{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:54:16Z","timestamp":1791863656605,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2022,8]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>Preterm birth (PTB<\/jats:styled-content>) is a major public health problem worldwide. It can occur spontaneously or be medically indicated for obstetric complications, such as pre\u2010eclampsia (PE<\/jats:styled-content>) or fetal growth restriction. The main objective of this study was to investigate whether there is a shared uteroplacental etiology in the first trimester of pregnancy across PTB<\/jats:styled-content> subtypes.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a retrospective cohort study of singleton pregnancies that underwent screening for preterm PE<\/jats:styled-content> as part of their routine first\u2010trimester ultrasound assessment at a tertiary center in London, UK<\/jats:styled-content>, between March 2018 and December 2020. Screening for preterm PE<\/jats:styled-content> was performed using the Fetal Medicine Foundation algorithm, which includes maternal factors, mean arterial pressure (MAP<\/jats:styled-content>), uterine artery pulsatility index (UtA\u2010PI<\/jats:styled-content>) and pregnancy\u2010associated plasma protein\u2010A<\/jats:styled-content> (PAPP\u2010A<\/jats:styled-content>). Women with a risk of \u2265\u20091 in 50 for preterm PE<\/jats:styled-content> were classified as high risk and offered prophylactic aspirin (150\u2009mg once a day) and serial ultrasound assessments. The following delivery outcomes were evaluated: PTB<\/jats:styled-content>\u2009<\u200937\u2009weeks, iatrogenic PTB<\/jats:styled-content> (iPTB<\/jats:styled-content>) and spontaneous PTB<\/jats:styled-content> (sPTB<\/jats:styled-content>). Logistic regression analyses were performed to assess the association of PTB<\/jats:styled-content>, iPTB<\/jats:styled-content> and sPTB<\/jats:styled-content> with an increased risk of preterm PE<\/jats:styled-content>. A model for prediction of PTB<\/jats:styled-content>\u2009<\u200937\u2009weeks and <\u200933\u2009weeks was developed and its performance was compared with that of an existing model in the literature.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 11\u2009437 women were included in the study, of whom 475 (4.2%) had PTB. Of these, 308 (64.8%) were sPTB<\/jats:styled-content> and 167 (35.2%) were iPTB<\/jats:styled-content>. Patients with PTB<\/jats:styled-content> had a higher body mass index, were more likely to be of black or Asian ethnicity, be smokers, have pregestational hypertension or diabetes, or have a history of previous PTB<\/jats:styled-content>. They also had higher MAP<\/jats:styled-content> (87.7 vs<\/jats:italic> 86.0\u2009mmHg<\/jats:styled-content>, P<\/jats:italic>\u2009<\u20090.0001), higher UtA\u2010PI<\/jats:styled-content> multiples of the median (MoM<\/jats:styled-content>) (0.99 vs<\/jats:italic> 0.92, P<\/jats:italic>\u2009<\u20090.0001) and lower PAPP\u2010A MoM<\/jats:styled-content> (0.89 vs<\/jats:italic> 1.08, P<\/jats:italic>\u2009<\u20090.0001) compared to women with a term birth. In women at high risk of PE<\/jats:styled-content>, the odds ratio for iPTB<\/jats:styled-content> was 6.0 (95%\u2009CI<\/jats:styled-content>, 4.29\u20138.43; P<\/jats:italic>\u2009<\u20090.0001) and that for sPTB<\/jats:styled-content> was 2.0 (95%\u2009CI<\/jats:styled-content>, 1.46\u20132.86; P<\/jats:italic>\u2009<\u20090.0001). A prediction model for PTB<\/jats:styled-content>\u2009<\u200937\u2009weeks and <\u200933\u2009weeks, developed based on this cohort, included previous PTB<\/jats:styled-content>, black ethnicity, chronic hypertension, diabetes mellitus, PAPP\u2010A MoM<\/jats:styled-content> and UtA\u2010PI MoM<\/jats:styled-content>. The performance of the model was similar to that of an existing first\u2010trimester prediction model for PTB<\/jats:styled-content>\u2009<\u200933\u2009weeks (area under the curve, 0.704 (95%\u2009CI<\/jats:styled-content>, 0.653\u20130.754) vs<\/jats:italic> 0.694 (95%\u2009CI<\/jats:styled-content>, 0.643\u20130.746)).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Increased first\u2010trimester risk for uteroplacental dysfunction was associated with both iPTB<\/jats:styled-content> and sPTB<\/jats:styled-content>, implying a shared etiological pathway. The same factors used to predict PE<\/jats:styled-content> risk show acceptable discrimination to predict PTB<\/jats:styled-content> at <\u200933\u2009weeks. Women at high risk of uteroplacental dysfunction may warrant additional monitoring and management for an increased risk of sPTB<\/jats:styled-content>. \u00a9 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24915","type":"journal-article","created":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T09:09:26Z","timestamp":1650445766000},"page":"185-191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Routine first\u2010trimester pre\u2010eclampsia screening and risk of preterm birth"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3991-9308","authenticated-orcid":false,"given":"V.","family":"Giorgione","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London London 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