Abstract
(JAMA. 2017;317(10):1047–1056) Since preterm delivery is a major cause of infant mortality, high medical costs, and long-term health effects, finding a way to predict such deliveries would be useful. Previous studies have shown mixed results when evaluating the association between cervical length or the existence of fetal fibronectin in cervicovaginal fluid with the risk of spontaneous preterm delivery. The current prospective observational cohort study was undertaken to evaluate the accuracy of universal screening in nulliparous pregnant women that included serial measurements of cervical lengths and quantitative vaginal fetal fibronectin levels for predicting spontaneous premature births.
Highlights
MAIN OUTCOMES AND MEASURES—Spontaneous preterm birth at less than 37 weeks was the primary outcome
The area under the receiver operating characteristic curve for screening between 22 and 30 weeks for fetal fibronectin level alone was 0.59, for transvaginal cervical length alone was 0.67, and for the combination as continuous variables was 0.67
Preterm birth, affecting approximately 12% of the deliveries in the United States, was responsible for 35% of the world’s 3.1 million annual neonatal deaths in 2006.1 rates have decreased over the past decade, health care costs and long-term health consequences for children born preterm are enormous, reaching more than $26.2 billion, or $51 600 for every infant born prematurely in the United States in 2006.2 Current strategies to identify women at risk are largely based on prior pregnancy outcomes, but risk assessment in women pregnant for the first time is difficult
Summary
The Eunice Kennedy Shriver National Institute of Child Health and Human Development established the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) to study nulliparous women with an overarching goal to identify factors that predict adverse pregnancy outcomes such as spontaneous preterm birth.[16] The study is a prospective cohort study with a target recruitment of 10 000 nulliparous women. Nulliparous women with singleton pregnancies were recruited from hospitals in 8 clinical centers in the United States. All local institutional review boards approved the study protocol. A detailed description of study methods and procedures is available.[16]
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