Preterm birth 2025: Causes, warning signs and modern management

Worldwide about one in ten babies is born before 37 completed weeks of pregnancy. Preterm birth is therefore a leading cause of health problems and child mortality. 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 classified as preterm when a baby is born before 37 completed weeks of gestation. Professional societies distinguish several categories because prognosis and care differ substantially.

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

Current numbers and trends

Estimates indicate the global preterm birth rate has been around ten percent of all births for years. In many high-income countries the rate is somewhat lower, but preterm birth remains a central concern in perinatal medicine.

International organisations such as the World Health Organization (WHO) and reports such as the "Born too soon" report show that global rates have not fallen significantly so far. At the same time, survival has improved markedly thanks to better care in specialised perinatal centres.

Causes and risk factors – why babies are born too early

Preterm birth rarely has a single cause. Multiple factors usually interact, and in some cases the trigger remains unclear. Important known risk factors include:

• Infections: for example bacterial vaginosis, urinary tract infections or untreated periodontal disease.
• Multiple pregnancy and assisted reproduction: twins or triplets, especially after IVF or ICSI, have a substantially higher risk of preterm birth.
• Cervical insufficiency: a short or prematurely dilating cervix, for example after a cone biopsy (conisation).
• Placental problems: placental insufficiency, placental abruption or a low-lying placenta.
• Maternal pre-existing conditions: chronic hypertension, pre-eclampsia, diabetes, autoimmune or kidney disease.
• Lifestyle: smoking, alcohol or drug use, severe underweight or obesity, and poor nutrition.
• Social and psychological factors: high stress levels, violence, financial hardship or lack of everyday support.

Detailed recommendations for assessing these risk constellations can be found in national guidelines (for example those issued by MoHFW or ICMR) and in specialty society guidance.

Warning signs of an impending preterm birth

Not every contraction is dangerous. Still, some symptoms should always be promptly evaluated in a clinic or practice:

• Regular, painful contractions before 37 weeks' 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 "slipping down".
• Marked cervical shortening on ultrasound.

Additional tests such as fetal fibronectin detection or certain inflammatory markers can help estimate the risk of delivery in the coming days, but they never replace clinical assessment.

Preventing preterm birth – prevention 2025

Prevention ideally starts before a planned pregnancy and continues throughout gestation. Key elements include:

• Optimal preparation: good control of chronic conditions, smoking cessation and counselling about medications before conception.
• Regular antenatal care: consistent attendance at check-ups, including cervical ultrasound monitoring for those at risk.
• 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: for significant cervical insufficiency or recurrent late miscarriages, cerclage or silicone pessaries can support the cervix.
• Infection screening and treatment: treating urinary tract infections, bacterial vaginosis and other infections reduces the risk of complications.
• Healthy lifestyle: balanced nutrition, exercise within recommended limits, adequate sleep and stress reduction support a stable pregnancy.

Many hospitals offer specialist clinics for high‑risk pregnancies where individual preterm birth risks can be discussed and a tailored plan developed.

Acute management for threatened preterm birth

If preterm contractions, bleeding or membrane rupture occur, this is an emergency that should always be assessed in a hospital. Management is individualised 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 can often delay delivery for several days.
• Antenatal corticosteroids: betamethasone or dexamethasone accelerate lung and organ maturation, especially between about 24 and 34 weeks' gestation.
• Magnesium sulfate for neuroprotection: in very preterm births, magnesium sulfate can reduce the risk of severe brain injury.
• Transfer to a perinatal centre: where possible, the pregnant person is transferred before birth to a centre with highly specialised neonatal care.

Guidance is provided, for example, by the WHO recommendations on antenatal corticosteroids and by national specialty guidelines.

Modern neonatology and the role of parents

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

• Gentle ventilation strategies with the lowest possible pressure peaks to protect the lungs.
• Modern incubators with stable temperature and noise control.
• Dedicated promotion of breastmilk, including milk banks and individualised nutrient fortification.
• Strict hygiene standards and infection prevention.

At the same time, parent‑infant bonding is central. Kangaroo care (skin‑to‑skin contact), early involvement of parents in care tasks and psychological support help families cope with the intensive period on the ward and support the child's development.

Long-term consequences and structured follow-up

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

• Delays in fine and gross motor development.
• Vision and hearing disorders that require regular screening.
• Chronic respiratory conditions such as bronchopulmonary dysplasia (BPD) or asthma.
• Attention and learning difficulties, sometimes accompanied by emotional challenges.

Many children benefit from interdisciplinary early intervention, for example through child development centres, physiotherapy, occupational therapy or speech therapy. It is important that parents stay alert, raise concerns, and seek support when needed.

Research and future perspectives

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

• Biomarkers and immune profiles: blood tests may help identify individual preterm birth risks earlier.
• Microbiome approaches: studies examine whether specific probiotics can reduce the risk of serious intestinal disease such as necrotising enterocolitis (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 earlier.

Support for parents of preterm infants

In addition to medical care, parents of preterm infants 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 support groups, lactation consultants, psychologists and child development services to ensure a good transition home.

Conclusion

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