World Journal of Pharmacology and Toxicology
Open Access

Preterm birth; Gestation; Neonatal outcomes; Cervical ripening agents; Antenatal corticosteroids

Introduction

Preterm birth, defined as delivery before 37 weeks of gestation, remains a significant global health concern, contributing to neonatal mortality, long-term health complications, and substantial healthcare costs. Despite decades of research and medical advancements, the prevention of preterm birth continues to pose a challenge. However, recent developments in pharmacology have shown promise in addressing this complex issue. This article explores the role of pharmacological interventions in preterm birth prevention, highlighting recent advancements, challenges, and future directions in maternal-fetal medicine [1, 2].

Understanding preterm birth

Preterm birth can occur due to various factors, including maternal medical conditions, infection, uterine abnormalities, cervical insufficiency, and placental issues. Identifying women at risk of preterm birth and implementing preventive measures is crucial for improving maternal and neonatal outcomes [3].

Pharmacological interventions for preterm birth preventsion

Progesterone supplementation:

Progesterone plays a vital role in maintaining pregnancy by inhibiting uterine contractions and promoting cervical integrity. Progesterone supplementation has been extensively studied as a preventive measure for preterm birth in women with a history of prior preterm delivery or other risk factors. Administered either vaginally or intramuscularly, progesterone has shown efficacy in reducing the risk of recurrent preterm birth [4].

Cervical ripening agents:

Cervical insufficiency, characterized by premature cervical effacement and dilation, is a significant risk factor for preterm birth. Pharmacological agents such as prostaglandin analogs (e.g., dinoprostone) and synthetic oxytocin receptor agonists (e.g., misoprostol) are used for cervical ripening in women at risk of preterm birth. These agents help promote cervical softening and dilation, facilitating labor induction or augmentation when necessary [5].

Antenatal corticosteroids:

Antenatal corticosteroids, such as betamethasone and dexamethasone, are administered to pregnant women at risk of preterm delivery between 24 and 34 weeks of gestation. These medications accelerate fetal lung maturation and reduce the incidence of respiratory distress syndrome and other neonatal complications associated with preterm birth [6].

Antibiotics for preterm premature rupture of membranes (PPROM):

Preterm premature rupture of membranes (PPROM) occurs when the amniotic sac ruptures before 37 weeks of gestation, increasing the risk of preterm birth and neonatal infection. Antibiotic therapy, such as intravenous ampicillin and erythromycin, is often initiated to prolong pregnancy and reduce the risk of maternal and fetal infections [7].

Recent advancements and future directions:

Recent research efforts have focused on identifying novel pharmacological targets and interventions for preterm birth prevention. This includes exploring the role of immunomodulatory agents, anti-inflammatory drugs, and uterine relaxants in mitigating the inflammatory pathways and uterine contractions associated with preterm labor. Additionally, advancements in pharmacogenomics may enable personalized approaches to preterm birth prevention, allowing for tailored interventions based on individual genetic profiles [8, 9].

Challenges and considerations:

While pharmacological interventions show promise in preterm birth prevention, several challenges must be addressed. These include optimizing drug dosing regimens, minimizing maternal and fetal side effects, ensuring equitable access to medications, and addressing the complex interplay of biological and environmental factors contributing to preterm birth risk [10].

Conclusion

Pharmacology plays a crucial role in the prevention of preterm birth, offering a range of interventions aimed at prolonging gestation and improving neonatal outcomes. From progesterone supplementation to antenatal corticosteroids and antibiotics for PPROM, pharmacological approaches continue to evolve, driven by ongoing research and innovation in maternal-fetal medicine. While challenges persist, the advancements in pharmacology provide hope for reducing the global burden of preterm birth and enhancing the health and well-being of mothers and their newborns.

1. Abdelmohsen UR, Grkovic T, Balasubramanian S, Kamel M, Quinn RJ et al. (2015) Elicitation of secondary metabolism in actinomycetes. Bioethanol Adv 33: 798-811.

Indexed at, Google Scholar, Crossref

2. Hosaka T, Ohnishi Kameyama M, Muramatsu H, Murakami K, Tsurumi Y et al. (2009) Antibacterial discovery in actinomycetes strains with mutations in RNA polymerase or ribosomal protein S12. Nat Biotechnol 27: 462-464.

Indexed at, Google Scholar, Crossref

3. Lee JA, Uhlik MT, Moxham CM, Tomandl D, Sall DJ (2012) Modern phenotypic drug discovery is a viable, neoclassic pharma strategy. J Med Chem 55: 4527-4538.

Indexed at, Google Scholar, Crossref

4. Watve MG, Tickoo R, Jog MM, Bhole BD (2001) How many antibiotics are produced by the genus Streptomyces? Arch Microbiol 176: 386-390.

Indexed at, Google Scholar, Crossref

5. Rosen J, Gottfries J, Muresan S, Backlund A, Oprea TI (2009) Novel chemical space exploration via natural products. J Med Chemv 52: 1953-1962.

Indexed at, Google Scholar, Crossref

6. Monciardini P, Iorio M, Maffioli S, Sosio M, Donadio S (2014) Discovering new bioactive molecules from microbial sources. Microb Biotechnol 7: 209-220.

Indexed at, Google Scholar, Crossref

7. Pidot S, Ishida K, Cyrulies M, Hertweck C (2014) Discovery of clostrubin, an exceptional polyphenolicpolyketide antibiotic from a strictly anaerobic bacterium. Angew Chem Int Ed Engl 53: 7856-7859.

Indexed at, Google Scholar, Crossref

8. Blin K, Kazempour D, Wohlleben W, Weber T (2014) Improved lanthipeptide detection and prediction for antiSMASH. PLoS ONE 9: e89420.

Indexed at, Google Scholar, Crossref

9. Castro Falcon G, Hahn D, Reimer D, Hughes CC (2016) Thiol probes to detect electrophilic natural products based on their mechanism of action. ACS Chem Biol.

Indexed at, Google Scholar, Crossref

10. Ziemert N, Alanjary M, Weber T (2016) The evolution of genome mining in microbes - a review. Nat Prod Rep.

Indexed at, Google Scholar, Crossref