To the Editor.—
I am pleased that Dr Iams1 wrote an editorial to accompany the article by Yawn and Yawn2 in a recent issue of The Journal. Dr Iams' editorial addresses the fact that some studies are successful in reducing the preterm birth rate and others are not. In my opinion, there is a reasonable explanation for these differences that is not discussed by Dr Iams.Those programs with successful results have been applied to total populations, including women with all levels of risk. This has been true in the French experience,3 in San Francisco, Calif,4 in North Carolina,5 and in Minnesota.2 In the case of France, the major contribution to the reduction in the rate of preterm delivery was obtained among women who were in the middle-risk category. No improvement could be measured in women who traditionally were categorized as being at high risk.
Papiernik E. Preventing Prematurity. JAMA. 1989;262(22):3128–3129. doi:10.1001/jama.1989.03430220049014