Potential biochemical markers for preterm labor: a pilot study in north India

Prediction of Preterm Delivery among Low-risk Indian Pregnant Women: Discriminatory Power of Cervical Length, Serum Ferritin, and Serum Alpha-fetoprotein

Background

Around 80% of preterm births (PTBs) occur spontaneously. Various biomarkers are being evaluated to assess the possible role of chorioamniotic inflammation in PTBs.

Aim

The aim of this study was to establish the accuracy of serum bio-markers( cut off values of ferritin and alpha-fetoprotein [AFP] at midtrimester) along with cervical length [CL] assessment to predict preterm delivery among low-risk women.

Methods

Three hundred low-risk pregnant women attending the antenatal clinic of a tertiary health care facility were included and underwent CL measurement during mid-trimester by transvaginal ultrasonography and their serum levels of ferritin and AFP were recorded. All were followed up till delivery.

Results

Receptor-operated characteristic curves for ferritin, AFP, and CL were constructed. Area under curves and Youden Index calculated for each marker were very low (<0.5) which is statistically considered very poor for a screening test.

Conclusion

Serum ferritin and AFP together with CL measurement in the second trimester of pregnancy had poor discriminatory value in predicting preterm delivery among low-risk asymptomatic pregnant women.

Perinatal Brain Injury As a Consequence of Preterm Birth and Intrauterine Inflammation: Designing Targeted Stem Cell Therapies

Chorioamnionitis is a major cause of preterm birth and brain injury. Bacterial invasion of the chorion and amnion, and/or the placenta, can lead to a fetal inflammatory response, which in turn has significant adverse consequences for the developing fetal brain. Accordingly, there is a strong causal link between chorioamnionitis, preterm brain injury and the pathogenesis of severe postnatal neurological deficits and cerebral palsy. Currently there are no treatments to protect or repair against brain injury in preterm infants born after pregnancy compromised by intrauterine infection. This review describes the injurious cascade of events in the preterm brain in response to a severe fetal inflammatory event. We will highlight specific periods of increased vulnerability, and the potential effects of therapeutic intervention with cell-based therapies. Many clinical trials are underway to investigate the efficacy of stem cells to treat patients with cerebral palsy. Stem cells, obtained from umbilical cord tissue and cord blood, normally discarded after birth, are emerging as a safe and potentially effective therapy. It is not yet known, however, which stem cell type(s) are the most efficacious for administration to preterm infants to treat brain injury-mediated inflammation. Individual stem cell populations found in cord blood and tissue, such as mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs), have a number of potential benefits that may specifically target preterm inflammatory-induced brain injury. MSCs have strong immunomodulatory potential, protecting against global and local neuroinflammatory cascades triggered during infection to the fetus. EPCs have angiogenic and vascular reparative qualities that make them ideal for neurovascular repair. A combined therapy using both MSCs and EPCs to target inflammation and promote angiogenesis for re-establishment of vital vessel networks is a treatment concept that warrants further investigation.

The value of acute phase reactants in predicting preterm delivery

OBJECTIVE

We aimed to determine the potential value of maternal serum levels of acute phase reactants in the prediction of preterm delivery in women with threatened preterm labor (TPL).

METHODS

Ninety-one pregnant women diagnosed with TPL and 83 healthy pregnant women as a control group were included in this prospective controlled study. All the pregnant women were followed until delivery and obstetric data and the serum levels of acute phase reactants were recorded for each participant. The study group was further divided into two groups according to the gestational age at delivery, which include women delivering prematurely and the ones who gave birth at term.

RESULTS

Serum albumin levels were significantly lower and mean serum ferritin levels were significantly higher in the study groups when compared the control group.

CONCLUSION

Although an association between decreased serum albumin level and TPL, also between increased serum ferritin levels and preterm birth and low birth weight were demonstrated, more extensive studies are needed to clarify the potential use of the acute phase reactants in the prediction of preterm birth.

Serum Ferritin as A Marker for Preterm Premature Rupture of Membranes -A Study From A Tertiary Centre in Central Kerala

BACKGROUND

Preterm birth is the leading cause of newborn deaths and also the leading cause of death in children under 5 years of age. There is wide spread suspicion that subclinical infection is a common accompaniment and cause of preterm labour. Ferritin is an acute phase reactant and it increases during inflammation.This study aims to determine whether serum ferritin levels which may be raised in the setting of any infective process could be used as a marker of spontaneous preterm labour or PPROM (Preterm premature rupture of membranes).

AIM

To determine whether serum ferritin levels, which may be raised in the setting of any infective process, could be used as a marker of spontaneous preterm labour or PPROM.

STUDY SETTING

Department of Obstetrics and Department of Biochemistry.

STUDY DESIGN

Descriptive comparative design.

MATERIALS AND METHODS

The study involved 3 groups. 50 patients of PPROM, 50 patients of spontaneous preterm labour and 50 pregnant women matching with haemoglobin and same gestational age Serum ferritin were analysed in all the 3 groups.

STATISTICAL ANALYSIS

Significance of difference in the means of serum ferritin levels between the pregnant women (preterm) in the 3 groups were found out using ANOVA and also using a post hoc test (Tukey test). A p-value of < 0.05 was considered significant.

RESULTS

There was a significant increase in serum ferritin in PPROM cases as compared to the control group. But no significant increase in spontaneous preterm labour cases as compared to the control group.

CONCLUSION

Serum ferittin can be used as a marker of PPROM but cannot be used as a marker for spontaneous preterm labour. A cut off value of 35.5 mg/l of serum ferritin may be used for predicting PPROM cases.

The diagnostic value of cervicovaginal and serum ferritin levels in midgestation time to predict spontaneous preterm delivery

BACKGROUND

The aim of this study was to determine diagnostic value of cervicovaginal ferretin and serum ferretin levels at midgestation time in predicting preterm delivery in singleton pregnancies.

PATIENTS AND METHODS

A diagnostic test study through a prospective cohort design was carried out on 300 singleton pregnant women in 2012. A blood sample was obtained from all the patients within 22-24 gestational weeks for laboratory assessment of serum ferretin, and cervicovaginal sample was also taken to assess cervicovaginal ferritin level. Ferritin levels were compared between term and preterm deliveries at 37, 34 and 32 weeks of gestation. Receiver operating characteristics (ROC) curves were plotted to assess the diagnostic test values.

RESULTS

Mean serum ferritin level was 55.38 [standard deviation (SD 23.8)] ng/mL in term deliveries versus a mean of 91.27 (SD 25.2) ng/mL in preterm deliveries, which showed a statistically significant difference (P < 0.001). The ferritin levels in cervicovaginal term delivery group had mean of 11.29 (SD 16.2) ng/mL compared with a mean of 21.95 (SD 10.1) ng/mL among those with preterm delivery before 37 weeks of gestational age(P < 0.001). The cervicovaginal ferritin level had a moderate to good diagnostic value with an area under curve being above 0.8 for all assessments. The serum ferritin level had a moderate to good diagnostic value with an area under curve being above 0.8 for all assessments. In both tests, its diagnostic value was higher for predicting preterm delivery at earlier gestational age.

CONCLUSIONS

The results of this study indicate that high levels of serum and cervicovaginal ferritin in singleton pregnancies may alert the clinician of the risk of preterm delivery. Serum and cervicovaginal ferritin measurement at midgestation may be used as a predictive scale for preterm delivery in singleton pregnancies.