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Women's Health Author: Barbi Phelps-Sandall, M.D. - Board Certified OBGYN Last Updated: Sep 22, 2017 - 2:50:33 PM

Understanding Premature Birth: Why It Affects so Many Women and How a New Test Can Help Identify a Patient's Risk

By Barbi Phelps-Sandall, M.D. - Board Certified OBGYN
Sep 22, 2017 - 2:09:54 PM

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( - Despite major advances in maternal-fetal medicine over the last several decades, there is one issue that continues to negatively affect women and babies, regardless of age, ethnicity or geographical location: premature birth. Premature birth is defined as delivering between 20 and 37 weeks, and it can happen to anyone. Babies born too soon can suffer from devastating physical and developmental complications and there can be significant emotional impact to the parents who care for these children. Premature birth also has tremendous implications for the overall healthcare system. Premature babies cost approximately ten times more than babies born at term and have an estimated 40 percent more doctor visits, due to the short and long-term medical interventions and care often required after birth.

Recent data released from the National Center for Health Statistics showed that the premature birth rate rose to 9.84 percent in 2016, up from 9.63 percent in 2015, marking the second consecutive increase after steady declines over the previous seven years. Given that an estimated 1 in 10 babies in the U.S. is born too soon, this data should be a compelling reminder for all healthcare providers that premature birth needs to be a top priority and point of discussion with their patients.

Women who’ve previously had a premature birth have the greatest risk of delivering early again. That said, approximately 40 percent of women who go on to have a premature baby are first time moms! There are common risk factors for premature birth, including: problems with the placenta, cervix or uterus, conceiving via In Vitro Fertilization (IVF), carrying multiples (more than one baby, i.e. twins or triplets), infections or other chronic health conditions like diabetes or high blood pressure, heightened stress or poor diet/nutrition. However, an estimated 50 percent of women who deliver early will not have any known risk factors.

In my practice, we screen for infection, measure cervical length, check vitamin D levels and

discuss with all patients the most common premature labor signs and symptoms that they should be aware of as they progress through their pregnancy, including: contractions that occur in 10-minute-or-less intervals, vaginal or fluid leakage from the vagina or cramping in the lower abdomen. However, if and when a woman is already experiencing any of these symptoms, it can be too late.

Fortunately, a new test recently became available for women that can help predict their individualized risk of delivering prematurely, very early into their pregnancy. The PreTRM® test is a blood test performed during the 19th or 20th week of pregnancy that analyzes specific proteins in the blood that have been shown to be accurate predictors of premature birth.  The test is intended for asymptomatic women who are carrying one child (not twins or triplets).

This is a first-of-its-kind validated test to help provide doctors and their patients with a specific risk factor for delivering early. And although the test cannot prevent premature birth, it can provide helpful information for doctors. If a patient’s test result shows an increased risk, I can work with my patient to manage her risk with the goal of giving her baby the best start in life.

One of my patients, a 41-year-old mother-of-two expecting her third child, opted to take the PreTRM test. She experienced premature labor symptoms with her second pregnancy and was on bedrest for six weeks prior to delivery. As the sole income earner for her growing family, she knew that she could not risk the time or expense of having a baby in the NICU if she were to deliver early the third time around. Her test revealed she had a slightly elevated risk of delivering early and as a result, I was able to monitor her more closely and intervene with appropriate medical treatments as symptoms of premature labor began to appear later into her pregnancy. With these interventions and additional visits, she successfully delivered a healthy baby at term. Most importantly, it provided both me, and my patient with additional knowledge and guidance about the progression of her pregnancy.

There are so many variables during pregnancy and many unknowns for both the mother and her doctor. To that end, it is important to be aware of all options that can help make the entire pregnancy more predictable and enjoyable. This, in addition to leading a healthy lifestyle, obtaining adequate rest and staying on top of routine prenatal appointments, will ensure that babies have the best start in life.

About Barbi Phelps-Sandall, M.D.

Barbi Phelps-Sandall, M.D., earned her BA and Certificate in Dental Hygiene at Ohio State University. She earned her Masters in Education at the University of Cincinnati. After working in research, education, and clinical practice in dental hygiene, she attended UCLA School of Medicine and earned her M.D.  Dr. Phelps-Sandall’s internship and residency in OB/GYN were done at Kaiser Foundation Hospital in Santa Clara, California.  She graduated from the Fellowship Program in Integrative Medicine at the University of Arizona. Presently, she works in private clinical practice in Mountain View, California.  Special interests include preventive and Integrative Medicine, high risk obstetrics, and minimally invasive surgery.  She is active in Kappa Kappa Gamma Palo Alto Alumni Association and PEO.  She has served on the board of the Vietnamese Voluntary Association, and presently sits on the board of Healing Journeys.

Her personal interests include reading, art history, fitness, hiking, scuba diving and animals.


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