Call for better collaboration to understand the complex causes of preterm birth

A new editorial co-authored by Imperial’s Professor Catherine Williamson spotlights the urgent need to better understand the causes of preterm birth.

“A major focus of the Tommy's Centre is collaboration. If the best scientists and clinicians work together... we can reduce preterm birth rates and improve outcomes for families" Professor Catherine Williamson Department of Metabolism, Digestion and Reproduction

Preterm birth is the leading cause of death in children under five in the UK and worldwide, with the House of Lords Preterm Birth Committee releasing a report on the matter in late 2024.

A new editorial published in PLOS Medicine and titled "Focusing on the Origins of Preterm Birth: Why Understanding Aetiology is Critical to Optimising Outcomes", builds on the House of Lords enquiry.

The editorial points to preterm birth not being a single condition, but rather a collection of overlapping conditions, with multifactorial, and often case-specific, underlying causes. As such, a one-size-fits-all approach to the prevention and treatment of preterm births is ineffective. Instead, the authors propose using a “triple risk” model to better classify preterm birth causes.

Current targets to reduce preterm birth largely focus on overall rates, which fail to consider underlying differences in drivers of preterm birth. Therefore, a more rigorous use of classification systems would enable interventions to be tailored accordingly. 

Professor Williamson, Chair in Women's Health in the Department of Metabolism, Digestion and Reproduction, and her fellow authors argue that without an attempt to classify preterm births at a more granular level, there is a risk of obstructing the identification of interventions, research studies, and policies that have the potential to improve outcomes for women and babies.

Importance of collaboration

The authors strongly support the role of the newly established Tommy’s National Centre for Preterm Birth Research in encouraging collaboration in this area of research.

The Centre, a UK-wide collaboration between five universities and hosted at Imperial’s Institute of Reproductive and Developmental Biology, is pioneering research into predictive testing and personalised treatments, including a major national genetic study supported by Genomics England, aimed at uncovering ethnic-specific risk factors for preterm birth.

Speaking about the Centre, Director Professor Williamson said: “At the Tommy’s National Centre for Preterm Birth Research, we are supporting a portfolio of research projects designed to understand why preterm birth occurs, target treatments to improve outcomes and develop better psychological and practical support for families.  

“A major focus of the Centre is collaboration. If the best scientists and clinicians work together, and if we include the voices and perspectives of people from diverse groups throughout the UK, together we can reduce preterm birth rates and improve outcomes for families.”

By working collaboratively to deepen our understanding of the causes of both spontaneous and medically indicated preterm births, there is real potential to transform outcomes for mothers, babies, and families across the UK and beyond.

Focusing on the Origins of Preterm Birth: Why Understanding Aetiology is Critical to Optimising Outcomes. Jennifer Jardine, Laura Goodfellow, Caroline Ovadia, Anna L. David, Catherine Williamson. PLOS Medicine. Published: May 20, 2025. https://doi.org/10.1371/journal.pmed.1004601