title: Reducing preterm birth by a statewide multifaceted program: an implementation study.
abstract: A comprehensive preterm birth prevention program was introduced in the state of Western Australia encompassing new clinical guidelines, an outreach program for health care practitioners, a public health program for women and their families based on print and social media, and a new clinic at the state's sole tertiary level perinatal center for referral of those pregnant women at highest risk. The initiative had the single aim of safely lowering the rate of preterm birth.
  
  
  
  The objective of the study was to evaluate the outcomes of the initiative on the rates of preterm birth both statewide and in the single tertiary level perinatal referral center.
  
  
  
  This was a prospective population-based cohort study of perinatal outcomes before and after 1 full year of implementation of the preterm birth prevention program.
  
  
  
  In the state overall, the rate of singleton preterm birth was reduced by 7.6% and was lower than in any of the preceding 6 years. This reduction amounted to 196 cases relative to the year before the introduction of the initiative and the effect extended from the 28-31 week gestational age group onward. Within the tertiary level center, the rate of preterm birth in 2015 was also significantly lower than in the preceding years.
  
  
  
  A comprehensive and multifaceted preterm birth prevention program aimed at both health care practitioners and the general public, operating within the environment of a government-funded universal health care system can significantly lower the rate of early birth. Further research is now required to increase the effect and to determine the relative contributions of each of the interventions.
authors.affiliation: Maternal-Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia; School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia. Electronic address: john.newnham@uwa.edu.au.
authors.forename: John P
authors.initials: JP
authors.lastname: Newnham
authors.affiliation: Maternal-Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia; School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Scott W
authors.initials: SW
authors.lastname: White
authors.affiliation: Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Meharry
authors.affiliation: Maternal-Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.
authors.forename: Han-Shin
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia; School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Pedretti
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Arrese
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Keelan
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Kemp
authors.affiliation: Maternal-Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia; School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Dickinson
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Dorota A
authors.initials: DA
authors.lastname: Doherty
mesh_terms: D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007234:Infant, Premature; D007318:Inservice Training; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*; D015397:Program Evaluation; D011634:Public Health; D061108:Social Media
keywords: implementation; population-based study; preterm birth; prevention