Pregnancy – Predicting and Preventing Preterm Labor

Paige Berryman was thrilled to be pregnant for the third time and doubly excited to learn she was carrying twins. Her pregnancy was complication-free, allowing Berryman, an obstetrician-gynecologist in Omaha, Neb., to practice medicine by day and chase around her 1- and 4-year-olds by night. But a routine visit to her obstetrician during her 30th week showed her cervix was shortening — a sign she could go into preterm labor.

Yet before placing her on bed rest or administering steroid injections to stimulate the growth of her twins’ lungs, Berryman’s doctor performed a simple in-office test to predict the likelihood of labor. That test, FullTerm™, The Fetal Fibronectin Test, determines the presence of fetal fibronectin, a “glue-like” protein that holds a baby in the womb. Fetal fibronectin is detectable in vaginal secretions in the very beginning of pregnancy, when this bond is first forming, and then again at the end of pregnancy, when your body is getting ready to deliver your baby.

“Fetal fibronectin is only secreted during weeks 22 and 35 if the bond between the placenta and uterus is disrupted,” says Dr. Errol R. Norwitz, an associate professor at Yale University School of Medicine and associate director of the division of maternal-fetal medicine at Yale-New Haven Hospital. This means that if this test is positive for the “glue” between weeks 22 and 35, a woman has a high chance of delivering within the next two weeks.

Luckily, Berryman’s test was negative. But, had her test been positive, those results would have helped map out the best course of treatment for her and her possibly preterm babies.

Investigating Preterm Labor
According to the National Center for Health Statistics, preterm births in the United States increased by just over 20 percent from 1990 to 2005. Because of this rise, Dr. Joseph Hwang, a maternal-fetal medicine specialist at the Perinatal Center of Iowa in Des Moines, says there has been a pressing need to pinpoint when a woman is likely to go into preterm labor.

Traditionally, doctors relied on physical examination to make this diagnosis. “This resulted in many women who had contractions, but not a real threat of preterm birth, being placed on bed rest and worrying about going into preterm labor,” Hwang says. Doctors also consider pregnancy history to be a predictor of preterm birth, but of course this isn’t applicable for first-time moms-to-be. Cervical length assessment by ultrasound is a newer diagnostic tool used to predict preterm birth, but although it’s helpful, Hwang says it still does not provide the most accurate results.

Launched in 1999, FullTerm™ was once primarily used in hospitals. But it’s now readily available at most obstetrician’s offices and clinics, according to Hwang. A majority of insurance plans cover the cost (about $100, according to the doctor’s average), and a doctor or midwife can perform the test from week 22 to 35 with a simple swab of the vagina. Results usually are ready within a few hours, “and there is no danger to the mother or baby,” Hwang notes.

A Mom-to-Be’s Next Steps
“If the test is negative, a pregnant woman can rest assured her chance of preterm birth is extremely unlikely. This is important because she can proceed with a normal activity level,” says Hwang.

Bed rest often is prescribed to restrict activity and help a pregnancy reach full term. Being banished to bed to lie on your left side has been known to decrease contractions and pelvic pressure, and lower blood pressure. “However, unfortunately, there is no scientific proof bed rest prevents preterm birth,” says Norwitz. In fact, the only measurable benefit of bed rest, according to Norwitz, is that it improves blood flow to the placenta.

So, what’s your best bet to lower your chances of preterm labor and being placed on bed rest? Hwang says to follow the general guidelines for a healthy pregnant lifestyle. “Eat a balanced diet, get plenty of rest, avoid smoking and consuming alcohol, and, most important, schedule regular prenatal care visits.”

What Are Your Chances?
The March of Dimes says 1 in 8 babies are born preterm every year. And there are several known risk factors for preterm birth. Here’s what’s commonly known to up the chances:
• Age. Being pregnant and younger than 18 or or older than 40.
• Health. High blood pressure, anemia, clotting disorders, diabetes, infections during pregnancy, and certain uterine or cervical problems; late prenatal care.
• Number of babies. Carrying twins or multiples.
• Weight. Having a low pre-pregnancy weight or being overweight.
• Lifestyle. Smoking, drinking alcohol, or using illegal drugs during your pregnancy.
• Stress. Strenuous work; personal and emotional stress, such as spousal abuse.

After spending 15 weeks on strict bedrest, Gina Roberts-Grey’s son was born preterm at 36 weeks. She wishes this test had been available 13 years ago to reduce some of the worry that he would be born even earlier than he was, but remains grateful he