase healthy deliveries and reduce preterm births. To tackle this problem, the Center for Medicare and Medicaid Innovation awarded grants to health care providers and community organizations to improve prenatal care to women covered by Medicaid or Children’s Health Insurance Program (CHIP). CDC is one of the federal agencies that identified Strong Start’s goals and focus and continues to provide initiative support.