<div><span style="font-family: helvetica; font-size: 15px;">All pregnant women should have prenatal (antenatal) care by skilled health providers in well-equipped health facilities. There is sufficient scientific evidence to show that birth outcomes are good when women attend prenatal care and the World Health Organization advocates at minimum four prenatal care visits for all pregnant women.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">Preterm birth is defined as the birth of a baby before 37 completed weeks. The causes for preterm births are complex and often several factors come in but women who receive prenatal care are at a lower risk of having a preterm birth regardless of the cause.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">A basic prenatal care package offered to pregnant women will prevent most of preterm births in several ways. Through regular prenatal care, women at a higher risk of having a preterm birth (a woman with a previous preterm birth) will be identified much earlier and specific interventions to monitor them or offer supportive treatment can be instituted. </span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">Screening and treatment of infections during the prenatal period such as syphilis, HIV, bacteriuria, malaria, bacterial vaginosis, tuberculosis and other infections thought to be causative of preterm births can also be effected. </span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">Nutrition status of pregnant women has been shown to have implications for preterm births. Identifying women with malnutrition early enough and offering nutritional counseling and supplementation, including micro-nutrient supplementation or counseling on food practices and attitudes can be achieved through regular prenatal care. Both obesity and underweight during pregnancy have been linked to preterm births and other adverse birth outcomes.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">Prenatal care offers the opportunity to counsel women on how best to prepare for the birth process including identifying early labor signs and symptoms such as early pregnancy bleeding, rupture of membranes and draining of amniotic fluid and early uterine contractions. All these can lead to early interventions, which can either prevent preterm births or lead to better survival of babies who are born preterm.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">Women who experience social and financial challenges including stressful situations during pregnancy can be identified through regular prenatal care. Maternal stress during pregnancy has been positively associated with the occurrence of preterm births. Screening for maternal stress before or during pregnancy and instituting appropriate interventions, has the potential of preventing preterm births. Research has shown that women who experience intimate-partner-violence are two times more likely to deliver a preterm baby. Newer models of prenatal care, such as group prenatal care that address issues such as maternal stress in pregnancy, depression, substance abuse, intimate-partner-violence, smoking and smoking cessation and exposure to second-hand smoke including other environmental pollutants have been shown to reduce the occurrence of preterm births.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">The role of prenatal care for women at high risk of preterm births is worth further emphasis. Adolescents are at a higher risk of preterm births due to their young age and limited access to preconception and prenatal care and therefore need a more enhanced prenatal care package. Women with previous preterm births or with medical complications during pregnancy such as high blood pressure, diabetes, thyroid disease or other complexities in pregnancy like intrauterine growth restriction are at a higher risk of preterm birth and will require multidisciplinary care, ideally in a ‘one-stop’ kind of prenatal care service. Such women can benefit from key interventions for improving survival for babies born preterm such as antenatal corticosteroids to improve preterm baby’s lung function, antibiotics to prevent infections and magnesium sulphate to protect the preterm baby’s brain.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">Prenatal care offers a window of opportunity where a woman can be reached multiple times with specific interventions both general and specific to her needs which can lead to prevention of preterm births or improve the survival of a baby who ends up being born preterm. A basic package of prenatal care offered to all women will lead to prevention of preterm births.  A more enhanced prenatal care package for women at higher risk of preterm birth including services that are specifically tailored to the individual woman’s risk profile (precision medicine) will also lead to reduction in preterm birth.  Quality prenatal care supported by interventions at policy, health system and community levels will lead to dramatic decreases in incidence of preterm birth.</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div><div><span style="font-family: helvetica; font-size: 15px;">By Dr Joseph Wangira Musana, Consultant Obstetrician, Gynecologist and Full Time Faculty at  Aga Khan University Hospital in Nairobi</span></div><div><span style="font-family: helvetica; font-size: 15px;">wangira.musana@aku.edu</span></div><div><br style="font-family: helvetica; font-size: 15px;"/></div>