Reading risk factors big and small to combat preterm birth

Laura Jelliffe-Pawlowski, PhD, on stage, talking at the Precision Medicine World Conference 2022

Laura Jelliffe-Pawlowski, PhD, a professor of epidemiology and global health sciences, researches risk factors for preterm birth, a leading cause of infant death and disability, and for preeclampsia, a complication of pregnancy that can result in preterm birth and low birth weight.

“One great frustration of mine is when we talk about preterm birth and adverse outcomes,  people say there’s nothing you can do about it, but if we keep saying that, we miss all the things we can do,” Jelliffe-Pawlowski said as she geared up to present at the Precision Medicine World Conference in Silicon Valley.

Jelliffe-Pawlowski and her colleagues at UCSF’s Preterm Birth Initiative have developed a healthy pregnancy blood test looking at growth factors and markers of inflammation. It pairs with a risk questionnaire on addressing hypertension, depression, anxiety, diabetes, low income status and exposure to racism to create a personalized risk profile.

For many risks, there are interventions that have been proven to help: cognitive-behavioral therapy to address anxiety and depression, tighter blood sugar control for diabetes, food vouchers from the Women, Infants and Children (WIC) program, use of a doula to help ensure that providers take their patients’ needs and preferences seriously. Daily low-dose aspirin can help those with hypertension during pregnancy have better outcomes.

The team’s argument at the precision medicine conference is that their personalized risk tool enables providers and patients to develop custom pregnancy care plans targeting specific risk factors, instead throwing a long list of do’s and don’ts at patients. The researchers point to evidence that many doctors avoid discussing maternal and infant risks with patients so as not to frighten them.

The team has also developed a blood test for babies born preterm, which measures metabolites to identify which are at highest risk of bad outcomes, including death, hyperbilirubinemia with kernicterus and necrotizing colitis.

“We think some of the signals may be telling us how the infants should be fed and which medicines they should and should not get,” Jelliffe-Pawlowski said. “Once we’ve identified the risk, we can find therapeutics.”

The test was developed in California and validated in Uganda; it is now being tested in a NIH funded multicenter study called PROMPT. It’s particularly important to test interventions addressing preterm birth in racially and ethnically diverse populations because outcomes Black families, in particular, face disproportionate risks.

The team hopes to make their healthy pregnancy tool and their blood tests widely available. They are commercializing them through a start-up called Egg HP.