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Neonatal Outcomes after Maternal Biomarker-Guided Preterm Birth Intervention: The AVERT PRETERM Trial
Matthew K Hoffman1, Carrie Kitto1, Zugui Zhang1
1Department of Obstetrics and Gynecology, ChristianaCare, Newark, DE 19718, USA.
Diagnostics (Basel, Switzerland)
|July 27, 2024
Summary
Screening pregnancies with a maternal blood biomarker test for spontaneous preterm birth (sPTB) risk and offering preventive treatments reduced neonatal morbidity and hospital length of stay in the AVERT PRETERM trial.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Spontaneous preterm birth (sPTB) remains a leading cause of neonatal morbidity and mortality.
- Current screening methods for sPTB in low-risk pregnancies are limited.
- Early identification and intervention are crucial for improving neonatal outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a maternal blood biomarker test for sPTB risk in clinically low-risk pregnancies.
- To assess if preventive treatments for screen-positive individuals improve neonatal outcomes compared to historical controls.
- To determine the impact on neonatal morbidity and mortality, and hospital length of stay.
Main Methods:
- The AVERT PRETERM trial prospectively screened singleton, non-anomalous pregnancies without a history of PTB using a validated maternal blood biomarker test.
- Screen-positive individuals (≥16% sPTB risk) were offered vaginal progesterone and aspirin, with regular nurse follow-up.
- Outcomes were compared to a clinically low-risk historical control group using survival analysis and logistic regression.
Main Results:
- A significant reduction in the neonatal morbidity index (NMI) was observed in neonates whose mothers accepted treatment (OR 0.81, p=0.03), indicating an 18% decrease in severe morbidity.
- Neonatal hospital length of stay (NNLOS) was significantly shorter for neonates in the prospective arm (HR 0.73, p=0.01), with a 21% mean decrease in the longest stays.
- Sensitivity analyses supported the primary findings across the entire intent-to-treat population.
Conclusions:
- Maternal blood biomarker risk stratification for sPTB is effective in identifying high-risk pregnancies within a historically low-risk cohort.
- Preventive interventions, including progesterone and aspirin, significantly improve neonatal outcomes and reduce healthcare resource utilization.
- This approach offers a promising strategy to ameliorate complications associated with preterm birth in singleton pregnancies.
