A research team at New York University (NYU), in collaboration with the International Healthy Outcomes of Pregnancy for Everyone (HOPE) Consortium, has unveiled a groundbreaking tool designed to assess the risk of premature births. The Preterm Birth Actionable Risk Index (PTB-ARIx) focuses on identifying pregnant individuals at high risk for delivering before 37 weeks, aiming to facilitate timely medical interventions.
The tool prioritizes risk factors associated with preterm birth (PTB) that have established, evidence-based treatments. For example, it highlights the use of low-dose aspirin to prevent preeclampsia, a serious condition characterized by high blood pressure during pregnancy. “Our goal is to move from reacting to preterm birth to preventing it by providing families and health care professionals with knowledge that they can act upon,” stated Laura Jelliffe-Pawlowski, a professor and senior associate dean of research at NYU Rory Meyers College of Nursing and the lead researcher on the project.
The presentation of the findings on the PTB-ARIx coincides with World Prematurity Day on November 17, 2023, highlighting the urgent need for improved strategies in managing preterm births.
The Urgency of Addressing Rising Preterm Birth Rates
PTB remains the leading cause of child mortality globally, with significant health implications for infants born prematurely. In the United States, over 350,000 babies are born prematurely each year, resulting in annual healthcare costs exceeding $25 billion. Alarmingly, the PTB rate for singleton births has increased from 8% to 8.7% between 2016 and 2023.
This situation is further complicated by disparities in treatment access. Studies reveal that Black individuals are less than half as likely to receive mental health treatment during pregnancy compared to their White counterparts, with rates of 19.1% for Black individuals versus 40.7% for White individuals. “The consistently low uptake of interventions known to improve maternal health and reduce preterm birth risk represents a critical missed opportunity, particularly in populations already experiencing health inequities,” Jelliffe-Pawlowski noted. The PTB-ARIx aims to bridge this gap by ensuring that risk identification is accompanied by actionable steps.
Quantifying Risks and Enhancing Communication
To develop the PTB-ARIx, Jelliffe-Pawlowski and her team analyzed data from 1.9 million live singleton births in California between 2016 and 2020. The index examines 18 specific risk factors during the first and second trimesters that can be addressed with evidence-based interventions. These factors span clinical aspects, such as preeclampsia and diabetes, as well as behavioral (e.g., smoking, substance use) and social determinants (e.g., food insecurity, housing instability).
By inputting and evaluating these risk factors, the index generates a score ranging from 0 to 3+, allowing healthcare providers to assess the risk level of each pregnancy. “This index offers a critical opportunity to improve patient-provider communication and increase the timely use of evidence-based, preventive care,” Jelliffe-Pawlowski added.
The research team continues to investigate the PTB-ARIx, looking to integrate treatment data to validate its potential in decreasing overall PTB rates. Collaborating with researchers at the University of Alabama, Jelliffe-Pawlowski is also working on a blood test that measures immune system signals during early pregnancy. This would serve as an additional screening method for PTB risk, complementing the PTB-ARIx.
The ultimate aim is to establish a digital platform that empowers both healthcare providers and patients. This platform would facilitate collaboration in identifying pregnancies at risk for PTB, thereby enhancing proactive prenatal care and reducing unnecessary premature births.
In addition to Jelliffe-Pawlowski, the PTB-ARIx research team includes notable contributors such as Audrey Lyndon of NYU Rory Meyers College of Nursing, Dana Gossett, Justin Brandt, and Sasha Hernandez from NYU Grossman School of Medicine, along with investigators from various institutions, including UC San Francisco, UC San Diego, University of Michigan, and others.
