Every year approximately 15 million babies are born preterm around the world. This accounts for more than 1 in 10 births globally. In the United States, about 1 out of every 10 infants is born preterm. Preterm birth is the leading cause of neonatal mortality and can have lifelong health consequences for babies who survive. Scientists have been working hard to better understand what causes preterm birth so that effective prevention strategies can be developed. One area of promising research is the use of proteomic testing to detect biomarkers in cervicovaginal fluids that may help identify women at high risk for preterm birth.

What is Preterm Birth?
Preterm birth is defined as babies born alive before 37 weeks of pregnancy have been completed. Pregnancy normally lasts around 40 weeks and preterm birth can occur either naturally or may be medically indicated if the mother or baby's health is at risk. Babies born very preterm, before 32 weeks of gestation, are at highest risk of short and long-term complications. Some of the most common complications of preterm birth include breathing problems, feeding difficulties, heart problems, vision and hearing impairment, cerebral palsy, and developmental delays. Long term follow up shows that preterm birth survivors are also at increased risk for obesity, high blood pressure, heart disease and other chronic health issues later in life.

Causes and Risk Factors for Preterm Birth
While the specific causes of Preterm Birth and Prom Testing remain unclear in many cases, there are certain risk factors that are known to increase the chances. Risk factors that are not modifiable include a history of previous preterm birth, short interval between pregnancies, multiple gestation (twins, triplets etc.), infections, and autoimmune disorders. Modifiable risk factors include maternal age under 17 or over 35, substance use during pregnancy, poor nutrition, too much or too little weight gain during pregnancy and excess physical or work strain, especially during the third trimester. Certain lifestyles and behaviors can also elevate risk including smoking, inadequate prenatal care, advanced maternal age, stress and physical/sexual abuse.

Promising Biomarkers for Prevention
Given the risk factors, doctors can identify women at higher risk. However, it is still difficult to accurately predict who will go into spontaneous preterm labor. One promising area of research are proteomic tests that analyze cervicovaginal fluids for distinctive biomarkers of impending preterm birth. These fluid biomarkers can detect molecular changes in the cervix and lower reproductive tract that indicate infection or inflammatory processes leading to early cervical remodeling and prematurity.

Studies show that analysis of multiple biomarkers together using proteomic techniques can more accurately predict who will deliver preterm within 1-2 weeks compared to using clinical risk factors alone. The fetal fibronectin test, which measures a glycoprotein in cervicovaginal fluids, is already used routinely but has limitations as an isolated test. Combining multiple biomarkers into a proteomic fingerprint appears more predictive. One study found that a 10 biomarker proteomic test identified 92% of spontaneous preterm deliveries within 2 weeks in a high risk population, while clinical factors alone only predicted 63%. This indicates huge potential for improved preterm birth forecasting.

Prom Testing Helping to Develop Prevention Strategies
If proteomic tests can greatly enhance prediction of imminent preterm delivery, it opens the door to targeted prevention strategies. Women identified at very high risk could be candidates for progesterone supplementation or cervical cerclage placement. Progesterone therapy is an established approach shown to delay delivery and reduce preterm birth rates in some high risk groups. Cervical cerclage surgery involves placing stitches around the cervix to prevent early dilation, but needs to be timely to be effective. For those predicted to deliver within the next 1-2 weeks, aggressive monitoring and transfer to specialist centers could optimize neonatal outcomes through interventions like corticosteroid adminstration to accelerate fetal lung maturity. Prom testing promises to move beyond risk factor identification towards individually tailored preterm birth prevention planning.

Current Barriers and Future Research
While the concept of proteomic testing for preterm birth holds great potential, there are still barriers to widespread clinical adoption. Further validation studies involving larger diverse populations are still needed. Long term clinical outcomes also need to be demonstrated for women managed based on prom test results. At present, the proteomic tests are done via laboratory analysis and not practical for point-of-care use in most clinical settings. Simplified testing platforms that can provide rapid results are under development. Dissemination and education efforts will help integrate prom testing into standard obstetric practice once clinical utility is firmly established. More research also aims to deepen understanding of the underlying molecular pathways driving preterm birth related biomarkers. Despite current limitations, prom testing shows enormous promise for revolutionizing preterm birth risk assessment and prevention planning in the years ahead.

Preterm birth continues to be a pressing global health issue due to associated neonatal and long term health complications. Identification of high-risk individuals through objective biomarkers holds great potential for targeted prevention strategies. Promising proteomic tests analyzing cervicovaginal fluid show enhanced predictive ability over existing clinical risk factor models alone. Widespread adoption of prom testing into standard prenatal care promises to reduce preterm birth rates through individually tailored monitoring and intervention. With further research and validation, proteomic testing may transform preterm birth prevention.

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