UNDERSTANDING RISK FOR PRETERM BIRTH USING THE FIRST TRIMESTER HEALTHY PREGNANCY QUESTIONNAIRE (HPQ)

If you're pregnant and want to know your chances of having a baby early (also called "preterm birth", which is birth before 37 completed weeks of pregnancy), you might be able to use a special quiz called the Health Pregnancy Questionnaire (HPQ) during your first three months of pregnancy to better understand your risk.
The HPQ is delivered by our smart bot Olivia and is discussion based. This format allows users to decide what information they do and do not want and allows them to guide the discussion as they see fit.
The HPQ gives you a score that shows your chances of having a baby early. It also provides information about the chances that either you or your baby will have other problems related to factors like how the placenta is functioning, baby growth, and baby illness during pregnancy or afterwards.
The HPQ also tells you about your specific risk factors and ways that you may be able to lower your risk.
- You can read more about the specific risk factors measured and about related interventions on our website HERE.
- Given that all expectant mothers are at some risk for preterm birth, it maybe helpful for you to review symptoms related to premature labor HERE.
- Aspirin therapy may be helpful for reducing the risk of preterm birth, preeclampsia, and for some other conditions in certain groups of expectant mothers. You can read more about aspirin HERE.
- You can find resources for addressing your risk and finding other resources on our Help and Resources page.
- The HPQ is designed to provide transparent, evidence-driven information about pregnancy health and risk information. In all instances, we recognize that social factors strongly affect patterns of risk and protection. The goal is to support information sharing and systemic change in caregiving without judgment or hierarchy. Please read more here about structural determinants of health and about our commitment to combat and work against mommy-blaming in the context of risk and information sharing.

It's really important to be working with a doctor or health provider who knows about pregnancy. This person can help you understand your risks better and help you make a health plan for your pregnancy. This can help you have your healthiest pregnancy possible.

The HPQ is based on the work of researchers in California and Iowa who identified a set first trimester risk factors that are able to reliably determine a person's risk for preterm birth and other specific pregnancy and newborn outcomes. They did this using a sample of more than 2 million births in California and more than 10,000 pregnancies in Iowa. You can find more details about this research in the European Journal of Obstetrics and Gynecology (you can review California results HERE and Iowa results HERE).

Below we present the expected rates of preterm birth, of other adverse pregnancy outcomes (described below), and of term birth (birth at or after 37 weeks) that we expect to see in expectant mothers completing the first trimester HPQ based on first trimester risk score.
- For the purposes of this tool, other adverse pregnancy or infant outcomes include having any of the following: Preeclampsia, placenta previa, placental abruption or antepartum hemorrhage, death before hospital discharge, small for gestational age, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, or retinopathy of prematurity.

As noted in the Figure below (based the California risk scoring data), the observed rates of preterm birth, of other adverse outcomes, and of term birth that we expect to see in those completing the first trimester HPQ by risk score are:

for expectant mothers with a first trimester risk score = 0.0:
- preterm birth = 3.1%
- other adverse outcomes - 6.0%
- term birth without adverse outcome = 90.9%
- while the risk for preterm birth in this group is below the average rate of about 10.4% observed across the United States, it is important for expectant mothers with scores in this range to know that there are other factors that may be further affecting this risk that are not measured by the HPQ (for example, infection, illness, placental function). Also, this risk can change over the course of pregnancy. It is important for expectant mothers with scores in this range to be under the care of a health provider who will be able to partner with you and help you have your healthiest pregnancy possible;

for an expectant mothers with a first trimester risk score that is from 0.001 and 0.999:
- preterm birth = 6.0%
- other adverse outcomes - 10.5%
- term birth without adverse outcome = 83.5%
- while the risk for preterm birth in this group is below the average rate of about 10.4% observed across the United States, expectant mothers with scores in this range have one or more factors present that are increasing their risk for preterm birth. It is also important to know that there are other factors that may be further affecting this risk that are not measured by the HPQ (for example, infection, illness, placental function). Also, this risk can change over the course of pregnancy. It is important for expectant mothers with scores in this range to be under the care of a health provider who will be able to partner with you and help you have your healthiest pregnancy possible;

for an expectant mothers with a first trimester risk score that is from 1.000 to 1.999 :
- preterm birth = 14.2%
- other adverse outcomes - 16.7%
- term birth without adverse outcome = 69.1%
- the risk for preterm birth in this group is above the average rate of about 10.4% observed across the United States, Expectant mothers with scores in this range have one or more factors present that are increasing their risk for preterm birth. It is also important to know that there are other factors that may be further affecting this risk that are not measured by the HPQ (for example, infection, illness, placental function). Also, this risk can change over the course of pregnancy. It is important for expectant mothers with scores in this range to be under the care of a health provider who will be able to partner with you and help you have your healthiest pregnancy possible;

for an expectant mothers with a first trimester risk score that is from 2.000 to 2.999:
- preterm birth = 26.1%
- other adverse outcomes - 17.6%
- term birth without adverse outcome = 56.3%
- the risk for preterm birth in this group is significantly above the average rate of about 10.4% observed across the United States, Expectant mothers with scores in this range have several factors present that are increasing their risk for preterm birth. It is also important to know that there are other factors that may be further affecting this risk that are not measured by the HPQ (for example, infection, illness, placental function). Also, this risk can change over the course of pregnancy. It is important for expectant mothers with scores in this range to be under the care of a health provider who will be able to partner with you and help you have your healthiest pregnancy possible;

for an expectant mothers with a first trimester risk score that is 3.000 or above:
- preterm birth = 40.6%
- other adverse outcomes - 18.8%
- term birth without adverse outcome = 40.5%
- the risk for preterm birth in this group is substantially above the average rate of about 10.4% observed across the United States, Expectant mothers with scores in this range have several factors present that are increasing their risk for preterm birth. It is also important to know that there are other factors that may be further affecting this risk that are not measured by the HPQ (for example, infection, illness, placental function). Also, this risk can change over the course of pregnancy. It is important for expectant mothers with scores in this range to be under the care of a health provider who will be able to partner with you and help you have your healthiest pregnancy possible.