Preterm birth test-and-treat strategy reduces neonatal morbidity, mortality
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Key takeaways:
- A blood test that predicts preterm birth risk, paired with targeted interventions, reduced neonatal morbidity and mortality.
- Treatment added an average 2.5 weeks to pregnancies at risk for preterm delivery.
Screening pregnancies without traditional risk factors for spontaneous preterm birth risk with a biomarker blood test and targeting preventive treatments for high-risk women reduced neonatal hospitalization, morbidity and mortality.
Data from the AVERT PRETERM trial, published in Diagnostics, also demonstrated that women considered to be low risk who screened positive for high preterm birth risk and accepted preventive treatment had extended gestation periods for singleton pregnancies. Preterm birth affects about one in 10 infants born in the U.S. each year, yet up to half of pregnant women who deliver prematurely have no known risk factors, according to Matthew K. Hoffman, MD, MPH, FACOG, the Matie E. Pinizzotto, MD, Endowed Chair of the department of obstetrics and gynecology for the Christiana Care Health System.
“The AVERT study found that the PreTRM [Sera Prognostics Inc.] test-and-treat strategy not only significantly reduces severe neonatal morbidity and mortality by 18% but also decreases the neonatal hospital stay by up to 28 days for babies born before 32 weeks,” Hoffman told Healio. “It also added an average of 2.5 weeks to pregnancies that would have otherwise [delivered] before 32 weeks. The study shows that this test, when paired with preventive intervention, represents a pivotal advancement in proactive prenatal care, particularly for pregnancies historically viewed as low risk.”
The AVERT PRETERM trial included 1,460 women with singleton pregnancies and no evidence of mullerian or fetal anomalies, cervical shortening, genetic anomalies, prior preterm birth, cervical cerclage or chronic maternal medical conditions. Researchers followed women from June 2018 to September 2020, comparing outcomes with a historical control arm of 10,000 women who gave birth between August 2016 and July 2018.
Women underwent testing for spontaneous preterm birth risk at 19 to 20 weeks’ gestation and were followed until after neonatal discharge. Women who screened positive with a 16% or higher risk for spontaneous preterm birth were offered vaginal progesterone 200 mg and aspirin 81 mg daily, along with twice-weekly phone calls with a nurse.
Primary outcomes were neonatal hospital length of stay, morbidity and mortality.
Overall, 34.7% of women screened positive for spontaneous preterm birth, of whom 56.4% accepted preventive treatments.
Compared with controls, infants born to women who screened positive and accepted treatment had lower neonatal morbidity and mortality scores (OR = 0.81; 95% CI, 0.67-0.98; P = .03) and 18% lower probability of severe neonatal morbidity and mortality. Infants born to women who accepted treatment also had shorter neonatal hospital length of stay (HR = 0.73; 95% CI, 0.58-0.92), with a mean stay decrease of 21% among infants with the longest hospital stays.
Results did not change after adjusting for race, hypertension, preeclampsia, gravidity and parity in sensitivity analyses.
“Physicians should consider the potential of integrating blood-based biomarker testing into routine prenatal care, especially for patients without obvious risk factors,” Hoffman said. “Adopting such tests could fundamentally change the landscape of prenatal care by shifting the focus toward prevention and early intervention. It's also essential for health care providers to engage in ongoing education about new technologies and treatment protocols, which can significantly influence patient outcomes.”
For more information:
Matthew K. Hoffman, MD, MPH, FACOG, can be reached at mhoffman@christianacare.org.