Risk Factors for Preterm Birth

Many factors can cause or contribute to spontaneous premature delivery. Fetal fibronectin is one of the most powerful predictors of preterm birth before 32 weeks compared with traditional risk factors.1

NIH preterm prediction study: Risk factors for preterm birth1

Adapted from Goldenberg RL, Iams JD, Mercer BM, et al. The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. Am J Public Health. 1998;88:233-238.

Fetal fibronectin is one of the most powerful predictors of preterm birth before 32 weeks.1

Other risk factors

  • Prior preterm birth — women with a prior preterm birth before 37 weeks have a rate of recurrent preterm birth as high as 55%.2 The risk of recurrent preterm birth rises with the number of prior preterm births.3 Risk also increases as the gestational age of the prior preterm birth decreases.4,5
  • Short cervix — as the cervical length decreases, the relative risk of preterm birth increases.3 There is a 5-fold increase in risk of preterm delivery before 35 weeks among women with a cervical length of 2.0 cm vs women with a cervical length of 4.0 cm.6
  • Multiples — another risk factor for preterm birth is having multiples. Between 1980 and 2004, the rates of twin births rose from 18.9 to 32.2 per 1000 live births.7 Approximately 60% of twin births occur before 37 weeks, and 12% of twin births occur before 32 weeks.8
  • Symptoms — contractions, cramping, bleeding, and statements such as “I just don’t feel good” are symptoms of preterm labor. In patients with symptoms and a positive fFN test, 44.7% will deliver before 37 weeks.9

The role of fetal fibronectin in predicting preterm birth

Fetal fibronectin is the single common biochemical marker for all 4 mechanisms of preterm birth.10 Fetal fibronectin can often be detected before the biophysical markers.11 

References

  1. Goldenberg RL, Iams JD, Mercer BM, et al. The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. Am J Public Health. 1998;88:233-238. 
  2. Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003;348:2379-2385.
  3. Iams JD, Goldenberg RL, Mercer BM, et al. The Preterm Prediction Study: recurrence risk of spontaneous preterm birth. Am J Obstet Gynecol. 1998;178:1035-1040
  4. Adams MM, Elam-Evans LD, Wilson HG, Gilbertz DA. Rates of and factors associated with recurrence of preterm delivery. JAMA. 2000;283:1591-1596.
  5. Mercer BM, Goldenberg RL, Moawad AH, et al. The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Am J Obstet Gynecol. 1999;181:1216-1221.
  6. Iams JD, Goldenberg RL, Meis PJ, et al. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med. 1996;334(9):567-572. 
  7. Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2004. Natl Vital Stat Rep. 2006;55(1):1-102.
  8. Singer E, Pilpel S, Bsat F, et al. Accuracy of fetal fibronectin to predict preterm birth in twin gestations with symptoms of labor. Obstet Gynecol. 2007;109(5):1083-1087.
  9. Peaceman AM, Andrews WW, Thorp JM, et al. Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol. 1997;177:13-18.
  10. Rapid fFN for the TLIIQ System [package insert]. AW-04196-002, Rev. 003. Marlborough, MA: Hologic, Inc.; 2015.
  11. Lockwood CJ, Kuczynski E. Risk stratification and pathological mechanisms in preterm delivery. Paediatr Perinat Epidemiol. 2001;15(suppl 2):78-89.

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