Based upon our recent insights into the determinants of preterm birth, which is the leading cause of death in children under five years of age worldwide, we describe potential analytic frameworks that provides both a common understanding and, ultimately the basis for effective, ameliorative action. Our research on preterm birth serves as an example that the framing of any human health condition is a result of complex interactions between the genome and the exposome. New discoveries of the basic biology of pregnancy, such as the complex immunological and signaling processes that dictate the health and length of gestation, have revealed a complexity in the interactions (current and ancestral) between genetic and environmental forces. Understanding of these relationships may help reduce disparities in preterm birth and guide productive research endeavors and ultimately, effective clinical and public health interventions.

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This work was supported in part by the Bill and Melinda Gates Foundation, the March of Dimes Prematurity Research Center at Stanford University, and the Charles and Marie Robertson Foundation.

Author information


  1. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA

    • David K. Stevenson
    • , Ronald J. Wong
    • , Gary L. Darmstadt
    • , Jeffrey B. Gould
    • , Michael Katz
    • , Jingjing Li
    • , Cecele C. Quaintance
    • , Gary M. Shaw
    •  & Paul H. Wise
  2. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA

    • Nima Aghaeepour
    • , Martin S. Angst
    •  & Brice Gaudilliere
  3. Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA

    • Daniel B. DiGiulio
    •  & David A. Relman
  4. Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94306, USA

    • Daniel B. DiGiulio
    •  & David A. Relman
  5. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA

    • Maurice L. Druzin
    •  & Ronald S. Gibbs
  6. Department of Genetics, Stanford Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA

    • Jingjing Li
    •  & Michael P. Snyder
  7. Departments of Bioengineering and Applied Physics, Stanford University and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA

    • Mira N. Moufarrej
    •  & Stephen R. Quake
  8. Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA

    • Xiaobin Wang
  9. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    • Xiaobin Wang


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The authors declare that they have no conflict of interest.

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Correspondence to David K. Stevenson.

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