Predicting Premature Birth

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FDA-approved test helps women and doctors manage high-risk pregnancies.

A new study published in the current issue of the American Journal of Obstetrics and Gynecology found the use of serial fetal fibronectin (fFN) and cervical length testing, between 22 and 32 weeks gestation, more accurately identified asymptomatic women pregnant with twins who are at the highest risk of premature delivery. The combination of both tests was an even better predictor of preterm birth and appeared to be most useful for the prediction of preterm birth between 28 and 32 weeks gestation. The fFN test is an FDA-approved, noninvasive test that provides high-risk women and their physicians with valuable information about the likelihood of premature birth. In this study a positive fFN result was associated significantly with shorter testing-to-delivery intervals, where as a short cervical length was not, thus more accurately predicting proximate preterm birth.

The test can be performed in a doctor’s office (similar to a Pap smear test) and measures the amount of fetal fibronectin—in the vagina. There are no side effects to either mom or baby, and the test can be repeated every two weeks until 35 weeks of pregnancy. During weeks 22 to 35, fetal fibronectin should be almost undetectable.

If the test is negative, a woman has a 99 percent chance of not delivering in the next 14 days. This means women can avoid over treatment with drugs and other medical interventions such as bed rest or hospital admission. Additionally, the reassurance of a negative test result allows women to continue their normal routines, such as working, traveling, caring for other children and socializing with friends and family.

While the goal is for every baby to be born healthy and at full term, the reality is premature birth, also known as preterm birth, is the number one obstetric problem and the number one cause of death for newborns in the United States. Defined medically as childbirth occurring earlier than 37 completed weeks of gestation, preterm birth affects 1 in 8 babies born in the United States.

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A positive result is a leading independent predictor of preterm birth at less than 32 weeks. Identifying the delivery window can help doctors better manage pregnancies destined to deliver preterm and attempt to keep babies in the womb for as long as possible. Doctors may prescribe various medications such as corticosteroids to optimized infant survival or adjust maternal behaviors to prolong pregnancies. Every extra day in the womb helps a baby's organs grow. Women for whom preterm birth is inevitable benefit from the early warning, which allows them to travel closer to a hospital with specialized maternal and infant services for these situations.

Premature babies have a higher incidence of lifelong health and developmental challenges, including cerebral palsy, mental retardation, chronic lung disease, and vision and hearing loss. Given the potential grave consequences of prematurity, there is a pressing need to identify patients at increased risk to help physicians prepare for a potential preterm birth.

Experts have identified certain factors that put some women at increased risk for delivering early. They include women who have had a previous preterm birth, women who are pregnant with multiples and women with certain uterine or cervical abnormalities.

For many women the signs of premature birth come too late and don’t allow the physician to utilize the proper treatment protocol to help ensure the best outcomes for the mother and her babies. With 1 in 8 babies born prematurely (before 37 weeks) annually in the U.S. this research can help physicians best identify which of their patients who are pregnant with twins are at the greatest risk before they begin to experience or exhibit signs of premature birth.

Considering the long-term consequences premature birth can cause, women need to know there are detection tools available that can potentially lead to improved birth outcomes.

Women interested in additional information on the Fetal Fibronectin Test are invited to visit Fullterm.net to learn more.

Written by Andrei Rebarber M.D. Dr. Rebarber is a Board-Certified Ob/GYN and Maternal Fetal Medicine Specialist in private practice at Mount Sinai Hospital in New York City. He can be reached at Maternal Fetal Medicine Associates, PLLC(212) 722-7409 or at Carnigie Hill Imaging for Women, PLLC (212) 722-7426

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