Reducing the global burden of disease in childhood – Authors' reply
Authors: Joshua P Vogel, Saifon Chawanpaiboon, A Metin Gülmezoglu
Journal: The Lancet Global Health (2019)

We 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 Article1Chawanpaiboon 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. 2018; 7: e37-e46Summary Full Text Full Text PDF PubMed Scopus (1145) Google Scholar 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”.2WHOWHO recommendations on antenatal care for a positive pregnancy experience.https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1Date: 2016Date accessed: February 20, 2019Google Scholar, 3WHOWHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy.https://apps.who.int/iris/handle/10665/94555Date: 2013Date accessed: February 20, 2019Google Scholar Providers should routinely offer advice and psychosocial interventions for tobacco cessation to all pregnant women who use tobacco (or quit recently), and women and families should be provided with advice and information about the risks of second-hand smoke exposure in the home and ways to reduce it. Furthermore, all health facilities should be smoke-free. It is worth noting that a 2018 report of 83 Cochrane systematic reviews on preterm birth prevention by Medley and colleagues4Medley N Vogel JP Care A Alfirevic Z Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews.Cochrane Database Syst Rev. 2018; 11 (CD012505.)PubMed Google Scholar found that pharmacological intervention for smoking cessation in pregnancy was one of only eight interventions showing benefit or possible benefit on preventing preterm birth. Bellington Vwalika and colleagues also highlight an important issue regarding the different methods used to estimate gestational age during pregnancy, and their effects on preterm birth rates at the population level. We consider it probable that the use of non-ultrasound-based methods of gestational age estimation (as is the case in many low-income and middle-income countries) are contributing to mis-estimation of preterm birth rates. Population-representative studies from low-income and middle-income countries that use good quality ultrasound examinations in early pregnancy to establish gestational age are needed to address these gaps.5Baqui A Ahmed P Dasgupta SK et al.Development and validation of a simplified algorithm for neonatal gestational age assessment—protocol for the Alliance for Maternal Newborn Health Improvement (AMANHI) prospective cohort study.J Glob Health. 2017; 7: 021201Crossref PubMed Scopus (12) Google Scholar In 2016, WHO recommended that all pregnant women should receive an antenatal ultrasound before 24 weeks to estimate gestational age, and improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman's pregnancy experience.2WHOWHO recommendations on antenatal care for a positive pregnancy experience.https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1Date: 2016Date accessed: February 20, 2019Google Scholar With implementation of this recommendation, we expect that estimation of preterm birth rates should improve over time. 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 birthsWe welcome the updated global, national, and regional estimates of preterm birth and of pneumonia in young children (January, 2019).1,2 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. 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 Access