Reducing the global burden of preterm births
Authors: Jasper V Been, Christopher Millett
Journal: The Lancet Global Health (2019)

We welcome the updated global, national, and regional estimates of preterm birth and of pneumonia in young children (January, 2019).1Chawanpaiboon S Vogel JP Moller AB et al.Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis.Lancet Glob Health. 2019; 7: e37-e46Summary Full Text Full Text PDF PubMed Scopus (1176) Google Scholar, 2McAllister DA Liu L Shi T et al.Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis.Lancet Glob Health. 2019; 7: e47-e57Summary Full Text Full Text PDF PubMed Scopus (260) Google Scholar Despite general progress in perinatal and paediatric outcomes, both conditions continue to contribute substantially to the overall global burden of morbidity and mortality in childhood. We were surprised that both reports only briefly highlight actions needed to address this. We wish to emphasise the role of effective tobacco control in reducing both preterm birth and childhood respiratory infections. Tobacco use is the primary preventable risk factor for morbidity and premature mortality worldwide, and has considerable impact on children's health by increasing the risk of stillbirth, preterm birth, low birthweight, infant mortality, asthma exacerbations, and respiratory infections.3Faber T Been JV Reiss IK Mackenbach JP Sheikh A Smoke-free legislation and child health.NPJ Prim Care Respir Med. 2016; 26: 16067Crossref PubMed Scopus (36) Google Scholar Important reductions in preterm birth (–4%), severe asthma exacerbations (–10%), and severe lower respiratory tract infections (–18%) have been shown after implementation of comprehensive legislation to prohibit smoking in public places, including the workplace.4Faber T Kumar A Mackenbach JP et al.Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis.Lancet Public Health. 2017; 2: e420-e437Summary Full Text Full Text PDF PubMed Scopus (113) Google Scholar Reductions in infant mortality have furthermore been shown following cigarette price increases in various countries.4Faber T Kumar A Mackenbach JP et al.Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis.Lancet Public Health. 2017; 2: e420-e437Summary Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 5Filippidis FT Laverty AA Hone T Been JV Millett C Association of cigarette price differentials with infant mortality in 23 European Union countries.JAMA Pediatr. 2017; 171: 1100-1106Crossref PubMed Scopus (21) Google Scholar Children have the right to grow up in a smoke-free world. Given the overwhelming evidence supporting the child health benefits of effective tobacco control, including reductions in preterm birth and lower respiratory tract infections, there is an urgent need to integrate tobacco control efforts into global strategies to reduce adverse perinatal and child health outcomes. We strongly urge the WHO–UNICEF–Lancet Commission on Child Health and Wellbeing to incorporate the child health benefits of tobacco control in their upcoming report. We declare no competing interests. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysisPreterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting. Full-Text PDF Open AccessReducing the global burden of preterm birthsIn their systematic review and meta-analysis, Saifon Chawanpaiboon and colleagues1 provide global, regional, and country-level estimates for the frequency of preterm birth (defined as occurring before 37 weeks of completed gestation). Their report improves upon an established method that has been used for similar analyses and, as such, is particularly useful when analysing trends over time. However, as the authors point out, data from several developing countries are either absent altogether or do not have sufficient quality to provide reliable estimates. Full-Text PDF Open AccessReducing the global burden of disease in childhood – Authors' replyWe agree with the point raised by Jasper Been and Christopher Millett in their letter regarding the important role of effective tobacco control in preventing preterm birth, and a wide range of other health conditions. Although our recent Article1 addressed estimates of the global, regional, and national burden of preterm birth (rather than preterm birth prevention strategies more broadly), the 2016 WHO recommendations on antenatal care for a positive pregnancy experience specify that "health-care providers should ask all pregnant women about their tobacco use (past and present) and exposure to second-hand smoke as early as possible in pregnancy and at every antenatal care visit". Full-Text PDF Open Access