RSU study helps prevent the risk of premature birth
In a study conducted by leading researchers at Rīga Stradiņš University (RSU) and Rīga Maternity Hospital on the causes of premature birth, a protocol has been developed outlining how to act in cases when pregnant women have a shortened cervix. Thanks to this, the risk of premature birth is now significantly reduced for such women.
Despite significant research efforts, doctors have long lacked clarity on the best method to help women affected by premature cervical shortening, which poses a risk of early delivery or loss of the baby. The researchers aimed to determine the underlying causes of cervical shortening and discovered genetic factors that influence cervical insufficiency and, consequently, the risk of premature birth.
The study first identified rare pathogenic variants of the PGR (progesterone receptor) and NR3C1 (glucocorticoid receptor) genes that are associated with cervical insufficiency. These genetic variants explain why progesterone treatment may be less effective or even ineffective in certain patient groups, providing a basis for personalised therapy. The findings support the theory of a genetic predisposition to premature birth and represent a significant contribution to reproductive medicine and genetics.
What the study revealed
When facing the threat of premature birth, doctors have a limited number of treatment options available. The scientific component of the RSU study has led to a shift in how treatment is approached for women with cervical shortening, improving patient outcomes. This long-term research project on cervical insufficiency now supports more informed clinical decisions. By taking genetically determined risk factors into account, it is now possible to predict the success of progesterone therapy more accurately and tailor treatment strategies. For example, doctors may offer pregnant women surgery (cervical cerclage) in certain cases, while in others, avoid unnecessary intervention.
The recommended treatment protocol is as follows: if the cervix is shortened, the patient is offered progesterone; if it is extremely shortened, both progesterone and surgery are offered. After surgery, the patient does not need to remain in hospital. Following a gentle regime, she is encouraged to stay mobile, which helps reduce the risk of deep vein thrombosis. This algorithm should be adopted across all medical institutions in Latvia, as it standardises and improves the care provided to pregnant women. Each year, around 300–400 women in Latvia (2.8 % of childbirths) with diagnosed cervical insufficiency require this type of care.
One of participants explained her participation in the study saying that by doing so she could help other young mothers in the future who might find themselves in a similar situation:
'If even a little bit of this problem can be understood, then it's sacred work and I hope that this problem can be eliminated for women in the future.'
Including genetic factors and clinical signs in treatment planning helps doctors (gynaecologists, obstetricians, and other healthcare professionals involved in maternity care) determine which patients are at greater risk of preterm birth. This allows them to choose the most appropriate course of action—progesterone therapy or surgery.
The study reinforces the importance of progesterone in reducing the risk of premature birth. It has been proven to be an effective method for reducing the risk of miscarriage throughout pregnancy. When used up to 36 weeks of pregnancy by patients with cervical shortening, progesterone significantly reduces the risk of miscarriage.
Benefits
The greatest benefit of this study lies in the prevention of premature birth and the safety it provides to patients. The results offer doctors a well-founded action plan that eliminates unnecessary risks for both mother and child, helping reduce the number of premature births in Latvia. This research has the potential to improve Latvia’s already low premature birth rate by ensuring even higher quality care.
The study also strengthens the quality of reproductive healthcare by reducing complications and improving outcomes. This has a positive impact on both maternal and infant health. Furthermore, healthcare costs are reduced, as fewer premature births mean fewer complications and less need for costly neonatal care.
The psychological burden on families is also alleviated. Reducing the likelihood of premature birth helps to ease the emotional stress experienced by families. During the study, an obstetrician explained the risks of pregnancy loss in detail to all 114 participants, and 15 women received genetic counselling. This support played an important role in alleviating stress and emotional strain on the families involved.
The research also has significant scientific and international impact. Its findings lay the groundwork for further exploration of genetic factors contributing to cervical insufficiency and premature birth. This may lead to the development of new therapies and diagnostic tools. The RSU study serves as an example of medical innovation and strengthens Latvia’s international reputation in medical research, with potential applications in treatment practices worldwide.
About the research programme
Rīga Stradiņš University, in collaboration with Rīga Maternity Hospital, launched a study in 2017 to investigate the causes, risk factors, and efficacy of treatments for premature cervical shortening. A follow-up study was conducted between 2021 and 2023 by leading researchers from RSU and Rīga Maternity Hospital, focusing on factors causing premature birth. This study involved gynaecologists, obstetricians, and geneticists and included 114 women. Researchers collected detailed medical histories and genetic material and monitored the participants until their discharge from hospital. Currently, research continues as part of the project Cervical shortening: patient genotype, phenotype and management tactics during pregnancy, which is expected to continue until 2026.
