{ "site": "The Missing Weeks", "url": "https://themissingweeks.org", "publisher": "AEXTech Holdings", "disclosure": "Published by AEXTech Holdings. Its founder, Alex Rogers, holds shares in Sera Prognostics, maker of the PreTRM mid-pregnancy risk test that appears on the timeline, and has an interest in a Blue Ox Healthcare Partners vehicle holding Sera warrants; he expects to have a stake in iMSO, a new company that plans to sell preterm-birth prevention programs using that test. Sera did not fund, review or see the site. AEXTech also sells a fuller version of the model behind it. Full text: https://themissingweeks.org/about", "notAdvice": "Population and program planning references, not individual medical, actuarial or legal advice.", "howToRead": "Weeks of gestation; 42 and later is postpartum. A window is open for a first prenatal visit at or before openThroughWeek, partly open (late, weaker evidence) through lateThroughWeek, and closed after. Events have no window. Grades: A = individual-participant meta-analysis of trials; B = trial or trial-based review meeting the bar with caveats stated; policy, measure and standard = timing set by policy, quality measures or practice guidance, with no preterm-birth effect claimed.", "evidenceBar": "An intervention is credited with preventing preterm birth only with at least one adequately powered randomized trial, or an individual-participant meta-analysis of trials, showing a statistically significant improvement in a preterm-birth band or a neonatal morbidity or mortality outcome, in a defined population.", "firstVisitWeek": 20, "summary": { "open": 6, "partlyOpen": 2, "closed": 1, "note": "Aspirin is late. The mid-pregnancy screen and the cervical-length window are still open, and they decide the rest." }, "windows": [ { "id": "cover", "name": "Coverage: application, presumptive eligibility", "kind": "window", "grade": "policy", "startWeek": 4, "endWeek": 42, "openThroughWeek": 42, "lateThroughWeek": null, "description": "A pregnancy can be covered the day it is known. Presumptive eligibility lets a qualified clinic grant Medicaid on the spot; retroactive eligibility reaches back three months once approved. Nothing on this chart can be paid for until this happens.", "status": "open" }, { "id": "first", "name": "First prenatal visit", "kind": "window", "grade": "measure", "startWeek": 6, "endWeek": 13, "openThroughWeek": 13, "lateThroughWeek": 20, "description": "The first-trimester visit is the standard quality measure (care begun by the end of week 13). It is where risk is read: history, blood pressure, prior preterm birth, the factors that decide which paths below apply.", "status": "closing" }, { "id": "ctscreen", "name": "First-trimester pre-eclampsia screen (where offered)", "kind": "window", "grade": "B", "startWeek": 11, "endWeek": 14, "openThroughWeek": 14, "lateThroughWeek": null, "description": "Combined screening at 11–14 weeks identifies the pregnancies in which aspirin prevents preterm pre-eclampsia (ASPRE, 2017). Not every plan buys it; risk-factor history is the usual substitute.", "status": "closed" }, { "id": "aspirin", "name": "Low-dose aspirin, where pre-eclampsia risk is elevated", "kind": "window", "grade": "B", "startWeek": 12, "endWeek": 16, "openThroughWeek": 16, "lateThroughWeek": 28, "description": "Start between 12 and 16 weeks; later starts up to 28 weeks are permitted but the evidence is strongest for early initiation. Reduced preterm pre-eclampsia by about 62% in screen-positive women (ASPRE, OR 0.38). Its effect runs through pre-eclampsia, not spontaneous labor. Pennies a day.", "status": "closing" }, { "id": "screen", "name": "Mid-pregnancy risk screen (proteomic blood test), then targeted care", "kind": "window", "grade": "B", "startWeek": 18, "endWeek": 21, "openThroughWeek": 20, "lateThroughWeek": null, "description": "Drawn at 18 weeks 0 days to 20 weeks 6 days in asymptomatic singleton pregnancies without known risk. Higher-risk results lead to a care protocol (in PRIME: progesterone, aspirin and care management). The evidence for treating screen-positive pregnancies this way is PRIME itself; the progesterone and aspirin rows below were established in other groups. PRIME's peer-reviewed co-primary results: composite neonatal morbidity OR 0.80 (0.66–0.96) and a 5% shorter neonatal stay; grade B rests on those. The trial stopped early for benefit, and the screened arm was open-label; both tend to make an effect look larger. The reductions in early preterm birth (32% below 35 weeks, 56% below 32 weeks) were pre-specified exploratory endpoints and company-reported. Our founder has a financial interest in wider use of this test; see About.", "status": "open" }, { "id": "cl", "name": "Anatomy scan with cervical-length measurement", "kind": "window", "grade": "A", "startWeek": 18, "endWeek": 24, "openThroughWeek": 22, "lateThroughWeek": 24, "description": "A short cervix on the mid-pregnancy scan is the strongest treatable signal of spontaneous preterm birth. The scan is routine; the measurement has to be asked for.", "status": "open" }, { "id": "prog", "name": "Vaginal progesterone, from a short cervix", "kind": "window", "grade": "A", "startWeek": 18, "endWeek": 24, "openThroughWeek": 24, "lateThroughWeek": 26, "description": "Daily vaginal progesterone in singleton pregnancies with a short cervix or a prior spontaneous preterm birth cuts preterm birth before 34 weeks by about 22% (EPPPIC individual-participant meta-analysis, RR 0.78). Cheap generic; the binding constraint is the measurement above. No benefit in twins.", "status": "open" }, { "id": "cerc", "name": "Cervical cerclage, short cervix with a prior preterm birth", "kind": "window", "grade": "B", "startWeek": 14, "endWeek": 24, "openThroughWeek": 24, "lateThroughWeek": null, "description": "A surgical stitch for the narrow group with both a short cervix and a history of preterm birth or mid-trimester loss. Placed before viability. High benefit in a small group; not a population program.", "status": "open" }, { "id": "glucose", "name": "Glucose screening", "kind": "window", "grade": "standard", "startWeek": 24, "endWeek": 28, "openThroughWeek": 28, "lateThroughWeek": 32, "description": "Routine at 24–28 weeks (earlier for those at risk). Not a preterm-birth lever on its own; on the chart because its window is where many late entrants first appear.", "status": "open" }, { "id": "acs", "name": "Antenatal corticosteroids, when preterm delivery is expected within 7 days", "kind": "event", "grade": "A", "startWeek": 24, "endWeek": 34, "openThroughWeek": null, "lateThroughWeek": null, "description": "Not scheduled; given when delivery is expected within a week, between 24 and 34 weeks. Reduces neonatal death and respiratory distress (Cochrane). It softens a preterm birth; it does not prevent one. Timing it right needs the pregnancy to be known and watched.", "status": "event" }, { "id": "deliv", "name": "Delivery", "kind": "event", "grade": null, "startWeek": 37, "endWeek": 42, "openThroughWeek": null, "lateThroughWeek": null, "description": "Term is 37 weeks and later. A preterm birth is a birth before 37 weeks; the cost rises steeply the earlier it comes.", "status": "event" }, { "id": "pp7", "name": "Blood-pressure check within 7 days, after a hypertensive pregnancy", "kind": "event", "grade": "standard", "startWeek": 42, "endWeek": 43, "openThroughWeek": null, "lateThroughWeek": null, "description": "Most postpartum readmissions for hypertension happen in the first week. The check is the cheapest thing on this chart that prevents an emergency.", "status": "event" }, { "id": "pp12", "name": "Postpartum visit by 12 weeks; coverage to 12 months", "kind": "event", "grade": "standard", "startWeek": 43, "endWeek": 46, "openThroughWeek": null, "lateThroughWeek": null, "description": "The comprehensive postpartum visit, mood screening, lactation support, and the glucose test after gestational diabetes. Medicaid coverage now runs 12 months after the end of pregnancy in most states.", "status": "event" } ], "page": "https://themissingweeks.org/timeline?w=20" }