Introduction

The causes of preterm delivery can be viewed from a number of different perspectives. Similarly, the concept of “prevention of preterm delivery” can be approached in different ways. Causes can be conceptualized along the spectrum from macro-level social and political forces all the way to immediate biological antecedents of the event (Figure 3.1). Contributing causes of preterm delivery in an individual case could be poverty, cocaine use, and placental abruption, comprising a cascade of events that ultimately requires medical intervention and delivery before term. In principle, interventions to interrupt that cascade can be considered at any of the points along the way.

This chapter considers only a subset of possible determinants of preterm delivery. For those processes operating at the societal level, such as poverty and geography, the comments will be brief. Although the ultimate determinants of preterm delivery may be based on these societal forces, societal changes occur slowly, and preventive measures are urgently needed. Thus, our focus is on individual attributes and behaviors, with a particular focus on those that can be modified, such as tobacco use or physical exertion.

To lay a foundation for the chapter, we first discuss some concepts of causality as they relate to preterm delivery; then we describe key sociodemographic patterns associated with prematurity, as presented in Berkowitz and Papiernik's comprehensive 1993 review.