Cost-Effectiveness of Fetal Fibronectin Testing to Predict Preterm Birth in Pregnant Women with Symptoms of Premature Labour

Objective To evaluate the cost-effectiveness of fetal fibronectin (fFN) versus no-fFN testing to detect true preterm labor in qualifying women with preterm labor symptoms at risk for preterm birth. Design Retrospective cost-effectiveness analysis. Method Retrospective cost-effectiveness analysis of fFN versus no-fFN testing to detect preterm labor at Women's Wellness and Research Center (WWRC), Qatar, was conducted. Clinical data of pregnant women were obtained from Cerner medical records from 2017-2022, whereas cost data were obtained from the pharmacy as well as finance and costing departments of HMC. The model included direct medical costs; thus, the perspective of HMC was adopted. Included resources were (i) fFN testing use, (ii) medications use (i.e. tocolytic, steroid), (iii) diagnostics and laboratory tests received during hospitalization (iv) management of adverse drug events, and (v) hospital stay excluding other resource costs. A decision analytic model was constructed to follow possible consequences of fFN or no-fFN testing. Primary end points were the success rate in prolonging delivery, defined as delivery at 48 hours following receiving one cycle of atosiban and antenatal corticosteroids from initial presentation to the emergency department as well as overall direct medical cost of management. Study population of 200 pregnant women between 24-34 weeks of gestational age at risk for preterm birth was used. Sensitivity analysis was conducted to enhance robustness of conclusions against input uncertainties and to increase generalizability of results. Results Our preliminary data showed that hundred women were available for inclusion in each study group. The fFN group had 12% success rate in prolonging delivery at 48 hours following receiving one cycle of atosiban and antenatal corticosteroids compared to 5% with no-fFN group, [risk ratio (RR)= 0.93; 95% CI, 0.85 to 1.01; P = 0.08]. fFN testing was estimated to dominate the no-fFN testing group, at a cost saving of QAR 236,702 (US$64,850), with total healthcare costs of QAR 171,623 (US$ 47,020) versus QAR 408,325 (US$ 111,870), respectively. Sensitivity analysis confirmed robustness of conclusions. Conclusions To the best of our knowledge, this is the first cost-effectiveness evaluation in the literature that provides new insights into the benefits of fFN versus no-fFN testing to detect preterm labor in women between 24-34 weeks of gestational age with preterm labor symptoms at risk for preterm birth. The fFN testing might be associated with prolonging delivery at 48 hours at a considerably lower cost. The study findings support recent trends in favor of fFN use.</p

Maternal and Neonatal Outcomes Post Bariatric Surgery: A Population-Based Study

Objectives  This study had two primary objectives. First, to evaluate the incidence, risk factors, and maternal and neonatal outcomes among pregnant women post-BS (the exposed group). Second, to evaluate these outcomes among pregnant women without a history of BS, these include women who are obese, overweight, and with normal weight (non-exposed groups). Design This population-based study was conducted using 12-month retrospective registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar. Methods: We examined 6,212 parturient women and their offspring. Participants were classified into exposed (post-BS) (N=315) and non-exposed (N=5897). Statistical analysis was conducted using SPSS 28 software. We analyzed the risk factors and outcomes using univariate and multivariable regression. Results were reported as odds ratios (cOR) and adjusted aOR with 95% confidence intervals (CI), while incidences were reported as percentages. P value was regarded as significant at Results Qatari, advanced maternal age, Parity >1, diabetes, and hypertension were found to be significant risk factors for women with post-BS. In addition, women in the post-BS group were found to be significantly more likely to have a cesarean delivery (37.5% vs. 24%, aOR=1.59, CI 1.18-2.14), preterm babies (10% vs. 7%, aOR=1.66, CI 1.06-2.59), and stillbirth (1.6% vs. 0.4%, aOR=4.53, CI 1.33-15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than obese (15% vs. 8%, aOR= 1.77, CI 1.153-2.73), overweight (15% vs. 7%, aOR=1.63, CI:1.09-2.43), and normal weight (15% vs. 8%, aOR=1.838, CI 1.23-2.75) women. Finally, women in the post-BS group were more likely to have low-birth weight neonates ( In contrast, post-BS had a lower risk of gestational diabetes than obese (19% vs. 40%, aOR=0.39, CI: 0.29-0.54) overweight (19% vs. 32%, aOR= 0.57, CI 0.42-0.79) women. Similarly, compared to the overweight group, post-BS had a lower incidence and risk of assisted birth (4% vs. 9%, aOR=0.46, CI 0.21-0.99). On the other hand, obesity significantly increased the risk of gestational diabetes, cesarean deliveries, and labor induction in comparison to the other groups. Conclusion  Pregnancies with post-BS should be considered a high-risk group for some outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women. </p