Preventing preterm births with hCG

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Preterm births are an expensive global health problem. The rates are increasing, despite the basic science and clinical research advances. According to the American College of Obstetricians and Gynecologists, birth between 20 to 37th completed gestational week is considered preterm. Births before 34 weeks is considered early, between 34-36 weeks considered late preterm births. Seventy percent of births occur during the late than in the early preterm birth weeks. Not all preterm labors results in preterm births, as myometrial contractions can spontaneously subside in many cases. Preterm births have multifactorial etiology such as race, ethnicity, socio-economic factors, medical and pregnancy conditions, behavioral characteristics and family history (genetics). The recurrence risk for preterm births varies from 15-80% depending on the number of previous preterm births and how early they occurred. Although there are tests like, fetal fibronectin and cervical length measurements, they are not always predictive of women who might be at risk for preterm births. The premature infants have breathing problems, feeding difficulties, cerebral palsy, developmental delays, and vision problems and hearing impairment. These complications are generally more severe in early than in late preterm births. Preterm infants require intensive care in neonatal intensive care units for the first several weeks after birth. The infants that survive the initial life threatening challenges are at a greater risk for early death and lifelong neurologic and cognitive difficulties. The currently available drugs for the treatment have either the side effects or work (progestins) only in women who have previous history preterm births. hCG, on the other hand, is a physiological pregnancy hormone. It is non-toxic, relatively safe and work in high-risk women as well as in those that threaten to deliver spontaneously preterm. In addition, hCG is inexpensive and can be made even cheaper by scaling up the production of recombinant hormone. The side effects that are commonly associated with intramuscular injections are rather mild and do not often require medical attention. Should hCG be proven effective, there are numerous possibilities to improve upon the way the hCG is currently administered for other clinical indications. For example, long acting analogs and synthetic hCG mimetics for oral use can be developed. Even though, regular hCG cannot be taken orally, due to its degradation in stomach, it can be taken as lozenges, as hCG weight loss clinics promote. The active ingredient, in a lozenge would slowly dissolve and rapidly gets into buccal blood circulation. hCG delivery by nanoparticle is an another potential area for development. The nanoparticle delivery can reduce the dose and frequency of administration. The intravenous drip infusions can be further refined for the even better clinical outcomes. The combination therapies could be an area for improvement. It takes advantage of the best features of different drugs, acting by some common and others by different mechanisms. This could make combination therapies more effective than single treatments. Moreover, they can also reduce the dose, toxicity and the cost of the drugs. Regardless of how preterm labors are triggered, myometrial activation is the final common pathway for preterm births. The side effects of drugs usually come from the lack of target specificity and unintended actions that might interfere with normal bodily functions. These effects can be avoided if the therapeutic agents can only block the myometrial contractions. Comparing hCG with the other drugs, including progestins, it is possible that hCG may come close to being specific in inhibiting the activation of myometrial contractions. However, this possibility can only be further validated by further research. Although there are compelling scientific and clinical reasons to start large-scale multicenter clinical trials with hCG, there are none at the present time, due to vested interest groups that control the resources. These clinical trials should be undertaken on a scale comparable to those done with 17-hydroxyprogesterone caproate and progesterone. hCG may not work in every case like other treatments. It may not work in chorioamnionitis cases, but this may depend on the stage (early vs late) of the infection. hCG treatment may not be a panacea, but it is likely to become an important part of obstetricians tool box to prevent preterm births across the world.

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