Preterm Birth and Placental Pathology

Spontaneous preterm delivery, defined as delivery occurring before 37+0 weeks of gestation, has a multifactorial origin with still a largely unraveled etiology and pathophysiology. Preterm birth (PTB), both spontaneous as iatrogenic, occurs in 10-15% of all pregnancies. Every year, globally around 15 million pregnancies end in premature birth, which is the leading cause of perinatal mortality and morbidity. PTB, irrespective of its origin (spontaneous or iatrogenic), has long-term adverse consequences for postnatal health and is a burden for health care expenditure. Despite decades of research, the etiology, pathogenesis and hereby the cause of onset of spontaneous preterm birth are still unknown.

The occurrence of spontaneous preterm delivery has been associated with

1. maternal risk factors, such as previous obstetrical history, including preterm birth or cervical surgery and pregnancy characteristics and

2. Anatomical and placental risk factors such as infection, inflammation and uterine distension.

3. Endocrine pathways and factors

More importantly, adequate identification of women at risk for spontaneous PTB is limited and interventions to prevent PTB are mostly ineffective. When suspected for imminent preterm birth, tocolytic treatment to allow for administration of corticosteroid to accelerate fetal lung maturation are started.

The current lack of identification of the exact processes leading to preterm birth hampers the development of accurate prediction tools and, consequently, preventive measures. Improved and timely prediction of preterm birth has therefor the potential to reduce maternal and fetal overtreatment, maternal hospital admittance with corresponding healthcare costs and unnecessary fetal exposure to corticosteroids in cases of continuation of the pregnancy.

The current special issue intends to address current gaps in knowledge and how to approach these.

Topics of interest and challenges in preterm birth, both spontaneous and iatrogenic, include, but are not limited to,

- Involved endocrine pathways and factors
- Predictive endocrine (bio)markers
- Lifestyle interventions
- Detection and identification of pathophysiologic biomarkers and mechanisms
- The use of amniotic fluid and umbilical cord blood markers
- Preventive strategies
- Perinatal pharmacology
- Perinatal immunology
- Development and implementation of innovative techniques
- The microbiome and virome
- Metabolomics
- Placental growth, development and health
- Implementation of personalized and precision medicine
- Global maternal and perinatal health