J Midwifery Womens Health. 2017 Nov;62(6):696-705. doi: 10.1111/jmwh.12658. Epub 2017 Nov 14.
Preterm birth continues to be a problem affecting low-, middle-, and high-income countries, with rates increasing in some areas despite ongoing efforts to reduce the incidence. This emphasizes the need for more effective interventions, particularly if we aim to achieve the broad health targets of the Sustainable Development Goals (SDGs) by 2030. The current focus on medically-oriented interventions such as reducing nonmedically-indicated induction of labor, cesarean birth, and multiple embryo transfers associated with assisted reproductive technologies, as well as the application of cervical cerclage and use of progesterone therapy, though important, are likely only partial solutions to the complex phenomenon of preterm birth. Preterm birth has multiple etiologies. The biologic mechanisms involved in preterm labor and how it may be triggered are not well understood. There is growing evidence to suggest some of these triggers may also be related to stress and environmental conditions. In this review, we focus on evidence concerning psychosocial (mind) and environmental factors (environment) as well as briefly review the evidence related to maternal and fetal factors (body) associated with the risk of preterm birth, with reference to some of the SDGs. We also assess emerging evidence regarding the interaction of the body, mind, and environment in relation to preterm birth, currently a gap in our knowledge, and how these interactions could impact clinical practice. Findings suggest that multidisciplinary expertise and approaches will be needed to develop effective interventions to address the complex etiologies of preterm birth, as opposed to single-risk-factor mitigation. Clinicians and researchers will play key roles in identifying many of these risk factors and shaping interventions that address this complex issue. Addressing the interlinkages between body, mind, and environment through the integration of research and clinical practice is critical to reducing the risk of preterm birth and contributing to the achievement of the SDGs.
早产仍然是一个影响低收入、中等收入和高收入国家的问题，尽管一直在努力降低发病率，但一些地区的早产率仍在上升。这强调了需要采取更有效的干预措施，特别是如果我们要在 2030 年前实现可持续发展目标（SDGs）的广泛健康目标。目前，人们关注的重点是医学干预措施，如减少不必要的引产、剖宫产和与辅助生殖技术相关的多个胚胎移植，以及宫颈环扎术的应用和孕激素治疗，尽管这些措施很重要，但它们可能只是解决早产这一复杂现象的部分方法。早产有多种病因。与早产相关的早产劳动的生物学机制及其触发方式尚不清楚。越来越多的证据表明，其中一些触发因素也可能与压力和环境条件有关。在这篇综述中，我们重点关注有关心理社会（心理）和环境因素（环境）的证据，并简要回顾与早产风险相关的母体和胎儿因素（身体）的证据，参考了一些可持续发展目标。我们还评估了与早产相关的身心环境相互作用的新证据，目前这是我们知识的一个空白，以及这些相互作用如何影响临床实践。研究结果表明，需要多学科专业知识和方法来制定有效的干预措施，以解决早产的复杂病因，而不是仅仅针对单一风险因素进行缓解。临床医生和研究人员将在确定这些风险因素和制定解决这一复杂问题的干预措施方面发挥关键作用。通过整合研究和临床实践来解决身心环境之间的相互联系，对于降低早产风险和实现可持续发展目标至关重要。
