Preterm birth : why it happens and strategies to prevent it.

WHO estimates that in 2015, 15 million babies are born prematurely. During the pregnancy, every moment is vital for the healthy growth of the baby. Even the latest weeks of pregnancy are essential for the right development of the brain, lungs, and liver. So, what are the consequences of preterm delivery? Unfortunately, complications of preterm babies lead to higher rates of deaths and the ones who survived may suffer some forms of disability like breathing problems, feeding difficulties, cerebral palsy, developmental delay, vision problem, and hearing problems. The baby is not the only one who suffers from preterm birth, also the just-become-mom has to take the financial and emotional burden. This can lead to profound depression, disturbance, anger, marital disturbances, and sleep deprivation. This is the classification that characterizes preterm birth before the 37 weeks.

  • extremely preterm (less than 28 weeks)
  • very preterm (28 to 32 weeks)
  • moderate to late preterm (32 to 37 weeks).

What causes preterm labor? Probably the early idiopathic activation of the normal labor process is caused by different risk factors. An important contributor to the overall increase in preterm births is the increasing numbers of couples that rely on assisted reproductive technologies, but it isn’t the only aspect. Black women have a higher risk of preterm labor, three to four times higher than women of other ethnics groups. The nutritional status has an important influence during pregnancy, indeed, women with a low rate of iron, folate, or zinc are more prone to preterm births. Preterm premature rupture of the membranes (PROM) leads to preterm labor, however, the reasons that cause this rupture are unknown, women are usually asymptomatic, so it’s very difficult to prevent this event. Other risk factors can be Infections, tobacco, maternal endocrine abnormalities such as uncontrolled diabetes mellitus and insufficient production of progesterone, maternal autoimmune factors, and a previous history of two or more miscarriages. One of the main reasons for preterm labor is inflammation. Indeed, factors associated with preterm labor are usually linked to inflammation. During pregnancy, the physiological status of the woman undergoes a lot of different changes, especially, the immune is modulated to prevent that the fetus is attacked by the immune system of the mother, also, the inflammatory pathway is adjusted. As a matter of fact, a successful pregnancy relies on the balance of these two pathways. Inflammation usually is linked to a harmful situation, like infections and tissue damage. However, during pregnancy, there is an important and delicate balance between the pro-inflammatory and anti-inflammatory species. This balance differentiates during the various phases of pregnancy, however, if this balance is abnormal the risk of adverse pregnancy outcome occurs. The main functions in which the inflammation is involved are ripening of the cervix, rupture of the membranes, and myometrial contractility. As you may know, timing in pregnancy is important, when the inflammation leads to the activation of these three functions mentioned before, a woman could experience preterm labor.

What are the therapeutic possibilities to prevent preterm birth? 

The guidelines suggest the use of progesterone to prevent preterm labor. Progesterone’s efficacy has been widely studied in different clinical conditions. Some evidence suggests that progesterone may inhibit the contraction before the delivery, keeping the pregnancy status. In the latest years, the efficacy of progesterone to reduce preterm labor has been questioned, because some studies show that progesterone isn’t helpful to prevent preterm labor. Even β2-Adrenergic Agonists were used to inducing muscle relaxation and prevent hyper-contractility to avoid preterm labor. However, in recent years authorities underlying the risk of the use of β2-Adrenergic Agonists in pregnancies. β2-Adrenergic Agonists have exhibited some adverse events like cardiovascular risk, lung edema, hyperglycemia, and hypokalemia. From 2014 the β2-Adrenergic Agonists can be used only in acute events and only in hospitals. You can see that Pre-term labor is a complex event that can lead to severe problems for the mom and the baby. Furthermore, there are limited solutions to these big problems. So there is something that can be done? Everyone knows that to maintain a healthy lifestyle you have to eat vegetables like spinaches, Broccoli, Tomatoes, Brussels sprouts, etc. You will be surprised to discover that something that can help preterm birth could be found in vegetables? But what element makes these vegetables so special during Pregnancy? Have you ever heard about Alpha-lipoic acid (ALA)? It’s a pleasure to introduce to you ALA! ALA is an endogenous molecule, that has a lot of interesting effects, especially has a great potential to regulate both pro-inflammatory and anti-inflammatory pathways. Also, ALA has a great role in immunomodulatory functions. Studies suggest that ALA presents an antioxidant activity that is fundamental to repair damaged biological molecules, such as proteins, lipids, and DNA. Furthermore, one of the most important roles of ALA is the transformation of Glucose in Energy. The human production of ALA is very low, this is the reason why you have to integrate with the diet. As described before, during pregnancy both pro-inflammation and anti-inflammation pathways must be balanced. The inflammation is fundamental to efficacy implantation, however, high inflammation could harm the baby or lead to preterm labor.  In this context, ALA plays a key role because it is able to modulate the various molecule involved in the inflammatory pathway and grant an accurate and selective equilibrium during pregnancy, especially ALA prevents complications like abortion. ALA has an interesting capability to modify the altered physiological affection, without affecting the physiological metabolic events. This isn’t the only important role of ALA during pregnancy, indeed, a low intake of ALA is linked to a retardant fetus development, ALA in fact prevents preterm labor, and has an important physiological role during the first-trimester pregnancy. Several studies showed how ALA is effective in reducing the symptomatology and preventing the symptoms of preterm delivery in women at risk, like cervical shortening and hospitalization. Indeed, is safe to use in pregnant women and no side effects were found. ALA is not the only important element, indeed during pregnancy, there is another fundamental factor, you may have heard about Hyaluronic acid (HA). HA is a glycosaminoglycan polymer of repeating disaccharide units of N-acetylglucosamine and β-glucuronic acid and is involved in a lot of important functions like proliferation, differentiation, inflammation, and tissue remodeling. Furthermore, HA has a great hydrating function indeed, it causes the expansion and hydration of tissue. Some studies show that women that experience miscarriage, without explainable reason, showed a reduction in HA production. So, it is demonstrated that high levels of HA are fundamental to maintain the correct development of pregnancy. Also, HA improves the rate of implantation in women undergoing assisted reproduction, so it is studied that HA is fundamental during the period of implantation. HA may present novel therapeutic strategies to prevent pregnancy loss.

Conclusion

In conclusion, preterm birth is an enormous problem that can lead to some difficulties for the baby and the mom. The therapeutic treatments are extremely limited, so it is fundamental to search for alternatives like the use of HA and ALA. These can give a real tool to doctors and obstetrics to help women and these can give the little new ones to the world the right time to grow as healthy as possible. We are here to support you and your baby. 

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