Interview: Prevention of Preterm Births

The main focus of this interview is to help raise awareness about the growing problem of preterm births. If you live in the U.S., see how your area rates at the March of Dimes report card. My area? F!

Q: Thanks for interviewing with Lively Women! Could you tell me a little about your background?

A: My name is Dr. Jonathan Hodor. I am a board-certified OB/GYN and a board-eligible Maternal-Fetal Medicine specialist practicing with Maryland Perinatal Associates, PC. I have a special interest in preterm labor (both assessment of risk factors as well as management) along with prenatal diagnosis, hypertensive disorders of pregnancy, diabetes in pregnancy, as well as multiple and high-order multiple pregnancies.

Q: Why is it so important to avoid preterm births?

A: The incidence of preterm birth (birth before 37 weeks) is continually increasing in the United States year after year. According to the March of Dimes, there are more than 500,000 preterm births in the U.S. annually, meaning a premature baby is born every minute. Approximately 12.5 percent or 1 in 8 babies in the United States are born preterm, putting them at risk for serious health problems.

Prematurity is especially serious as it is the number one cause of neonatal death. Additionally, premature babies are at increased risk for the following health conditions: bleeding from the brain, cerebral palsy, mental retardation, attention deficit disorder, chronic lung disease and vision and hearing loss. Half of all neurological disabilities in children are related to premature birth.

Q: What is the best test to detect the likelihood of preterm birth?

A: There is an FDA-approved, noninvasive test that provides physicians with valuable information about the likelihood that premature birth will occur. FullTerm™, The Fetal Fibronectin Test is the single strongest independent predictor of preterm birth at less than 32 weeks. Collection can be performed in a doctor’s office (similar to a Pap smear test) and the test measures the amount of fetal fibronectin–the “glue” that holds the baby in the womb—in the vagina. During weeks 22 to 35 of a pregnancy, fetal fibronectin should be almost undetectable.

A negative test result means that fetal fibronectin is not present in the vagina and there is a greater than 99 percent chance that delivery will not occur within the next 14 days. This offers women assurance that they will not deliver for an additional two weeks meaning they can avoid over treatment with drugs and other medical interventions such as bed rest or hospital admission.

A positive result is the single strongest independent predictor of preterm birth at less than 32 weeks. The combination of a positive FullTerm, The Fetal Fibronectin Test followed by measuring the length of the cervix via ultrasound provides additional valuable predictive data about the likelihood that a woman will deliver in two weeks. This information can help physicians delay or possibly prevent a preterm birth through the use of drugs, bed rest and other medical interventions. Women for whom preterm birth is inevitable benefit from the early warning, which allows them to travel closer to a hospital with specialized services for premature babies.

Q: Which women should consider the test?

A: Any woman that is deemed high risk should consider talking to their physician about this test. The three main groups of women at risk of delivering prematurely are:

• Women who have had a previous preterm birth
• Women who are pregnant with multiple babies
• Women with certain uterine or cervical abnormalities

Other possible risk factors include:

• Late or no prenatal care
• High blood pressure, diabetes, clotting disorders, being underweight before pregnancy, obesity, or other chronic health problems in the mother
• Certain infections during pregnancy
• Domestic violence, including physical, sexual or emotional abuse
• Lack of social support and stress
• Cigarette smoking, alcohol use, or illicit drug use during pregnancy

It is also important to remember that if a woman (with or without risk factors) has symptoms of preterm labor which she reports to her physician or clinical provider, a fetal fibronectin sample should be considered first line prior to any digital exams and/or transvaginal ultrasound if she is between 22 and 34-weeks’ gestation.

While much is known about the risk factors for premature birth, it’s important for all women to understand that nearly half of all premature births have no known cause.

Q: What else can women do to help avoid a preterm?

A: Treatment strategies to avoid preterm birth include bed, tocolytic drugs and corticosteroid drugs. Drug therapy may help delay birth for up to a week and accelerate development of the baby’s organs, giving the baby the best chance for survival. Additionally, treatment with the hormone progesterone has been shown to reduce the incidence of premature birth in women who have had a previous preterm birth.

Q: Do you have anything to add?

A: Biomarkers for Risk Assessment are very important in the evaluation of a woman at risk and/or symptomatic when evaluating for Preterm Labor.

These markers include both the biochemical marker, Fetal Fibronectin (fFN), and the biophysical marker, cervical length by transvaginal ultrasound. Both together allow physicians to more accurately identify women at risk; develop ongoing surveillance programs; institute appropriate interventions, as well as increase patient education and preparation. And as noted above, it also avoids unnecessary treatment and expense and helps these women maintain personal, family, and professional lifestyle.

Preterm birth remains a serious problem.

Women at risk need to be identified early for evaluation and intervention. fFN is a powerful predictor of preterm birth and should be utilized in all obstetrical and perinatal offices that have access to a rapid turn-around time for a result, as well as all hospitals performing deliveries.

Physicians should be collecting samples in all women between 22-34 weeks’ gestation with obstetrical risk factors and/or who are symptomatic prior to performing digital examinations and/or transvaginal ultrasound cervical lengths.

There is no financial cost to the patient if the collected sample is not sent (as long as the cervical length is > 25mm) and/or the digital exam is reassuring. The only cost is to the physician and/or the clinical practitioner performing the test and this is time which is < 30 seconds.

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