Preterm labour and birth
Preterm birth (delivery before 37 weeks) is a significant global health issue, accounting for approximately 11% of births worldwide and is the leading cause of morbidity and mortality in babies. In the UK, 60,000 babies are born prematurely every year. Around 40% of spontaneous preterm births are associated with infection, most commonly caused by bacteria travelling from the vagina up through the neck of the womb. The structure at the entrance to the womb, the cervix, plays an important role in pregnancy as it forms a physical barrier to protect the womb and the developing baby from infection, as well as producing antibacterial proteins that fight infection.
Premature babies are at an increased risk of brain damage, which can result in cerebral palsy, as well as poor lung development, causing lifelong damage. Current treatments are ineffective at delaying delivery and do not improve neonatal outcome. It is crucial that new therapeutics are developed to prevent infection in the womb and protect the development of babies.
Fig. 1. Intrauterine infection/inflammation and fetal injury.
The presence of infection/inflammation can result in the preterm, pathological initiation of labour, with adverse consequences for the fetus. Inflammatory mediators may reach the fetal circulation by placental transmission into the umbilical cord or indirectly via the amniotic fluid. Amniotic fluid exposed tissues, such as the fetal skin and lung, can drive the fetal inflammatory response. Prolonged in utero exposure to inflammatory mediators can result in fetal injury. The fetus is susceptible to lung injury and bronchopulmonary dysplasia (BPD), as well as brain white matter lesions and neurological conditions such as cerebral palsy and autism. REF Boyle, A. K., Rinaldi, S. F., Norman, J. E. & Stock, S. J. (2017) Preterm birth: Inflammation, fetal injury and treatment strategies. J Reprod Immunol, 119, 62-66.