II 

108TH CONGRESS 

1ST SESSION S. 1726

To reduce preterm labor and delivery and the risk of pregnancy-related 

deaths and complications due to pregnancy, and to reduce infant mortality caused by prematurity. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 14, 2003

Mr. ALEXANDER (for himself and Mr. DODD) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL

To reduce preterm labor and delivery and the risk of pregnancy-related deaths and complications due to pregnancy, 

and to reduce infant mortality caused by prematurity.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Prematurity Research 

5 Expansion and Education for Mothers who deliver Infants 

6 Early Act’’ or the ‘‘PREEMIE Act’’. 

7 SEC. 2. FINDINGS AND PURPOSE. 

8 (a) FINDINGS.—Congress makes the following find9 ings: 
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1 (1) Premature birth is a serious and growing 

2 problem. The rate of preterm birth increased 27 per3 cent between 1981 and 2001 (from 9.4 percent to 

4 11.9 percent). In 2001, more than 476,000 babies 

5 were born prematurely in the United States. 

6 (2) Preterm birth accounts for 23 percent of 

7 deaths in the first month of life. 

8 (3) Premature infants are 14 times more likely 

9 to die in the first year of life. 

10 (4) Premature babies who survive may suffer 

11 lifelong consequences, including cerebral palsy, men12 tal retardation, chronic lung disease, and vision and 

13 hearing loss. 

14 (5) Preterm and low birthweight birth is a sig15 nificant financial burden in health care. The esti16 mated charges for hospital stays for infants with any 

17 diagnosis of prematurity/low birthweight were 

18 $11,900,000,000 in 2000. The average lifetime med19 ical costs of a premature baby are conservatively es20 timated at $500,000. 

21 (6) The proportion of preterm infants born to 

22 African-American mothers (17.3 percent) was sig23 nificantly higher compared to the rate of infants 

24 born to white mothers (10.6 percent). Prematurity 
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1 or low birthweight is the leading cause of death for 

2 African-American infants. 

3 (7) The cause of approximately half of all pre4 mature births is unknown. 

5 (8) Women who smoke during pregnancy are 

6 twice as likely as nonsmokers to give birth to a low 

7 birthweight baby. Babies born to smokers weigh, on 

8 average, 200 grams less than nonsmokers’ babies. 

9 (9) To reduce the rates of preterm labor and 

10 delivery more research is needed on the underlying 

11 causes of preterm delivery, the development of treat12 ments for prevention of preterm birth, and treat13 ments improving outcomes for infants born preterm. 

14 (b) PURPOSES.—It the purpose of this Act to—

15 (1) reduce rates of preterm labor and delivery; 

16 (2) work toward an evidence-based standard of 

17 care for pregnant women at risk of preterm labor or 

18 other serious complications, and for infants born 

19 preterm and at a low birthweight; and 

20 (3) reduce infant mortality and disabilities 

21 caused by prematurity. 
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1 SEC. 3. RESEARCH RELATING TO PRETERM LABOR AND DE2 LIVERY AND THE CARE, TREATMENT, AND 

3 OUTCOMES OF PRETERM AND LOW BIRTH4 WEIGHT INFANTS. 

5 (a) GENERAL EXPANSION OF NIH RESEARCH.—

6 Part B of title IV of the Public Health Service Act (42 

7 U.S.C. 284 et seq.) is amended by adding at the end the 

8 following: 

9 ‘‘SEC. 409J. EXPANSION AND COORDINATION OF RESEARCH 

10 RELATING TO PRETERM LABOR AND DELIV11 ERY AND INFANT MORTALITY. 

12 ‘‘(a) IN GENERAL.—The Director of NIH shall ex13 pand, intensify, and coordinate the activities of the Na14 tional Institutes of Health with respect to research on the 

15 causes of preterm labor and delivery, infant mortality, and 

16 improving the care and treatment of preterm and low 

17 birthweight infants. 

18 ‘‘(b) AUTHORIZATION OF RESEARCH NETWORKS.—

19 There shall be established within the National Institutes 

20 of Health a Maternal-Fetal Medicine Units Network and 

21 a Neonatal Research Units Network. In complying with 

22 this subsection, the Director of NIH shall utilize existing 

23 networks. 

24 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section, 
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1 such sums as may be necessary for each of fiscal years 

2 2004 through 2008.’’. 

3 (b) GENERAL EXPANSION OF CDC RESEARCH.—

4 Section 301 of the Public Health Service Act (42 U.S.C. 

5 241 et seq.) is amended by adding at the end the fol6 lowing: 

7 ‘‘(e) The Director of the Centers for Disease Control 

8 and Prevention shall expand, intensify, and coordinate the 

9 activities of the Centers for Disease Control and Preven10 tion with respect to preterm labor and delivery and infant 

11 mortality.’’. 

12 (c) STUDY ON ASSISTED REPRODUCTION TECH13 NOLOGIES.—Section 1004(c) of the Children’s Health Act 

14 of 2000 (Public Law 106–310) is amended—

15 (1) in paragraph (2), by striking ‘‘and’’ at the 

16 end; 

17 (2) in paragraph (3), by striking the period and 

18 inserting ‘‘; and’’; and 

19 (3) by adding at the end the following: 

20 ‘‘(4) consider the impact of assisted reproduc21 tion technologies on the mother’s and children’s 

22 health and development.’’. 

23 (d) STUDY ON RELATIONSHIP BETWEEN PRE24 MATURITY AND BIRTH DEFECTS.—
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1 (1) IN GENERAL.—The Director of the Centers 

2 for Disease Control and Prevention shall conduct a 

3 study on the relationship between prematurity, birth 

4 defects, and developmental disabilities. 

5 (2) REPORT.—Not later than 2 year after the 

6 date of enactment of this Act, the Director of the 

7 Centers for Disease Control and Prevention shall 

8 submit to the appropriate committees of Congress a 

9 report concerning the results of the study conducted 

10 under paragraph (1). 

11 (e) REVIEW OF PREGNANCY RISK ASSESSMENT

12 MONITORING SURVEY.—The Director of the Centers for 

13 Disease Control and Prevention shall conduct a review of 

14 the Pregnancy Risk Assessment Monitoring Survey to en15 sure that the Survey includes information relative to med16 ical care and intervention received, in order to track preg17 nancy outcomes and reduce instances of preterm birth. 

18 (f) STUDY ON THE HEALTH AND ECONOMIC CON19 SEQUENCES OF PRETERM BIRTH.—

20 (1) IN GENERAL.—The Director of the National 

21 Institutes of Health in conjunction with the Director 

22 of the Centers for Disease Control and Prevention 

23 shall enter into a contract with the Institute of Med24 icine of the National Academy of Sciences for the 

25 conduct of a study to define and address the health 
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1 and economic consequences of preterm birth. In con2 ducting the study, the Institute of Medicine shall—

3 (A) review and assess the epidemiology of 

4 premature birth and low birthweight, and the 

5 associated maternal and child health effects in 

6 the United States, with attention paid to cat7 egories of gestational age, plurality, maternal 

8 age, and racial or ethnic disparities; 

9 (B) review and describe the spectrum of 

10 short and long-term disability and health-re11 lated quality of life associated with premature 

12 births and the impact on maternal health, 

13 health care and quality of life, family employ14 ment, caregiver issues, and other social and fi15 nancial burdens; 

16 (C) assess the direct and indirect costs as17 sociated with premature birth, including mor18 bidity, disability, and mortality; 

19 (D) identify gaps and provide rec20 ommendations for feasible systems of moni21 toring and assessing associated economic and 

22 quality of life burdens associated with pre23 maturity; 

24 (E) explore the implications of the burden 

25 of premature births for national health policy; 
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1 (F) identify community outreach models 

2 that are effective in decreasing prematurity 

3 rates in communities; 

4 (G) consider options for addressing, as ap5 propriate, the allocation of public funds to bio6 medical and behavioral research, the costs and 

7 benefits of preventive interventions, public 

8 health, and access to health care; and 

9 (H) provide recommendations on best 

10 practices and interventions to prevent pre11 mature birth, as well as the most promising 

12 areas of research to further prevention efforts. 

13 (2) REPORT.—Not later than 1 year after the 

14 date on which the contract is entered into under 

15 paragraph (1), the Institute of Medicine shall submit 

16 to the Director of the National Institutes of Health, 

17 the Director of the Centers for Disease Control and 

18 Prevention, and the appropriate committees of Con19 gress a report concerning the results of the study 

20 conducted under such paragraph. 

21 (g) EVALUATION OF NATIONAL CORE PERFORMANCE

22 MEASURES.—

23 (1) IN GENERAL.—The Administrator of the 

24 Health Resources and Services Administration shall 

25 conduct an assessment of the current national core 
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1 performance measures and national core outcome 

2 measures utilized under the Maternal and Child 

3 Health Block Grant under title V of the Social Secu4 rity Act (42 U.S.C. 701 et seq.) for purposes of ex5 panding such measures to include some of the 

6 known risk factors of low birthweight and pre7 maturity, including the percentage of infants born to 

8 pregnant women who smoked during pregnancy. 

9 (2) REPORT.—Not later than 1 year after the 

10 date of enactment of this Act, the Administrator of 

11 the Health Resources and Services Administration 

12 shall submit to the appropriate committees of Con13 gress a report concerning the results of the evalua14 tion conducted under paragraph (1). 

15 SEC. 4. PUBLIC AND HEALTH CARE PROVIDER EDUCATION 

16 AND SUPPORT SERVICES. 

17 Part P of title III of the Public Health Service Act 

18 (42 U.S.C. 280g et seq.) is amended by adding at the end 

19 the following: 

20 ‘‘SEC. 399O. PUBLIC AND HEALTH CARE PROVIDER EDU21 CATION AND SUPPORT SERVICES. 

22 ‘‘(a) IN GENERAL.—The Secretary, directly or 

23 through the awarding of grants to public or private non24 profit entities, shall conduct a demonstration project to 

25 improve the provision of information on prematurity to 
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1 health professionals and other health care providers and 

2 the public. 

3 ‘‘(b) ACTIVITIES.—Activities to be carried out under 

4 the demonstration project under subsection (a) shall in5 clude the establishment of programs—

6 ‘‘(1) to provide information and education to 

7 health professionals, other health care providers, and 

8 the public concerning—

9 ‘‘(A) the signs of preterm labor, updated 

10 as new research results become available; 

11 ‘‘(B) the screening for and the treating of 

12 infections; 

13 ‘‘(C) counseling on optimal weight and 

14 good nutrition, including folic acid; 

15 ‘‘(D) smoking cessation education and 

16 counseling; and 

17 ‘‘(E) stress management; and 

18 ‘‘(2) to improve the treatment and outcomes for 

19 babies born premature, including the use of evi20 dence-based standards of care by health care profes21 sionals for pregnant women at risk of preterm labor 

22 or other serious complications and for infants born 

23 preterm and at a low birthweight. 

24 ‘‘(c) REQUIREMENT.—Any program or activity fund25 ed under this section shall be evidence-based.
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1 ‘‘(d) NICU FAMILY SUPPORT PROGRAMS.—The Sec2 retary shall conduct, through the awarding of grants to 

3 public and nonprofit private entities, projects to respond 

4 to the emotional and informational needs of families dur5 ing the stay of an infant in a neonatal intensive care unit, 

6 during the transition of the infant to the home, and in 

7 the event of a newborn death. Activities under such 

8 projects may include providing books and videos to fami9 lies that provide information about the neonatal intensive 

10 care unit experience, and providing direct services that 

11 provide emotional support within the neonatal intensive 

12 care unit setting. 

13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section, 

15 such sums as may be necessary for each of fiscal years 

16 2004 through 2008.’’. 

17 SEC. 5. INTERAGENCY COORDINATING COUNCIL ON PRE18 MATURITY AND LOW BIRTHWEIGHT. 

19 (a) PURPOSE.—It is the purpose of this section to 

20 stimulate multidisciplinary research, scientific exchange, 

21 and collaboration among the agencies of the Department 

22 of Health and Human Services and to assist the Depart23 ment in targeting efforts to achieve the greatest advances 

24 toward the goal of reducing prematurity and low birth25 weight. 
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1 (b) ESTABLISHMENT.—The Secretary of Health and 

2 Human Services shall establish an Interagency Coordi3 nating Council on Prematurity and Low Birthweight (re4 ferred to in this section as the Council) to carry out the 

5 purpose of this section. 

6 (c) COMPOSITION.—The Council shall be composed of 

7 members to be appointed by the Secretary, including rep8 resentatives of—

9 (1) the agencies of the Department of Health 

10 and Human Services; and 

11 (2) voluntary health care organizations, includ12 ing grassroots advocacy organizations, providers of 

13 specialty obstetrical and pediatric care, and re14 searcher organizations. 

15 (d) ACTIVITIES.—The Council shall—

16 (1) annually report to the Secretary of Health 

17 and Human Services on current Departmental ac18 tivities relating to prematurity and low birthweight; 

19 (2) plan and hold a conference on prematurity 

20 and low birthweight under the sponsorship of the 

21 Surgeon General; 

22 (3) establish a consensus research plan for the 

23 Department of Health and Human Services on pre24 maturity and low birthweight; 
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1 (4) report to the Secretary of Health and 

2 Human Services and the appropriate committees of 

3 Congress on recommendations derived from the con4 ference held under paragraph (2) and on the status 

5 of Departmental research activities concerning pre6 maturity and low birthweight; 

7 (5) carry out other activities determined appro8 priate by the Secretary of Health and Human Serv9 ices; and 

10 (6) oversee the coordination of the implementa11 tion of this Act. 

12 SEC. 6. AUTHORIZATION OF APPROPRIATIONS. 

13 There are authorized to be appropriated to carry out 

14 this Act, such sums as may be necessary for each of fiscal 

15 years 2004 through 2008.

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