Understanding phenotype and mechanisms of spontaneous preterm birth in sub-Saharan Africa (PRECISE-SPTB)

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Preterm birth, birth before 37 weeks of pregnancy, is a major cause of infant death and illness in sub-Saharan Africa. Over 80% of preterm births globally have been estimated to occur in sub-Saharan African (sSA) and Asian countries, the majority being due to women going into preterm labour spontaneously or their membranes (waters) rupture early (classified together as spontaneous preterm birth, SPTB). Despite knowledge of the global impact of SPTB, most of the research into this often devastating pregnancy outcome has focussed on pregnant women in high income countries such as the UK and USA. Much less in known about SPTB in women from low income countries. However, the underlying biological causes of SPTB are complex and heavily influenced by environment, nutrition, infection and other risk factors that pregnant women are exposed to. Region specific research is essential if we are to improve maternal and newborn healthcare in countries where the burden of preterm birth is highest. Addressing this need, we plan to study to clinical and social risk factors (from 5000 women recruited to the PRECISE Network pregnancy cohort, https://precisenetwork.org/) combined with biological markers of SPTB in the female reproductive tract, blood and placental tissue in women from Kenya, The Gambia and Mozambique. We will integrate these data to enhance our biological understanding of SPTB as well as identifying novel biomarkers relevant to sub-Saharan African populations to predict risk of SPTB.We will also create sustainable teams of SPTB researchers by training five new African scientists and supporting their supervisor as research leaders. We will, with colleagues in The Gambia, establish a bioinformatics training programme and a laboratory science network for our researchers in Sub Saharan Africa and the UK. We anticipate that this work will impact future strategies for clinical risk management, prevention and treatment that specifically addresses the needs of women in sub-Saharan Africa, as well as having potential relevance to SPTB globally.