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

早产，即怀孕37周之前出生，是撒哈拉以南非洲婴儿死亡和患病的主要原因。据估计，全球超过80%的早产发生在撒哈拉以南非洲（sSA）和亚洲国家，大多数是由于妇女自发早产或其膜（沃茨）早期破裂（统称为自发性早产，SPTB）。尽管了解SPTB的全球影响，但大多数对这种通常具有破坏性的妊娠结局的研究都集中在英国和美国等高收入国家的孕妇身上。对低收入国家妇女的SPTB知之甚少。然而，SPTB的潜在生物学原因是复杂的，并受到环境，营养，感染和孕妇接触的其他风险因素的严重影响。如果我们要改善早产负担最高的国家的孕产妇和新生儿保健，区域特定研究至关重要。为了满足这一需求，我们计划研究临床和社会风险因素（来自PRECISE网络怀孕队列招募的5 000名妇女，https：//precisenetwork.org/），并结合肯尼亚、冈比亚和莫桑比克妇女生殖道、血液和胎盘组织中的SPTB生物标志物。我们将整合这些数据，以提高我们对SPTB的生物学理解，并确定与撒哈拉以南非洲人群相关的新生物标志物，以预测SPTB的风险。我们还将通过培训五名新的非洲科学家并支持他们的主管担任研究领导，创建可持续的SPTB研究人员团队。我们将与冈比亚的同事一起，为我们在撒哈拉以南非洲和英国的研究人员建立一个生物信息学培训计划和实验室科学网络。我们预计，这项工作将影响未来的临床风险管理、预防和治疗战略，专门解决撒哈拉以南非洲妇女的需求，并对全球SPTB具有潜在的相关性。

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.