Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of interventions to prevent iatrogenic preterm birth?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Individual, health system, clinical practice, and policy/insurance interventions

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Pregnant women or women considering becoming pregnant

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Decrease in preterm births
• Decrease in health care costs
• Decrease in Cesarean sections

Describe any health-related risks, side effects, or harms that you are concerned about.

Stillbirth

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

National attention is focused on the rising problem of late preterm births and looking for mechanisms to reduce the preventable causes. Infants born even slightly preterm are at greater risk for poor health outcomes than full-term infants. Elective induction of labor and elective Cesarean section may be contributing to the rise in iatrogenic prematurity, with increased risk of infant morbidity and disability. Preterm births are also associated with greater health care costs. Iatrogenic preterm birth is potentially preventable, so it is important to understand the effectiveness of interventions to prevent iatrogenic preterm birth.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is general agreement among clinicians and policymakers on the importance of reducing the numbers of iatrogenic preterm births, but there is uncertainty regarding the effective strategies to accomplish this.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Professional associations, policymakers, insurers, and malpractice organizations all have an interest, and they may implement or promote the effective strategies found to achieve reductions in iatrogenic preterm birth rates.

Describe the timeframe in which an answer to your question is needed.

Not aware of a specific timing issue

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

We are unsure whether any particular group is at greater risk, as this question has not previously been systematically reviewed.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Professional associations, policymakers, insurers, and malpractice organizations all have an interest, and they may implement or promote the effective strategies found to achieve reductions in iatrogenic preterm birth rates.

Are you making a suggestion as an individual or on behalf of an organization?

Please tell us how you heard about the Effective Health Care Program