Researchers at NYU and partners in the International Healthy Outcomes of Pregnancy for Everyone (HOPE) Consortium have developed a new tool, the Preterm Birth Actionable Risk Index (PTB-ARIx), to identify pregnant women at high risk for preterm birth (delivery before 37 weeks). T
he tool focuses on risk factors with established treatments, such as low-dose aspirin for preventing preeclampsia, aiming to link risk assessment directly to medical interventions to prevent preterm birth.
The PTB-ARIx was created using data from 1.9 million singleton births in California (2016-2020). It evaluates 18 clinical, behavioral, and social risk factors present in the first and second trimesters that can be mitigated by evidence-based treatments. The index produces a risk score from 0 to 3+, with a higher score indicating higher risk of early preterm birth and related adverse outcomes such as low birth weight.
Key findings include:
- The tool strongly predicts very early preterm birth (before 32 weeks) and is highly accurate when combined with preeclampsia diagnosis.
- Individuals with a PTB-ARIx score of 3 or higher had over 70% incidence of preterm birth or serious complications.
- Preeclampsia risk factors increased preterm birth risk by 6.7 times.
- Regular prenatal care helped reduce risk among high scorers.
The tool performed consistently across racial, ethnic, and insurance groups, addressing health inequities in preterm birth risk assessment.
Preterm birth rates have risen in the US from 8% to 8.7% for singleton births between 2016 and 2023. This trend coincides with increasing maternal risk factors like hypertension, diabetes, asthma, infections, and mental health conditions. Many effective interventions remain underused, especially in underserved populations, contributing to persistent health disparities.
The PTB-ARIx aims to close the “know-do” gap by facilitating actionable risk identification early in pregnancy. Ongoing work includes integrating the index with treatment data, developing complementary blood tests to assess immune signals of risk, and creating digital platforms to support providers and patients in proactive prenatal care.
This new tool offers promise for improving maternal and neonatal health by moving from reactive to preventive strategies in managing preterm birth risk.
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