Predicting and preventing preterm birth in Europe: current challenges and gaps

Preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality across Europe despite advances in obstetric care. While PTB rates vary widely across the region, overall declines in recent decades have been limited, revealing persistent gaps in risk assessment and prevention. Here we review current challenges and disparities in European PTB prediction and prevention, highlighting the complex constellation of maternal, fetal, environmental, and sociodemographic risk factors. Extending gestational age represents an opportunity to improve outcomes among pregnancies at higher PTB risk. Unfortunately, existing tools for PTB risk assessment and prevention show limited effectiveness arising from the fact that the PTB event is a frequent outcome with various underlying causes.The limitations of existing clinical prediction tools, which can only account for a minority of PTBs, underscore the need for more accurate and accessible screening methods. Although cervical length screening and some biomarkers demonstrate promise for risk stratification, they are not uniformly implemented, and the few effective interventions that risk stratification would implement lack broad consensus or standardization. These interventions, including progesterone therapy, low-dose aspirin, and lifestyle modifications, may require regional approaches reflecting population-specific risk profiles. The PTB burden is a persistent concern across Europe. Constituent populations are diverse, comprising a mosaic of risk factors of varying significance that fail to predict the majority of PTBs. During this time of evolving demographics in the Europe, assessing PTB risk becomes even more challenging. The stagnation of PTB incidence rates also strongly suggests that new tools are needed to achieve improvements for mothers, babies, public health, and to reduce associated long-term costs of PTB. To move forward, optimizing gestational age and neonatal outcomes in Europe will require more unified guidelines, optimized implementation of known preventative strategies, investment in novel risk assessment tools, and public health policies that address modifiable risk factors both pre- and post-conception. Addressing these gaps is essential to reduce PTB-related health burdens and promote maternal and neonatal well-being across diverse European settings.