State of the Art ReviewPreterm Birth

Prevention of preterm birth: Harnessing science to address the global epidemic

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Science Translational Medicine  12 Nov 2014:
Vol. 6, Issue 262, pp. 262sr5
DOI: 10.1126/scitranslmed.3009871


  • Fig. 1. Key phases of parturition and fetal development.

    The phases of parturition, from implantation through involution in conjunction with key time points of fetal development, are shown. Research into the mechanisms responsible for maintaining uterine quiescence and initiating activation of labor is critical for elucidating the pathways to preterm labor and designing efficacious interventions to prevent PTBs.

  • Fig. 2. Pathways to PTB.

    The pathways to preterm labor and PTB are multifactorial and complex. Multiple molecular mechanisms are influenced by a variety of risk factors, including genetic, epigenetic, biological, behavioral, social, clinical, and environmental influences.

  • Fig. 3. Uterine miRNA-based pathways that regulate myometrial CAPs.

    The double-negative feedback loop between miR-200 members and ZEB proteins, emphasizing the central role of ZEB1 in mediating the opposing effects of the miR-200 and miR-199a/214 clusters on the contractile apparatus (2932). 20α-HSD, 20α-hydroxysteroid dehydrogenase; STAT5B, signal transducer and activator of transcription 5B; PR, progesterone receptor; P4, progesterone; ER, estrogen receptor; E2, estrogen; ZEB, zinc finger E-box–binding homeobox; COX-2, cyclooxygenase-2; CAPs, contraction-associated proteins.

  • Fig. 4. Tissue types of the uterine wall.

    The maternal and fetal tissue types of the uterine wall outside the placental implantation site. The myometrium and decidua are maternal tissues, whereas the chorion, amnion, and amniotic fluid are of fetal origin. Note that the maternal decidua is in direct contact with the fetal chorion. These tissues may mediate cooperative or divergent signals that lead to preterm or term parturition.

  • Fig. 5. Translational science targets.

    Potential areas of focus for investigating mechanistic targets for prevention and treatment of preterm labor and birth are proposed. Research on the mechanisms behind different pathways and risk factors that contribute to prematurity should be aimed at identifying pathway-specific targets for which drugs, therapies, prevention strategies, and other intervention programs can be developed.

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