Preterm Birth 2025: Causes, Warning Signs and Modern Treatment

Worldwide, about one in ten babies is born before 37 weeks of gestation. Preterm birth is therefore a leading cause of health problems and mortality in childhood. This guide explains in plain language what preterm birth is, which warning signs should be taken seriously, and how modern medicine protects preterm infants today.

What is a preterm birth?

A birth is considered preterm when a baby is born before the completion of 37 weeks of gestation. Professional societies distinguish several groups because prognosis and care differ significantly.

In general: the earlier a baby is born, the more intensive the hospital care and the more important structured follow-up examinations after discharge become.

Statistics and trends

Estimates indicate that the global preterm birth rate has remained around ten percent of all births for years. In many European countries it is somewhat lower, but preterm birth remains a central concern of perinatal medicine.

International organizations such as the World Health Organization (WHO) and reports like the 'Born Too Soon' report show that rates worldwide have so far decreased little. At the same time, survival chances have clearly improved thanks to better care in perinatal centres.

Causes and risk factors – why babies are born too early

A preterm birth rarely has a single cause. Usually several factors interact, and in some cases the trigger remains unclear. Major known risk factors include:

• Infections: for example bacterial vaginosis, urinary tract infections or untreated gum disease.
• Multiple pregnancy and assisted reproduction: twins or triplets, especially after IVF or ICSI, have a significantly higher risk of preterm birth.
• Cervical insufficiency: a cervix that is too short or opens early, for example after a conisation.
• Placental problems: placental insufficiency, premature separation or a low-lying placenta.
• Maternal pre-existing conditions: chronic high blood pressure, pre-eclampsia, diabetes, autoimmune and kidney diseases.
• Lifestyle: smoking, alcohol or drug use, severe underweight or overweight, and poor nutrition.
• Social and psychological factors: high stress, violence, financial worries or lack of everyday support.

Detailed recommendations for assessing these risk constellations can be found in national guidelines on the prevention and management of preterm birth.

Warning signs of an impending preterm birth

Not every contraction indicates danger. However, there are symptoms that should always be promptly assessed in a clinic or practice:

• Regular, painful contractions before 37 weeks of gestation.
• Suspected loss of amniotic fluid or premature rupture of membranes.
• Vaginal bleeding, brownish or foul-smelling discharge.
• Strong pressure downwards or the sensation that the baby is "dropping."
• Marked shortening of the cervix on ultrasound.

In addition, tests such as detection of fetal fibronectin or certain inflammatory markers are used. They help better estimate the risk of delivery in the coming days but never replace clinical assessment.

Preventing preterm birth – Prevention 2025

Prevention ideally begins before a planned pregnancy and continues throughout pregnancy. Important components include:

• Optimal preparation: good control of chronic conditions, smoking cessation and counselling on medication use already before conception.
• Regular prenatal care: consistent attendance at prenatal appointments, including cervical ultrasound monitoring in risk situations.
• Progesterone for a short cervix: vaginal progesterone can reduce the risk of preterm birth in singleton pregnancies with a shortened cervix.
• Cerclage or cervical pessary: with significant cervical insufficiency or repeated late pregnancy losses, cerclage or silicone pessaries can stabilise the cervix.
• Infection screening and treatment: promptly treated urinary tract infections, bacterial vaginosis or other infections reduce the risk of complications.
• Healthy lifestyle: balanced diet, exercise within recommendations, adequate sleep and stress reduction support a stable pregnancy.

Many hospitals offer specialised clinics for high-risk pregnancies. There, individual preterm birth risks can be discussed and a tailored plan created.

Acute management for threatened preterm birth

When preterm labour, bleeding or rupture of membranes occurs, it is an emergency situation that should always be assessed in a hospital. Further management is planned individually and may include:

• Monitoring of mother and baby: CTG, ultrasound, laboratory tests and swabs for infection diagnostics.
• Tocolysis: labour-suppressing medications such as atosiban or calcium channel blockers often delay delivery by a few days.
• Antenatal corticosteroids: betamethasone or dexamethasone promote lung and organ maturation, especially between about 24 and 34 weeks of gestation.
• Magnesium sulphate for neuroprotection: in very early births, magnesium sulphate can reduce the risk of severe brain injury.
• Transfer to a perinatal centre: when possible, the pregnant person is transferred before delivery to a centre with highly specialised neonatology.

Guidance is provided, among other sources, by the WHO on antenatal corticosteroids and national society guidelines.

Modern neonatology and the role of parents

Perinatal centres combine high‑tech medicine with developmentally supportive care. This includes:

• Gentle ventilation strategies with as low pressure peaks as possible to protect the lungs.
• Modern incubators with stable temperature and noise control.
• Consistent promotion of breast milk, including milk banks and individualized nutrient adjustments.
• Strict hygiene standards and infection prevention.

At the same time, parent–child bonding plays a central role. Kangaroo care (skin-to-skin contact), early inclusion of parents in caregiving tasks and psychological support help families cope with the intensive time on the ward and support the child's development.

Long-term consequences and structured follow-up

Many moderately or late preterm infants reach a normal school and working life with good support. Nevertheless, certain health issues are more common in preterm children:

• Fine and gross motor developmental delays.
• Vision and hearing impairments that require regular screening.
• Chronic respiratory conditions such as bronchopulmonary dysplasia or asthma.
• Attention and learning difficulties, sometimes accompanied by emotional challenges.

Many children benefit from interdisciplinary early intervention, for example through paediatric rehabilitation centres, physiotherapy, occupational therapy or speech therapy. It is important that parents stay alert, speak up about concerns and seek support when needed.

Research and future perspectives

Research teams worldwide are working on new ways to better predict preterm birth risk and to care for preterm infants even more safely:

• Biomarkers and immune profiles: blood tests aim to help identify individual preterm birth risks early.
• Microbiome approaches: studies are examining whether certain probiotics can reduce the risk of severe intestinal diseases like NEC.
• 'Artificial womb': experimental systems aim to provide extremely preterm infants with additional maturation time outside the uterus.
• Digital support: apps and telemedicine can help monitor high-risk pregnancies more closely and detect warning signs early.

Support for parents of preterm infants

In addition to medical care, parents of preterm infants especially need reliable information and psychosocial support. Organisations such as the European Foundation for the Care of Newborn Infants (EFCNI) provide information materials, checklists and contact points for families. Many hospitals also work with preemie initiatives, lactation consultants, psychologists and paediatric rehabilitation centres to support the transition home.

Conclusion

Preterm births cannot be completely prevented. However, knowing the main risk factors, taking warning signs seriously and relying on guideline‑based care in an experienced perinatal centre improve the chances for a stable start in life. Good follow-up care and appropriate support help preterm infants and their families to navigate this special path step by step.