Every year, about one in 10 babies born in the United States is premature before 37 weeks of pregnancy, according to the March of Dimes. Premature birth is the leading cause of infant mortality, with devastating effects and a set of long-term health consequences for babies. Preterm births also result in profound emotional and psychological implications for the parents. And yet, for decades, predicting which pregnancies are most at risk of premature labor has remained a significant challenge both for doctors and patients. In recent years, however, a promising tool --PreTRM-- has emerged to help identify those at risk for premature labor. PreTRM is a blood test that can predict the risk of preterm birth with remarkable accuracy. For many obstetricians, this new test offers hope for a future where preterm births are more preventable.
However, before delving into the potential of PreTRM, a better understanding of the severity of preterm birth is required. Most babies born before 37 weeks of pregnancy have several health issues. According to the Centers for Disease Control and Prevention (CDC), premature infants are at risk for developmental delays, lung problems, infections, and even neurological disorders such as cerebral palsy or ADHD. These health problems can persist into adulthood. For mothers, the emotional toll can be just as significant, leading to conditions like postpartum depression and post-traumatic stress disorder due to the unexpected and often traumatic experience of preterm delivery. While some pregnancies are clearly at risk for premature birth, such as those with a previous history of preterm deliveries, diabetes, or hypertension, they are not. Thus, physicians and their families are often caught blind-sided, having to make high-stakes decisions over the management of the pregnancy for the health of the baby and the mother.
The PreTRM, developed by Sera Prognostics, is a blood test taken during a woman's second trimester to measure two proteins in the blood. These proteins include sex-hormone binding globulin and insulin-like growth factor binding proteins commonly known as SHBG and IBP. Tests have shown that these proteins tend to rise in women likely to deliver prematurely. Their ratio can help predict a woman to go into early labor. In 2017, Dr. Phelps-Sandall was already the mother of one preterm baby when she first learned about the PreTRM test. Pregnant with her third child, she was concerned about delivering prematurely again and decided to test the new method. Results were reassuring: the test returned negative, meaning the risk of preterm birth was low. That helped Dr. Phelps-Sandall and her patient make more informed decisions about the pregnancy, avoid interventions they didn't need, such as bed rest, and feel more confident that the pregnancy could proceed along a routine path.
Today, Dr. Phelps-Sandall offers the test to all her patients, regardless of risk. "It gives us information we never really had before," she says. "It allows us to approach prenatal care with more certainty."Though yet to be approved by the FDA, the test is available via certified labs. Doctors can order the test for their patients, or women can directly order it through Sera Prognostics. The lab analyzes the levels of the proteins in blood samples and provides a report indicating the likelihood of preterm birth. PreTRM is quite a significant development because, until now, doctors could not tell which women would deliver prematurely without previous preterm births. PreTRM helps identify at-risk pregnancies, particularly in women with no apparent risk factors, offering a way to intervene early if necessary. While PreTRM has been a game-changer, it is part of a bigger conversation about improving prenatal care and decreasing preterm births. Studies have noted that half of all preterm births happen to women who do not show any known risk factors. The early detection capability of tools like PreTRM could help doctors intervene before the pregnancy reaches that critical stage of early labor and thus give more hope for babies born full-term.
Even with advancements like PreTRM, it is essential to note the long-term effects of preterm birth both on the child and the parent. Many premature babies have underdeveloped lungs that can easily give way to asthma and chronic respiratory issues such as bronchopulmonary dysplasia. They are also susceptible to neurological impairments, such as learning disabilities, attention deficit hyperactivity disorder, and psychiatric disorders, including anxiety and depression. Early birth may further contribute to problems of the heart, digestion, and vision that can have lifelong effects on the child's health. The emotional toll of premature labor can be just as severe for the pregnant person. Anxiety, postpartum depression, and PTSD are pretty common in many women during preterm labor. Research has shown that women who experience a preterm birth are more likely to struggle with bonding with their baby, thereby complicating postpartum recovery even further.
Managing the stress of a preterm pregnancy is essential, as it can have a direct impact on both maternal and infant health. Thankfully, tools like PreTRM give a measure of control and certainty, reducing the likelihood of unexpected preterm labor and allowing both doctors and mothers to make more informed decisions about their care. Another critical issue the research reveals is the disparity in preterm birth rates among different populations. Studies have indicated that Black and Native American women in the U.S. have a higher likelihood of experiencing preterm birth compared to other races. The causes of this inequality are not entirely known, but access to quality health care, socio-economic status, and stress levels are considered contributing factors. The recognition of these disparities in healthcare practices should be addressed so that all women receive equal prenatal care regardless of their background.
With continued research and more widespread use of the PreTRM test, a significant decrease in preterm birth and early birth health complications is expected to follow. Dr. Matthew Hoffman, the primary researcher leading PreTRM studies, said, "We are facing two critical questions in obstetrics: when and how to deliver the baby. PreTRM helps us answer the question of when with much more confidence. Preterm birth has been a significant concern in maternal and child health for a long time, but with innovations such as the PreTRM test, there is newfound optimism. The test has the potential not only to improve the care women receive during pregnancy but also to reduce the emotional, physical, and long-term health challenges that preterm births create. Introducing PreTRM is one monumental step forward in the fight against preterm births. The test, if done earlier and more precisely, can identify women who are at risk and provide better, more personalized care for them, which might save lives and improve the health of both mothers and babies even though preterm birth remains one of the most serious problems, if properly equipped, one day the hope of a future when more babies will be born at full term, and healthier will lead to healthier moms and babies.
