New Approach May Help Prevent Preterm Births


New research findings may soon help doctors personalize preterm birth prevention treatments by identifying which women at higher risk for preterm birth will be helped by progesterone injections. Injections of one type of progesterone, a synthetic form of a hormone that’s naturally produced during pregnancy, have been shown to reduce the risk of recurrent preterm birth by about a third.

Nearly half a million babies are born too soon each year in the United States. Preterm birth, or birth before 37 weeks of pregnancy, is the leading cause of newborn death, and babies who survive an early birth often face an increased risk of a lifetime of health challenges, such as breathing problems, cerebral palsy, intellectual disabilities, and more. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants. Preterm birth is a serious health problem that costs the United States more than $26 billion annually.

Tracy Manuck, MD, Assistant Professor of Maternal Fetal Medicine and Co-Director of the University of Utah Prematurity Prevention Clinic at University of Utah Health Care, is the chief investigator of the study, and physicians from the Intermountain Medical Center fetal medicine program played a key role in the research. Dr. Manuck worked with a team of collaborative investigators from the University of Utah and Intermountain Healthcare’s Maternal Fetal Medicine Department including Marc Jackson, MD, Sean Esplin, MD, and Michael Varner, MD, to understand why progesterone treatments prevent preterm birth for some women but not for others.

The goal: Determine whether women will or won’t be helped by progesterone — then fast-track her to the best treatment. 
The team hopes to determine whether there’s a way to personalize the treatment of women who are at risk for preterm birth based on their genetic makeup. Their latest findings were presented at the Society for Maternal-Fetal Medicine’s 34th annual meeting, which was held last week in New Orleans.

“This is the first step in using pharmacogenomics to prevent preterm birth,” says Edward McCabe, MD, of the March of Dimes. “There’s a group of women in whom progesterone will be effective and others for whom it won’t be and who will need different treatments. Knowing which group a woman belongs to would fast-track her to the proper treatment. The goal is to find personalized treatments that work for individuals to prevent preterm birth.”

Dr. McCabe presented the Utah research team with the prestigious March of Dimes award for Best Abstract in Prematurity last week at the Society for Maternal-Fetal Medicine’s meeting. This is the second time in five years the collaborative team has won the award. Dr. Manuck was the principal investigator on both studies. 2014 is the 11th year the March of Dimes award has been presented.

How the researchers conducted the study. 
Dr. Manuck and her colleagues at Intermountain looked at 50 women who were followed in a prematurity prevention clinic headed by Dr. Esplin at Intermountain Medical Center. All of the women received progesterone treatment, but some delivered prematurely despite treatment. The team then sequenced all of the areas of the women’s genomes that code for proteins and general biologic pathways that are involved in progesterone metabolism. They found that several genes and mutations were more likely to be expressed in women who didn’t respond to progesterone.

“There are a lot of reasons women have preterm babies, and there’s not going to be a single fix that cures the problem for everyone,” says Dr. Jackson. “But this research is important because it can help identify women who would benefit from treatment with progesterone, lowering their risk for preterm birth. And it may be especially important in some families who have multiple women — sisters, aunts, and cousins — who have premature babies, as they can share a genetic predisposition for preterm birth.”

Intermountain is supporting preterm delivery prevention in several ways. 
The research received financial support from the Intermountain Research and Medical Foundation, as part of a grant to fund Dr. Jackson’s project titled “IGAP: Identification of Genes Associated with Prematurity.” The study is part of an ongoing clinical effort to reduce preterm births in Utah, which includes the Prematurity Prevention Clinic in Maternal-Fetal Medicine at Intermountain Medical Center that’s staffed by Dr. Esplin.

The clinic, which focuses on the pregnancy care of women who have already had one preterm baby, has shown that specialized care can lower rates of recurrent preterm birth and NICU admissions. Results from studies conducted in the clinic have already been published in the American Journal of Obstetrics and Gynecology authored by Drs. Manuck, Esplin, Jackson, and others.