PREGNANCY.
EMPOWERED.

RISK AND
PROTECTIVE FACTORS
FOR PRETERM BIRTH INCLUDED IN THE HPQ

The HELLO EGG Healthy Pregnancy Questionnaire (HPQ) is a simple survey that pregnant individuals can take for free by signing up with HELLO EGG. It consists of 40 questions that can help determine if someone is at risk for giving birth prematurely or having another pregnancy complication.

The HPQ looks at various factors that have been linked to preterm birth, as well as other pregnancy-related issues like preeclampsia and intrauterine growth restriction. However, there are many other factors that can also contribute to preterm birth that are not included in the HPQ.

It's important to work with a healthcare provider to understand your risk for preterm birth and other pregnancy complications. Everyone is at some risk for preterm birth, so it's important to be aware of the signs of premature labor and other warning signs that require urgent medical attention.

The HPQ considers different risk and protective factors such as race/ethnicity and insurance status. These factors can affect a person's risk for preterm birth due to social determinants of health like poverty and racism.

Completing the HPQ can provide a personalized risk assessment based on these factors. The factors considered in the HPQ are divided into protective factors and risk factors. It's important to note that the accuracy of the HPQ's prediction is based on data available at a single point in time and can be improved with additional clinical and testing data.

What is the HPQ?

A Note About "Social Determinants of Health (SDoH)" and "Mother/Mommy Blaming"

Social determinants of health (SDoH) refer to the conditions in the environment where people are born, live, learn, work, play, worship, and age that can affect their health and wellbeing. These factors can impact various aspects of life, including pregnancy outcomes.

The US Healthy People 2030 initiative lists several social determinants of health, such as safe housing, transportation, neighborhoods, racism, discrimination, violence, education, job opportunities, income, access to nutritious food and physical activity, polluted air and water, language, and literacy skills.

HELLO EGG and the HPQ aim to promote pregnancy health by acknowledging the role of social factors. Failure to recognize these factors may lead to blaming mothers for outcomes during pregnancy and afterward. Also, social factors can influence decisions regarding the sharing of personal health information.

HELLO EGG and the HPQ strive to provide open access to pregnancy health information, considering social factors that cause patterns of risk and protection. The goal is to support systemic change in caregiving without judgment or hierarchy. Discrimination, racism, poverty, and access to quality healthcare intersect and underpin the importance of presenting results by race/ethnicity and insurance grouping.

The HPQ includes several social determinants of health that impact pregnancy outcomes. Our team continues to conduct research in partnership with pregnant people, researchers, clinicians, and public health professionals to understand the role of SDoH in pregnancy outcomes more deeply.

You can find help and resources related to social determinants of health and other factors included (and not included) in the HPQ HERE.

Protective Factors Included in the HPQ

The HPQ has a list of things that can help reduce the chances of having a premature birth. These things have been studied in different parts of the United States and other places and have been found to be helpful.

The list includes factors that are considered protective in one or more groups. Sometimes a factor may increase the risk for preterm birth in one group, but also protect against it in another group. We've listed the factors under protection or risk based on what's most common and well-known. However, we also discuss the exceptions that we've observed.

Factors considered as mostly protective factor for preterm birth in one or more groups in the HPQ include:

previous pregnancy
more than 12 years of education
mother born outside of the United States
receiving supplemental nutritional services through the Women, Infants, and Children (WIC) supplemental nutrition program
public insurance for prenatal care (in those with public insurance for delivery)

Members in HELLO EGG are able to create a Healthy Pregnancy Plan that addresses protective factors (along with risk factors) for preterm birth and other pregnancy-related complications. Access to the Healthy Pregnancy Planning tool is also free with HELLO EGG sign up.

Click here to learn more about the protective factors included in the HPQ.

Risk Factors Included in the HPQ

The HPQ looks at factors that can increase the risk of having a baby too early or having other pregnancy problems.

We include factors where treatment and care can help decrease the risk or improve health during and after pregnancy as well as factors that may help you better understand your risk but where there are no clear intervention.

Not all known risk factors for preterm birth or other pregnancy complication are included in the HPQ, so it's important to talk with your doctor about your own pregnancy and create a personalized care plan.

The HPQ shows results based on race/ethnicity and insurance type because these factors are connected to patterns of risk and protection. It's important to acknowledge that factors like racism, discrimination, and other social injustices and inequalities contribute to higher rates of preterm birth and other pregnancy problems in marginalized groups.

We highly recommend that users of HELLO EGG and visitors to EGG HP seek out additional help and resources that may be of help to you in your pregnancy journey. Some resources can found on our site here. Other key resources for Black and Brown pregnant people and new mothers include, for example:

HPQ risk factors for preterm birth are divided into topic grouping which align with how the HPQ is organized. Risk factors observed in one or more race/ethnicity by insurance groups include:

Pregnancy History

previous preterm birth
short or long time since last pregnancy (less than 18-months or 5 or more years)
previous cesarean section

Demographic Factors

expected age at delivery less than 18-years of age
expected age at delivery more than 34-years of age
less than 12 years of education

Current Health and Diagnoses:

Weight, Diabetes, and Hypertension

high body mass index
low body mass index
diabetes (diagnosed before or during pregnancy)

hypertension (diagnosed before or during pregnancy)

Other Conditions and Infection

sickle cell anemia
anemia (non-sickle cell)
asthma
dislipidemia (abnormally high or low cholesterol, low density lipoproteins (LDLs), high density lipoproteins (HDLs), triglycerides)
autoimmune disorder (for example, rheumatoid arthritis, psoriasis/psoriatic arthritis, multiple sclerosis, systemic lupus erythematosus, other)
malignancy/ cancer
infection during pregnancy (COVID-19 or another infection like the flu, a urinary tract infection, or a sexually transmitted infection)

Mental Wellness and Care

mental health condition (e.g. anxiety, depression)
insomnia or sleep condition
3 or fewer prenatal visits by the time of delivery

Exposures

smoking, vaping, or ingesting nicotine or cannabis
other drug or alcohol use

Members in HELLO EGG are able to create a Healthy Pregnancy Plan that addresses risk and protective factors for preterm birth and other pregnancy-related complications. Access to the Healthy Pregnancy Planning tool is also free with HELLO EGG sign up.

Click here to learn more about the risk factors included in the HPQ