Study explores the limits of neighborhood data in predicting preterm birth

Contemporary OB/GYN:

Hi, I'm Celeste Cruz with Contemporary OB/GYN, and I'm here with Dr. Kuhr to discuss how neighborhood level indices may impact spontaneous preterm birth risk. Do you want to introduce yourself?

Daniel L. Kuhr, MD:

Hi, yeah, thank you for having me. My name is Dan Kuhr. I am a third-year fellow in maternal fetal medicine at the Icahn School of Medicine at Mount Sinai in New York City.

Contemporary OB/GYN:

So, to get started, can you go over the limits of using cervical length to predict spontaneous preterm birth?

Kuhr:

Yeah, you know, we have a complicated relationship with cervical length in obstetrics, because, on one hand, it is one of the best tools we have to predict spontaneous preterm birth, and at the same time, when you actually plot it out at predicting who's going to deliver before 37 weeks, it doesn't actually give us a lot of predictive value. And so, there's a need for more tools that can maybe increase our ability to accurately make that prediction.

Contemporary OB/GYN:

And with this in mind, what did your study find about the impact of neighborhood level indices on determining spontaneous preterm birth risk?

Kuhr:

Yeah, you know, we examined the index of concentration at the extremes, which is a measure of segregation, and the childhood opportunity index, which reflects the neighborhood resources. And we found that even if you include those in models, they don't increase the ability to predict preterm birth over cervical length alone, and so we only found an increase in prediction when we included individual patient characteristics.

Contemporary OB/GYN:

And so, what further research is necessary to build on this data?

Kuhr:

Well, these are only 2 indices, and so there are definitely other social determinants of health that can be explored through other neighborhood indices, and I think we need more solutions and maybe even bigger population level data. Our study only included 1000 patients with a total of 1038 pregnancies, and so it could be that we're not seeing an effect because we need an even bigger population to study.

Contemporary OB/GYN:

And what advice do you have for clinicians that are attempting to determine spontaneous preterm birth risk in their patients?

Kuhr:

The best thing that you can do is take a really good history when you meet a patient at the beginning of pregnancy, and really make sure you can get accurate gestational ages of delivery when possible, because we do know that history of a prior spontaneous preterm birth is also a risk factor, and so that and referring patients to MFMs or your local Sono unit for cervical surveillance when appropriate, can really help risk stratify those patients and those who need interventions can get them in a timely manner.