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A new global initiative, GAPPS, seeks to prevent prematurity and stillbirth.

GAPPS 220x130 updatedThroughout the world, prematurity is the leading cause of death in children under age 5, and millions of stillbirths occur late in pregnancy or just minutes before birth. Here in the U.S., one in eight babies is born preterm (which is before 37 completed weeks of gestation).

Because the biology of pregnancy and childbirth is poorly understood, many underlying causes of this widespread situation remain a mystery. In fact, current healthcare strategies in the richest countries cannot prevent a preterm birth once labor begins.

The Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s, is leading an international effort to address these challenges. In May 2009, GAPPS convened the first conference to discuss the burden of prematurity and stillbirth, prioritize research efforts and build a foundation for necessary policy changes.

The International Conference on Prematurity and Stillbirth co-sponsored by the Bill & Melinda Gates Foundation, March of Dimes, PATH, Save the Children, UNICEF and the World Health Organization brought together nearly 200 people from around the world who are experts in science, public health and policy to develop a coordinated strategy for preventing prematurity and stillbirth worldwide.

Working globally and collaboratively

During the conference, participants developed recommendations for a five-year Global Action Agenda a roadmap for future research, interventions and advocacy. “This conference marks a new era in reducing prematurity and stillbirth worldwide,” says Marian Sokol, president of First Candle, an organization working to advance infant health and survival. “It has undoubtedly shaped my thinking and underscored my commitment to working globally and in partnership wherever possible.”

Following the conference, GAPPS developed the Global Action Agenda with input from 12 interdisciplinary work groups. The recommendations will guide GAPPS’ work and the efforts of global health experts who seek to improve the health of newborns, children and their mothers around the world.

“Preterm birth and stillbirth are complex local and global health problems that require an interdisciplinary approach and an international commitment,” says Dr. Craig Rubens, executive director of GAPPS. “We are proud to coordinate this effort and serve as a catalyst for innovative solutions.”

GAPPS is helping to speed the adoption of effective prevention and treatment options through research. The GAPPS team of international investigators has identified 21 evidence-based interventions that can be used in low-resource settings. GAPPS is collaborating with organizations such as PATH to ensure widespread use of these interventions and to discontinue those that are ineffective.

Understanding the biology of pregnancy

Over the long term, GAPPS will lead pioneering research to better understand the biological processes of pregnancy and childbirth, and the racial and ethnic disparities in preterm birth and stillbirth.

“The most significant barrier to the development of new interventions is a lack of scientific information on normal and abnormal gestational biology,” Rubens explains. “But advances in systems biology will help us gain a better understanding of birth outcomes. With this information in hand, we can develop novel ways to predict, treat and prevent preterm birth and stillbirth.”

To jump-start this work, GAPPS created a new repository of biospecimens linked to phenotypic data from pregnant women, newborns and relatives. The GAPPS Repository will include contributions from families of diverse racial, ethnic, regional and socioeconomic backgrounds.

Many causes of this widespread situation remain a mystery." ~ Dr. Craig Rubens

By studying these specimens and data, researchers from GAPPS and organizations throughout the world hope to identify biomarkers that will identify women at risk of preterm birth and stillbirth.

Researchers at the Seattle Children’s Research Institute, Fred Hutchinson Cancer Research Center and the University of Washington provided guidance for the GAPPS Repository. Collection began in the fall of 2009.

Currently, hospitals in the state of Washington are participating in the GAPPS Repository network. Once collection processes are refined, GAPPS will partner with additional healthcare facilities in low-, middle- and high-income countries to expand the reach of the repository. This nexus of information will accelerate international efforts to prevent preterm birth and stillbirth.

“The development of the Global Action Agenda and the launch of the GAPPS Repository are critical steps toward our goal of saving millions of babies around the world,” says Children’s CEO Dr. Thomas Hansen, who is on the GAPPS leadership team and is a GAPPS core investigator as a neonatologist. “Thanks to the hard work of the GAPPS team, we are furthering global research on prematurity and stillbirths and helping ensure that interventions will reach families here at home and around the world.”

For more information about GAPPS, please visit

Did you know that in low-resource countries:

o More newborns die from prematurity than from HIV/AIDS or tuberculosis.
o 99% of all stillbirths occur in these nations. Approximately one-third occur during labor and delivery, which are preventable. Many stillbirths are strongly linked to maternal deaths.

And, in the United States:

o One in eight babies is born prematurely, and the incidence of preterm birth is rising.
o An estimated $26 billion is spent annually on healthcare costs related to prematurity.
o Stillbirth is 10 times more common than sudden infant death syndrome (SIDS).