# Implementation protocol for a treatment bundle targeting modifiable risk factors for preterm birth

## TL;DR

This study presents a low-cost protocol to reduce preterm birth by addressing smoking, vaginal imbalance, and cervical shortening in high-risk populations.

## Contribution

A feasible, low-cost treatment bundle targeting modifiable risk factors for preterm birth in high-prevalence settings.

## Key findings

- Addressing smoking, vaginal dysbiosis, and cervical shortening may reduce preterm birth risk.
- Integrating targeted interventions into prenatal care is feasible and potentially effective.
- The strategy offers a scalable approach to reduce preterm birth and health inequalities.

## Abstract

Preterm birth (PTB) is the main cause of perinatal and neonatal morbidity and mortality worldwide. Widespread implementation of guidelines for early identification and management of patients at risk for adverse pregnancy outcomes is still feeble. This work aims to implement a simple and low-cost bundle to access and manage major modifiable risk factors for PTB. We included first trimester pregnant women seen at Health Units from Jaú – SP, Brazil, where PTB prevalence ranges from 13,4% to 18%. The protocol is based on three aspects: a questionnaire to access smoking status and clinical history; Gram staining and of vaginal microbiota evaluation using Nugent’s criteria and evaluation of cervical infections; and transvaginal ultrasound. Pregnant women who smoke and are willing to quit will be treated with auricular acupuncture and referred to a support group if necessary. All patients will be advised on intimate hygiene habits, and those with dysbiosis will be treated. Cervical length will be accessed using transvaginal ultrasound, and those diagnosed with cervical shortening will be treated with vaginal progesterone. This study highlights the importance of implementing active measures to reduce PTB risk factors in a high prevalence setting.

Main findings: This protocol suggests that addressing smoking, vaginal microbial imbalance, and cervical shortening may contribute to reducing the risk of preterm birth in high-prevalence populations.Added knowledge: The study adds evidence that integrating targeted interventions for modifiable biological and behavioral factors into routine prenatal care is both feasible and potentially effective.Global health impact for policy and action: The proposed strategy offers a scalable and low-cost approach that may help reduce preterm birth rates and related inequalities in maternal and child health, particularly in underserved regions.

Main findings: This protocol suggests that addressing smoking, vaginal microbial imbalance, and cervical shortening may contribute to reducing the risk of preterm birth in high-prevalence populations.

Added knowledge: The study adds evidence that integrating targeted interventions for modifiable biological and behavioral factors into routine prenatal care is both feasible and potentially effective.

Global health impact for policy and action: The proposed strategy offers a scalable and low-cost approach that may help reduce preterm birth rates and related inequalities in maternal and child health, particularly in underserved regions.