A large U.S. study published recently in Pregnancy concluded that early blood testing paired with added prenatal support can help prevent earliest preterm births and improve newborn health, as prematurity can worsen bleeding and recovery risks.
Infants can be at risk of early delivery and internal bleeding due to several different diseases or pregnancy complications, including fetal and neonatal alloimmune thrombocytopenia (FNAIT). While FNAIT is caused by maternal antibodies that lower a baby’s platelets, being born prematurely often adds complications that lengthen hospital stays and increase the need for intensive care.
These results come from the PRIME randomized controlled trial of 5,018 pregnant women. In the study, a mid-pregnancy blood test called PreTRM identified women at higher risk for spontaneous preterm birth. Those women received daily vaginal progesterone, low-dose aspirin and weekly nurse support, while others received usual care. The results showed 56% fewer births before 32 weeks and 32% fewer births before 35 weeks, ages when babies face the greatest danger.
“[T]he PRIME trial demonstrates that mid-second-trimester blood IGFBP4/SHBG screening followed by a targeted intervention bundle significantly reduces neonatal morbidity and neonatal hospital length of stay compared with routine care and is associated with important reductions in early preterm birth,” explained the study’s authors.
Read more about testing and diagnosis for FNAIT
Newborn outcomes also improved. Babies in the screening-guided care group had 20% lower odds of serious health problems and 20% fewer admissions to the neonatal intensive care unit, or NICU. Overall hospital stays were shorter, saving about 545 NICU days. For families dealing with FNAIT, fewer NICU admissions can mean faster access to specialized monitoring for bleeding and earlier bonding at home.
The PreTRM test measures two proteins in a mother’s blood, the IGFBP4 to SHBG ratio, between weeks 18 and 20 of pregnancy. Even though most participants were considered low risk and had no prior preterm birth, guided care reduced neonatal illness with an odds ratio of 0.80 and shortened hospital stays with an incidence rate ratio of 0.95.
Importantly, the trial excluded women already known to be at high risk, showing the test can find hidden risk. About one in four women tested were flagged as higher risk. Among those who accepted treatment, no infants were born before 32 weeks in a modified analysis. Side effects were mostly mild and related to progesterone.
An accompanying company announcement highlighted what this could mean in practice: about 39 women would need to be screened to prevent one NICU admission and about four women need to be screened with PreTRM and treated to prevent one NICU day. For patients, including those navigating FNAIT, earlier risk detection may translate into fewer emergencies, shorter hospitalizations and better starts for newborns.
“The PreTRM Test represents a meaningful step forward in how we identify and manage risk for preterm birth,” said Dr. Brian Iriye, principal investigator for the PRIME study, in the company announcement.
Sign up here to get the latest news, perspectives, and information about FNAIT sent directly to your inbox. Registration is free and only takes a minute.
