Prediction and prevention of preterm birth: a quagmire of evidence

Shennan, Andrew

doi:10.1002/uog.19063

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…12 13 There were clinical prediction models that aim to estimate the likelihood of preterm birth that include laboratory tests that are typically inaccessible in lowresource settings, such as fetal fibronectin, insulin-like growth factor binding protein-1, interleukin 6 (IL-6) and placental α-macroglobulin-1. [14][15][16][17][18][19] Most current research on Preterm Birth (PTB) prediction focuses on finding PTB risk factors using a hypothesis-testing methodology in highly controlled environments. PTB has been linked to a number of risk factors, including previous preterm labour, multiple gestation (carrying several children), diabetes, problems with the cervix, uterus or placenta, smoking, and infections.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

“…There were clinical prediction models that aim to estimate the likelihood of preterm birth that include laboratory tests that are typically inaccessible in low-resource settings, such as fetal fibronectin, insulin-like growth factor binding protein-1, interleukin 6 (IL-6) and placental α-macroglobulin-1 14–19. Most current research on Preterm Birth (PTB) prediction focuses on finding PTB risk factors using a hypothesis-testing methodology in highly controlled environments.…”

Section: Introductionmentioning

confidence: 99%

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Developing and validating a risk prediction model for preterm birth at Felege Hiwot Comprehensive Specialized Hospital, North-West Ethiopia: a retrospective follow-up study

et al. 2022

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ObjectiveTo develop and validate a risk prediction model for the prediction of preterm birth using maternal characteristics.DesignThis was a retrospective follow-up study. Data were coded and entered into EpiData, V.3.02, and were analysed using R statistical programming language V.4.0.4 for further processing and analysis. Bivariable logistic regression was used to identify the relationship between each predictor and preterm birth. Variables with p≤0.25 from the bivariable analysis were entered into a backward stepwise multivariable logistic regression model, and significant variables (p<0.05) were retained in the multivariable model. Model accuracy and goodness of fit were assessed by computing the area under the receiver operating characteristic curve (discrimination) and calibration plot (calibration), respectively.Setting and participantsThis retrospective study was conducted among 1260 pregnant women who did prenatal care and finally delivered at Felege Hiwot Comprehensive Specialised Hospital, Bahir Dar city, north-west Ethiopia, from 30 January 2019 to 30 January 2021.ResultsResidence, gravidity, haemoglobin <11 mg/dL, early rupture of membranes, antepartum haemorrhage and pregnancy-induced hypertension remained in the final multivariable prediction model. The area under the curve of the model was 0.816 (95% CI 0.779 to 0.856).ConclusionThis study showed the possibility of predicting preterm birth using maternal characteristics during pregnancy. Thus, use of this model could help identify pregnant women at a higher risk of having a preterm birth to be linked to a centre.

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Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Developing and validating a risk prediction model for preterm birth at Felege Hiwot Comprehensive Specialized Hospital, North-West Ethiopia: a retrospective follow-up study

et al. 2022

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Section: Cost-effectiveness Of Prevention Strategiesmentioning

confidence: 99%

“…The attendant problems and adverse clinical and economic sequelae of late preterm and early term birth have heightened interest in prevention strategies and their cost-effectiveness [52]. Strategies that involve identifying women at high risk of delivering early are constrained by low positive predictive values of existing prediction tests for symptomatic women with threatened preterm birth or for asymptomatic high-risk women [52]. Tsoupras and colleagues conducted decisionanalytic modelling based economic evaluation to estimate the potential cost-effectiveness of alternative "test-and-treat" strategies in the prevention of spontaneous preterm birth before 34 and 37 weeks gestation [53].…”

Section: Cost-effectiveness Of Prevention Strategiesmentioning

confidence: 99%

Health economic aspects of late preterm and early term birth

Petrou

2019

Seminars in Fetal and Neonatal Medicine

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Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies. The article highlights the limited perspective and time horizon of most studies of economic costs in this area; the limited evidence surrounding health economic aspects of early term birth; the gaps in current knowledge; and it discusses directions for future research in this area, including the need for validated tools for measuring preference-based health-related quality-of-life outcomes in infants that will aid cost-effectiveness-based decision-making.

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“…Moreover, PTB can cause psychological and physical distress and illness for the mother and the community [ 5 ]. There are a wide variety of treatments to prevent PTB, including cervical cerclage and progesterone [ 6 – 9 ]. However, two-thirds of patients with PTB have no apparent risk factors to explain its occurrence, which means that prevention of PTB may not be effective and it remains important to identify new preventive strategies for PTB [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Low-dose aspirin for the prevention of preterm birth in nulliparous women: systematic review and meta-analysis

Yan,

Zheng,

Wang

et al. 2024

BMC Pregnancy Childbirth

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Objective The objective was to assess the efficacy and safety of low-dose aspirin for the prevention of preterm birth in nulliparous women. Data sources We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to June 2022. Study eligibility criteria Randomized controlled trials that compared aspirin to placebo in nulliparous women were eligible. Methods This study was reported in accordance with the PRISMA 2020 checklist. The primary outcomes of this study were the rates of preterm birth at less than 37 weeks and less than 34 weeks of gestation. The secondary outcomes included postpartum hemorrhage, placental abruption, cesarean section, any hypertensive disorder of pregnancy and small for gestational age. Relative risks with their 95% confidence intervals were calculated for analysis. Heterogeneity was assessed by Cochran’s Q test and Higgins’s I2. A random-effects model was used when I2 was > 50% to generate the RR and 95% CI; otherwise, a fixed-effects model was used. The risk of publication bias was assessed by funnel plots. We performed sensitivity analysis by sequentially omitting each included study to confirm the robustness of the analysis. Results Seven studies with a total of 29,029 participants were included in this review. Six studies were assessed as having a low risk of bias or an unclear risk of bias, and one study was judged as having a high risk of bias. In nulliparous women, low-dose aspirin was associated with a significant reduction in the rate of preterm birth at less than 34 weeks of gestational age (RR 0.84,95% CI: 0.71–0.99; I2 = 0%; P = 0.04), but we did not observe a significant difference in the rate of preterm birth at less than 37 weeks of gestation (RR 0.96,95% CI: 0.90–1.02; I2 = 31%; P = 0.18). Low-dose aspirin was associated with a significant increase in the rates of postpartum hemorrhage (RR 1.32,95% CI: 1.14–1.54; I2 = 0%; P = 0.0003), placental abruption (RR 2.18,95% CI: 1.10–4.32; I2 = 16%; P = 0.02) and cesarean section (RR 1.053, 95% CI: 1.001–1.108; I2 = 0%; P = 0.05) in nulliparous women. We also did not observe a significant effect of low-dose aspirin on the rates of any hypertensive disorder of pregnancy (RR 1.05, 95% CI: 0.96–1.14; I2 = 9%; P = 0.28) or small for gestational age (RR 0.96, 95% CI: 0.91–1.02; I2 = 0%; P = 0.16) in nulliparous women. Funnel plots indicated that no significant publication bias existed in this meta-analysis. Except for preterm birth at less than 34 weeks of gestation, placental abruption and cesarean section, the sensitivity analysis showed similar results, which confirmed the robustness of this meta-analysis. Conclusions Low-dose aspirin might reduce the risk of preterm birth at less than 34 weeks of gestation in nulliparous women. The use of low-dose aspirin in nulliparous women increased the risk of postpartum hemorrhage and might increase the risk of placental abruption and cesarean section.

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Prediction and prevention of preterm birth: a quagmire of evidence

Cited by 4 publications

References 12 publications

Developing and validating a risk prediction model for preterm birth at Felege Hiwot Comprehensive Specialized Hospital, North-West Ethiopia: a retrospective follow-up study

Developing and validating a risk prediction model for preterm birth at Felege Hiwot Comprehensive Specialized Hospital, North-West Ethiopia: a retrospective follow-up study

Health economic aspects of late preterm and early term birth

Low-dose aspirin for the prevention of preterm birth in nulliparous women: systematic review and meta-analysis

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