Ohio State researcher Jay Iams led the multi-center effort, which found that few screening tools appear to be helpful in predicting whether women will experience preterm births. Grants from the National Institutes of Health funded the study.     By Jo McCulty

Nationwide study shows no benefit to home uterine monitoring

A new study suggests that home uterine activity monitors, long used by women who are at high risk for preterm birth, have no value in actually predicting early delivery.

The study, led by researchers at the Ohio State Medical Center with grants from the National Institutes of Health, also found that other screening tools for preterm birth may not be as effective as originally believed.

The study and an accompanying editorial, published in the Jan. 24 issue of The New England Journal of Medicine, reinforces the results of earlier clinical studies that found ambulatory monitors were no better at detecting premature birth than were many other diagnostic tools or surveillance programs.

In the multicenter study led by Jay Iams, director of OSU Medical Center's Division of Maternal-Fetal Medicine, researchers found that while uterine contraction frequency is significantly related to preterm birth, the measurement of such data is not clinically useful in predicting early birth.

"Technically, uterine monitoring sounds like a concept that should have merit, but studies aren't supportive," said Iams, who notes that home monitoring has been around since the mid-1980s and has been the subject of considerable debate.

When introduced to the market, home monitors were heralded as an early warning system to help get women believed to be in early labor to hospitals where they could be given medications to stop the contractions and allow the pregnancy to continue normally. As it was then, premature delivery is a leading cause of disability and death in newborns.

Despite studies casting doubt on their effectiveness, many doctors continue to prescribe the monitors for high-risk women. Patients wear the monitors daily to detect uterine contractions, often a sign of early labor. The device relays information via phone line to nurses at a central monitoring office who contact the patient's physician if there is a problem. Used daily for up to 10 weeks during a pregnancy, the devices can cost as much as $100 per day.

The NIH study involved 306 women with and without risk factors for preterm birth who were monitored from 24 to 36 weeks gestation.

During the course of the study, uterine activity was recorded from the portable monitors for at least two hours each day. Participants also received periodic monitoring for preterm birth using digital and transvaginal ultrasound assessment of the cervix and collection of fetal fibronectin, a protein that has been shown to predict preterm delivery.

None of the tests demonstrated superiority over the others for predicting preterm delivery, nor did any have good sensitivity or provide a positive predictive value.

"We found relatively small differences in contraction frequency between women who subsequently delivered a preterm infant and those who gave birth at term," said Iams.

Transvaginal ultrasound was the most sensitive and consistent predictor of preterm birth before 35 weeks. However, this test had a positive predictive value below 40 percent, even in women with increased risk for preterm delivery.

Iams said the results of this and previous studies indicate more work lies ahead to find accurate methods to detect uterine contractions.

In a 1998 study, doctors from Kaiser Permanente Medical Center in Santa Clara, Calif., compared daily monitoring with weekly phone contact with nurses. The study showed that neither the monitoring nor the daily calls were better than weekly calls in preventing preterm birth.

The most recent study was conducted at 11 sites in the United States as part of the National Institute of Child Health and Human Development (NICHD) Network of Maternal-Fetal Medicine Units.

Preterm birth complicates from 8 percent to 10 percent of all births, said Catherine Spong, chief of the NICHD's Pregnancy and Perinatology Branch and coordinator of the study network.

Premature infants are at a greater risk for life-threatening infections, respiratory distress and serious damage to the intestines. Most deaths of premature infants occur before the 32nd week of pregnancy.

In addition, the cost of caring for premature infants in the United States exceeds $4 billion each year.

Drug-free therapy relieves patients with panic disorder

A recent study showed that four out of five patients suffering from panic disorder remained symptom-free six months after they stopped taking medication to treat the often-debilitating illness. The secret may lie in cognitive behavior therapy (CBT) -- a psychological-based treatment the subjects received after halting their prescribed medication. CBT helps patients understand the nature of panic disorder and also helps them change reactions to anxiety-provoking situations.

Researchers evaluated patients with panic disorder immediately after a 12-week course of CBT treatment and again six months later. One group of patients stopped taking antidepressants during the therapy, while the other group continued with their prescribed medication. "Most of the patients who stopped taking their medications while undergoing CBT experienced no immediate or long-term problems," said Brad Schmidt, a study co-author and an associate professor of psychology.

Panic disorder -- an unexplained sudden and intense onset of fear and anxiety -- affects 6 million to 14 million adults in the United States. About half of the patients with panic disorder that come to Schmidt's clinic are on medication. But antidepressants have a slew of side effects, ranging from sexual problems to cardiovascular complications.

www.osu.edu/researchnews/archive/cbt.htm