Abstract
Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from US newborn intensive care units. We aimed to determine whether NFPs are a potentially effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population. This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010–2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans. Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight < 1,250 g) were evaluated. Nearly 1 in 5 women (19.8 %) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3 % were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4 % were aware of effective pharmacologic preventative strategies. Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.
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Martin, J. A., Hamilton, B., Ventura, S. J., et al. (2011). Births: Final data for 2009. National Vital Statistics Reports, 60(1), 1.
Behrman, R., & Butler, A. (Eds.) (2007). Preterm birth: Causes, consequences, and prevention. Washington: National Academies Press.
Slattery, M. M., & Morrison, J. J. (2002). Preterm delivery. Lancet, 360(9344), 1489–1497.
Esplin, M. S., O’Brien, E., Fraser, A., Kerber, R. A., Clark, E., Simonsen, S. E., et al. (2008). Estimating recurrence of spontaneous preterm delivery. Obstetrics and Gynecology, 112(3), 516–523.
Barton, J. R., & Sibai, B. M. (2008). Prediction and prevention of recurrent preeclampsia. Obstetrics and Gynecology, 112(2 Pt 1), 359–372.
Manuck, T. A., Henry, E., Gibson, J., Varner, M. W., Porter, T. F., Jackson, G. M., et al. (2011). Pregnancy outcomes in a recurrent preterm birth prevention clinic. American Journal of Obstetrics and Gynecology, 204(4), 320 e321–e326.
Meis, P. J., Klebanoff, M., Thom, E., Dombrowski, M. P., Sibai, B., Moawad, A. H., et al. (2003). Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. New England Journal of Medicine, 348(24), 2379–2385.
Meis, P. J. (2005). Hydroxyprogesterone for the prevention of preterm delivery. Obstetrics & Gynecology, 105(5 Pt 1), 1128–1135.
Bujold, E., Roberge, S., Lacasse, Y., Bureau, M., Audibert, F., Marcoux, S., et al. (2010). Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: A meta-analysis. Obstetrics and Gynecology, 116(2 Pt 1), 402–414.
Sampaio, L. H., Sousa, A. L., Barcelos, M. C., Reed, S. G., Stefani, M. M., & Duthie, M. S. (2012). Evaluation of various cytokines elicited during antigen-specific recall as potential risk indicators for the differential development of leprosy. European Journal of Clinical Microbiology & Infectious Diseases: Official Publication of the European Society of Clinical Microbiology, 31(7), 1443–1451.
Chang, H. H., Larson, J., Blencowe, H., Spong, C. Y., Howson, C. P., Cairns-Smith, S., et al. (2013). Preventing preterm births: Analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet, 381(9862), 223–234.
Iams, J. D., & Berghella, V. (2010). Care for women with prior preterm birth. American Journal of Obstetrics and Gynecology, 203(2), 89–100.
Spong, C. Y. (2007). Prediction and prevention of recurrent spontaneous preterm birth. Obstetrics and Gynecology, 110(2 Pt 1), 405–415.
DeFranco, E. A., Stamilio, D. M., Boslaugh, S. E., Gross, G. A., Muglia, L. J. (2007). A short interpregnancy interval is a risk factor for preterm birth and its recurrence. American Journal of Obstetrics and Gynecology, 197(3), 264.e261–e266.
Zhu, B. P., Rolfs, R. T., Nangle, B. E., & Horan, J. M. (1999). Effect of the interval between pregnancies on perinatal outcomes. New England Journal of Medicine, 340(8), 589–594.
Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84(5), 478–485.
Acknowledgments
The authors thank Trece Swanson, DNP, CNM, for assistance with subject interviews and data collection (supported by the University of Utah Department of Obstetrics and Gynecology, Salt Lake City, Utah). They also thank the administration and staff of the Utah Department of Health Neonatal Follow-up Program in Salt Lake City, UT, for their support and facilitation of this Project.
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Clark, E.A.S., Esplin, S., Torres, L. et al. Prevention of Recurrent Preterm Birth: Role of the Neonatal Follow-up Program. Matern Child Health J 18, 858–863 (2014). https://doi.org/10.1007/s10995-013-1311-0
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DOI: https://doi.org/10.1007/s10995-013-1311-0