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Jyothi L, Datta M, Mitra D, Biswas J, Maitra A, Kar K. Prediction of Preterm Delivery among Low-risk Indian Pregnant Women: Discriminatory Power of Cervical Length, Serum Ferritin, and Serum Alpha-fetoprotein. Int J Appl Basic Med Res 2023; 13:198-203. [PMID: 38229722 PMCID: PMC10789465 DOI: 10.4103/ijabmr.ijabmr_179_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/13/2023] [Accepted: 10/16/2023] [Indexed: 01/18/2024] Open
Abstract
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.
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Affiliation(s)
- Lakavath Jyothi
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Mousumi Datta
- Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Divyangana Mitra
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Jhuma Biswas
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Arghya Maitra
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Kaushik Kar
- Department of Biochemistry, Rampurhat Medical College and Hospital, Rampurhat, West Bengal, India
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Liao J, Shenhav L, Urban JA, Serrano M, Zhu B, Buck GA, Korem T. Microdiversity of the vaginal microbiome is associated with preterm birth. Nat Commun 2023; 14:4997. [PMID: 37591872 PMCID: PMC10435516 DOI: 10.1038/s41467-023-40719-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality. The vaginal microbiome has been associated with PTB, yet the mechanisms underlying this association are not fully understood. Understanding microbial genetic adaptations to selective pressures, especially those related to the host, may yield insights into these associations. Here, we analyze metagenomic data from 705 vaginal samples collected during pregnancy from 40 women who delivered preterm spontaneously and 135 term controls from the Multi-Omic Microbiome Study-Pregnancy Initiative. We find that the vaginal microbiome of pregnancies that ended preterm exhibited unique genetic profiles. It was more genetically diverse at the species level, a result which we validate in an additional cohort, and harbored a higher richness and diversity of antimicrobial resistance genes, likely promoted by transduction. Interestingly, we find that Gardnerella species drove this higher genetic diversity, particularly during the first half of the pregnancy. We further present evidence that Gardnerella spp. underwent more frequent recombination and stronger purifying selection in genes involved in lipid metabolism. Overall, our population genetics analyses reveal associations between the vaginal microbiome and PTB and suggest that evolutionary processes acting on vaginal microbes may play a role in adverse pregnancy outcomes such as PTB.
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Affiliation(s)
- Jingqiu Liao
- Program for Mathematical Genomics, Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA.
| | - Liat Shenhav
- Center for Studies in Physics and Biology, Rockefeller University, New York, NY, USA
| | - Julia A Urban
- Program for Mathematical Genomics, Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Myrna Serrano
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, VA, USA
| | - Bin Zhu
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, VA, USA
| | - Gregory A Buck
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, VA, USA
- Department of Computer Science, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Tal Korem
- Program for Mathematical Genomics, Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA.
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, ON, Canada.
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3
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Peris M, Reid SM, Dobie S, Bonacquisto L, Shepherd DA, Amor DJ. Second trimester maternal serum biomarkers and the risk of cerebral palsy. Prenat Diagn 2021; 41:1101-1110. [PMID: 34270813 DOI: 10.1002/pd.6011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/25/2021] [Accepted: 06/27/2021] [Indexed: 11/09/2022]
Abstract
AIMS To investigate whether second trimester maternal serum screening (2TMSS) biomarkers are associated with cerebral palsy (CP) and identify CP characteristics associated with abnormal biomarker levels. METHOD In this retrospective case-control data linkage study, we linked mothers of 129 singleton CP cases from a population register to their 2TMSS records and selected 10 singleton pregnancy controls per case (n = 1290). We compared mean and abnormal levels of alpha-fetoprotein (AFP), beta subunit of human chorionic gonadotrophin (β-hCG), unconjugated estriol (uE3), and inhibin between cases and controls and within CP subgroups. RESULTS Compared to control pregnancies, CP pregnancies had higher mean levels of AFP (1.10 vs. 1.01 multiple of the population median [MoM], p = 0.01) and inhibin (1.10 vs. 0.98 MoM, p ≤ 0.01). CP pregnancies were 2.5 times more likely to be associated with high levels of AFP (OR 2.52 [95% confidence interval [CI] 1.30, 4.65]; p < 0.01) and 2.6 times for inhibin (OR 2.63 [95% CI 1.37, 4.77]; p < 0.01), and 6.8 times when AFP and inhibin were both elevated (OR 6.75 [95% CI 2.41, 18.94]; p < 0.01). In CP cases, high AFP and high inhibin levels were associated with preterm birth and low birthweight. INTERPRETATION Abnormal second-trimester biomarker levels suggest abnormal placentation plays a role in the causal pathway of some CP cases.
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Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Stephen Dobie
- Victorian Clinical Genetics Services, Melbourne, Australia
| | | | - Daisy A Shepherd
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia
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Abstract
OBJECTIVE. The purpose of this article is to describe the imaging findings associated with complex fetal abdominal wall defects and provide an algorithmic method for arriving at a final diagnosis. CONCLUSION. Fetal ventral abdominal wall defects are a complex group of conditions with a broad spectrum of associated multisystem anomalies and manifestations. Correct characterization and classification of these defects require not only familiarity with imaging findings but also a systematic approach to avoid diagnostic confusion.
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Yuan X, Long W, Liu J, Zhang B, Zhou W, Jiang J, Yu B, Wang H. Associations of serum markers screening for Down's syndrome with pregnancy outcomes: A Chinese retrospective cohort study. Clin Chim Acta 2018; 489:130-135. [PMID: 30529497 DOI: 10.1016/j.cca.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We examined the associations between Down's serum screening analytes and pregnancy outcomes in Chinese women. METHODS A retrospective cohort study of 2470 pregnant women was conducted. Maternal serum triple tests (AFP, fβ-hCG, uE3), maternal characteristics and pregnancy outcomes were recorded from our prenatal screening and hospitalization information system, respectively. RESULTS The elevated concentration of uE3 in the early-second trimester was associated with increased risk of LGA infants and macrosomia, decreased risk of PE and small SGA infants (for LGA: OR: 1.34, 95% CI: 1.09-1.65; for macrosomia: OR:1.39, 95% CI: 1.08-1.78; for PE: OR: 0.61, 95% CI: 0.40-0.95; for SGA: OR: 0.35, 95% CI: 0.25-0.49). The increased ratio of AFP/uE3 was associated with reduced risk of GDM in the study populations (BMI ≥ 25; OR: 0.96, 95% CI: 0.0.93-1.00). The higher ratio of AFP/fβ-hCG + uE3 associated with increased risk of SGA infants and ICP in these subjects (BMI ≥ 25) was also observed (for SGA: OR: 1.11, 95% CI: 1.03-1.18; for ICP: OR: 1.27, 95% CI: 1.06-1.53). CONCLUSIONS Down's serum screening analytes were associated with pregnancy outcomes in Chinese population and might provide an alternative tools for risk estimates on these unfavorable outcomes.
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Affiliation(s)
- Xiaosong Yuan
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Wei Long
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Jianbing Liu
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Bin Zhang
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Wenbai Zhou
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Jian Jiang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China
| | - Bin Yu
- Department of Prenatal Diagnosis Laboratory, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China.
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No. 16 Bo Ai Road, Changzhou, Jiangsu Province, China.
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Yefet E, Kuzmin O, Schwartz N, Basson F, Nachum Z. Labor induction versus expectant management at early term in pregnancies with second trimester elevated human chorionic gonadotropin or alpha fetoprotein. J Obstet Gynaecol Res 2018. [DOI: 10.1111/jog.13618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Enav Yefet
- Department of Obstetrics and Gynecology; Emek Medical Center; Afula Israel
| | - Olga Kuzmin
- Department of Obstetrics and Gynecology; Emek Medical Center; Afula Israel
| | | | - Flora Basson
- Department of Obstetrics and Gynecology; Emek Medical Center; Afula Israel
| | - Zohar Nachum
- Department of Obstetrics and Gynecology; Emek Medical Center; Afula Israel
- Rappaport Faculty of Medicine; Technion; Haifa Israel
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Lucaroni F, Morciano L, Rizzo G, D' Antonio F, Buonuomo E, Palombi L, Arduini D. Biomarkers for predicting spontaneous preterm birth: an umbrella systematic review. J Matern Fetal Neonatal Med 2018; 31:726-734. [PMID: 28274163 DOI: 10.1080/14767058.2017.1297404] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify all systematic reviews investigating the role of maternal and fetal biomarkers for predicting spontaneous preterm birth (SPTB). METHODS Medline and Web of Sciences databases were searched electronically. Studies exploring the association between maternal biomarkers and spontaneous delivery were considered suitable for inclusion. A synthesis of the systematic reviews was performed with the umbrella methodology. Statistical measures of association (Odd ratio, OR, relative risk, RR) and predictive accuracy (sensitivity, specificity, positive and negative likelihood ratios were used to synthesize results of the included studies. RESULTS 21,614 articles were identified, 542 were assessed with respect to their eligibility for inclusion and 14 systematic reviews included. Cervical fibronectin was the biomarkers which showed the highest strength of association with the occurrence of SPTB (delivery within 24 h OR 7, 95%CI 3-17; delivery <7 days (OR 12, 95%CI 8-16). Maternal serum alpha fetoprotein, was associated with an OR of 4 and 3 for early and late SPTB. C-reactive protein had an OR of 2 (95%CI 1-2) and 8 (95%CI 4-16) when detected in maternal plasma and amniotic fluid, respectively. Among cytokines, interleukin-6 had an OR and an LR + for SPTB of 2 and 12 when detected in maternal serum. CONCLUSIONS Cervical fetal fibronectin, alpha fetoprotein, C- reactive protein and interleukin 6 can have an overall good diagnostic accuracy in identifying pregnancies at risk of SPTB. Large prospective studies in different sub-set of women are needed to ascertain whether the combination of different serological and imaging marker can improve antenatal prediction of this condition.
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Affiliation(s)
- Francesca Lucaroni
- a Department of Biomedicine and Prevention University Rome Tor Vergata , Rome , Italy
| | - Laura Morciano
- a Department of Biomedicine and Prevention University Rome Tor Vergata , Rome , Italy
| | - Giuseppe Rizzo
- a Department of Biomedicine and Prevention University Rome Tor Vergata , Rome , Italy
| | - Francesco D' Antonio
- b Department of Clinical Medicine, Faculty of Health Sciences , UiT, The Arctic University of Norway , Tromsø , Norway
| | - Ersilia Buonuomo
- a Department of Biomedicine and Prevention University Rome Tor Vergata , Rome , Italy
| | - Leonardo Palombi
- a Department of Biomedicine and Prevention University Rome Tor Vergata , Rome , Italy
| | - Domenico Arduini
- a Department of Biomedicine and Prevention University Rome Tor Vergata , Rome , Italy
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Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med 2017; 45:817-820. [PMID: 27771626 DOI: 10.1515/jpm-2016-0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to evaluate the predictive value of α-fetoprotein in maternal serum (MS-AFP) as a marker for diverse pregnancy outcomes. METHODS The study was based on pregnancy and delivery data from 5520 women between 1999 and 2014 at University Hospital of Zurich (UHZ). INCLUSION CRITERIA both MS-AFP and pregnancy outcome were known for the same pregnancy. Pregnancy outcomes and characteristics such as fetal malformation, intrauterine fetal death (IUFD) and intrauterine growth retardation as well as maternal age, weight before pregnancy, gestational age (GA) at delivery, newborn weight, length and head circumference were analyzed with respect to the MS-AFP value. MS-AFP value was categorized into three groups: elevated MS-AFP>2.5 multiples of the median (MoM), normal 0.5-2.49 MoM and decreased <0.5 MoM. RESULTS Newborn weight (g) and length (cm) were significantly lower in the elevated MS-AFP (P<0.001) group, and infants had 1 week lower GA at delivery (P<0.05). In the group of elevated MS-AFP (n=46), 26.1% of pregnancies were significantly related to adverse pregnancy outcomes, such as fetal malformations, fetuses small for gestational age (SGA) and IUFD. Adverse pregnancy outcomes of 5.6% were registered in the group of normal MS-AFP and 7.3% in the group of low MS-AFP (P<0.05). CONCLUSION MS-AFP level in the second trimester is still an important indicator of fetal surface malformations; however, ultrasound still outweighs as a screening method. Nevertheless, pregnant women with elevated MS-AFP values and with no sonographically detected fetal malformations should additionally receive the third trimester ultrasound examination to exclude other possible complications of pregnancy.
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Knight AK, Smith AK. Epigenetic Biomarkers of Preterm Birth and Its Risk Factors. Genes (Basel) 2016; 7:E15. [PMID: 27089367 PMCID: PMC4846845 DOI: 10.3390/genes7040015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 01/21/2023] Open
Abstract
A biomarker is a biological measure predictive of a normal or pathogenic process or response. Biomarkers are often useful for making clinical decisions and determining treatment course. One area where such biomarkers would be particularly useful is in identifying women at risk for preterm delivery and related pregnancy complications. Neonates born preterm have significant morbidity and mortality, both in the perinatal period and throughout the life course, and identifying women at risk of delivering preterm may allow for targeted interventions to prevent or delay preterm birth (PTB). In addition to identifying those at increased risk for preterm birth, biomarkers may be able to distinguish neonates at particular risk for future complications due to modifiable environmental factors, such as maternal smoking or alcohol use during pregnancy. Currently, there are no such biomarkers available, though candidate gene and epigenome-wide association studies have identified DNA methylation differences associated with PTB, its risk factors and its long-term outcomes. Further biomarker development is crucial to reducing the health burden associated with adverse intrauterine conditions and preterm birth, and the results of recent DNA methylation studies may advance that goal.
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Affiliation(s)
- Anna K Knight
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA 30322, USA.
| | - Alicia K Smith
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA 30322, USA.
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
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10
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REN FENG, HU YU, ZHOU HUAN, ZHU WENYING, JIA LI, XU JINGJING, XUE JING. Second trimester maternal serum triple screening marker levels in normal twin and singleton pregnancies. Biomed Rep 2016; 4:475-478. [DOI: 10.3892/br.2016.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/11/2016] [Indexed: 11/06/2022] Open
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Stegmann BJ, Santillan M, Leader B, Smith E, Santillan D. Changes in antimüllerian hormone levels in early pregnancy are associated with preterm birth. Fertil Steril 2015; 104:347-55.e3. [PMID: 26074093 DOI: 10.1016/j.fertnstert.2015.04.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/02/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the association of preterm birth with antimüllerian hormone (AMH) levels both in isolation and in combination with other markers of fetoplacental health commonly measured during integrated prenatal screening (IPS) for aneuploidy. DESIGN Retrospective case-control study. SETTING Not applicable. PATIENT(S) Pregnant women in Iowa who elected to undergo IPS and who subsequently delivered in Iowa, including women giving birth at <37 weeks' gestation and controls who delivered at ≥37 weeks' gestation. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Probability of a preterm birth. RESULT(S) Second trimester AMH levels were not associated with preterm birth, either independently or after controlling for other markers of fetoplacental health. The AMH difference was not associated with preterm birth when modeled alone, but a statistically significant association was found after adjusting for maternal serum α-fetoprotein (MSAFP) and maternal weight change between the first and second trimesters. After stratifying the model by MSAFP level, most of the risk for preterm birth was identified in women with an MSAFP >1 multiple of the median and who had a stable or rising AMH level in early pregnancy. CONCLUSION(S) A lack of decline in the AMH level in early pregnancy can be used to identify women with a high probability for preterm birth, especially when MSAFP levels are >1 multiple of the median. Monitoring changes in the AMH level between the first and second trimesters of pregnancy may help identify women who would benefit from interventional therapies such as supplemental progesterone.
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Affiliation(s)
| | - Mark Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
| | | | - Elaine Smith
- Department of Epidemiology, College of Public Health, Iowa City, Iowa
| | - Donna Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
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Güdücü N, Gönenç G, Işçi H, Yiğiter AB, Dünder I. Can quadruple test parameters predict SGA infants? J OBSTET GYNAECOL 2014; 33:269-71. [PMID: 23550855 DOI: 10.3109/01443615.2012.759915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the role of quadruple test parameters in predicting the risk of delivering a small for gestational age (SGA) infant. The quadruple test results of patients performed at 16-18 weeks of pregnancy were searched retrospectively. Alpha-fetoprotein (AFP) levels higher than 2 MoM were associated with a risk of delivering an SGA infant (p = 0.025), sensitivity 8%, specificity 98%, positive predictive value 25%, negative predictive value 91%. Other quadruple test parameters were not related to delivery of an SGA infant. The introduction of AFP as a screening test for the detection of SGA infants does not seem feasible, but we suggest clinicians take it into account when counselling the patients about the results of Down syndrome screening tests.
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Affiliation(s)
- N Güdücü
- Department of Obstetrics and Gynecology, Avrupa Hospital, Istanbul Bilim University, Istanbul, Turkey.
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13
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Interprétation des valeurs atypiques des marqueurs sériques. ACTA ACUST UNITED AC 2014; 43:5-11. [DOI: 10.1016/j.jgyn.2013.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/31/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
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Metcalfe A, Langlois S, MacFarlane J, Vallance H, Joseph KS. Prediction of obstetrical risk using maternal serum markers and clinical risk factors. Prenat Diagn 2013; 34:172-9. [DOI: 10.1002/pd.4281] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology; University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia; Vancouver Canada
| | - Sylvie Langlois
- Perinatal Services BC; Provincial Health Services Authority; Vancouver Canada
- Department of Medical Genetics; University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia; Vancouver Canada
| | - Julie MacFarlane
- Perinatal Services BC; Provincial Health Services Authority; Vancouver Canada
| | - Hilary Vallance
- Department of Pathology; University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia; Vancouver Canada
| | - K. S. Joseph
- Department of Obstetrics and Gynecology; University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
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15
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A proposed method to predict preterm birth using clinical data, standard maternal serum screening, and cholesterol. Am J Obstet Gynecol 2013; 208:472.e1-11. [PMID: 23500456 DOI: 10.1016/j.ajog.2013.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/14/2013] [Accepted: 03/07/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to create a predictive model for preterm birth (PTB) from available clinical data and serum analytes. STUDY DESIGN Serum analytes and routine pregnancy screening plus cholesterol and corresponding health information were linked to birth certificate data for a cohort of 2699 Iowa women with serum sampled in the first and second trimester. Stepwise logistic regression was used to select the best predictive model for PTB. RESULTS Serum screening markers remained significant predictors of PTB, even after controlling for maternal characteristics. The best predictive model included maternal characteristics, first-trimester total cholesterol, total cholesterol change between trimesters, and second-trimester alpha-fetoprotein and inhibin A. The model showed better discriminatory ability than PTB history alone and performed similarly in subgroups of women without past PTB. CONCLUSION Using clinical and serum screening data, a potentially useful predictor of PTB was constructed. Validation and replication in other populations, and incorporation of other measures that identify PTB risk, like cervical length, can be a step toward identifying additional women who may benefit from new or currently available interventions.
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Spaggiari E, Ruas M, Dreux S, Valat AS, Czerkiewicz I, Guimiot F, Schmitz T, Delezoide AL, Muller F. Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay. Am J Obstet Gynecol 2013; 208:303.e1-7. [PMID: 23313312 DOI: 10.1016/j.ajog.2013.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/08/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein. STUDY DESIGN A retrospective cohort study in 658 patients with maternal serum alpha-fetoprotein ≥2.5 multiple of median, performed at routine Down syndrome screening. Maternal serum alpha-fetoprotein was assayed a second time in 341 of them. Outcomes were recorded in all cases. RESULTS The group with unexplained maternal serum alpha-fetoprotein persistently ≥2.5 multiple of median was associated with more pregnancy complications 37 of 92 (40.2%) as fetal death, preeclampsia, intrauterine growth restriction, and congenital nephrotic syndrome, compared with the group with maternal serum alpha-fetoprotein that returned to a normal level 37 of 226 (16.4%) (P < .001). CONCLUSION When maternal serum alpha-fetoprotein returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat maternal serum alpha-fetoprotein assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. Alpha-fetoprotein should be monitored in pregnancies associated with unexplained high maternal serum alpha-fetoprotein. A management strategy based on ultrasound examination, second maternal serum alpha-fetoprotein assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, University Paris Diderot and Paris Sorbonne-Cité, Paris, France
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Transvaginal sonographic evaluation of the cervix in asymptomatic singleton pregnancy and management options in short cervix. J Pregnancy 2012; 2012:201628. [PMID: 22523687 PMCID: PMC3317216 DOI: 10.1155/2012/201628] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 11/02/2011] [Indexed: 11/30/2022] Open
Abstract
Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.
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Menon R, Torloni MR, Voltolini C, Torricelli M, Merialdi M, Betrán AP, Widmer M, Allen T, Davydova I, Khodjaeva Z, Thorsen P, Kacerovsky M, Tambor V, Massinen T, Nace J, Arora C. Biomarkers of spontaneous preterm birth: an overview of the literature in the last four decades. Reprod Sci 2012; 18:1046-70. [PMID: 22031189 DOI: 10.1177/1933719111415548] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Understanding spontaneous preterm birth ([PTB] < 37 weeks) is difficult due to heterogeneities associated with multitudes of risk factors and pathophysiological pathways. Several biomarkers are routinely used clinically for predicting preterm labor; however, these factors are either nonspecific or detected too late. OBJECTIVE Systematic review of literature on PTB biomarkers in the last 40 years to map out the existing knowledge and gaps in understanding PTB biomarkers. SEARCH STRATEGIES Five electronic databases were searched for human studies on PTB biomarkers published in any language between 1965 and 2008. SELECTION CRITERIA The phenotype of interest for final data extraction was exclusively spontaneous PTB with no rupture of membranes. Data extraction included (a) general characteristics of the study (clinical setting, period, and study design), (b) study/participant characteristics (inclusion and exclusion criteria, race/ethnicity, number of participants, gestational age at sampling, (c) characteristics of the biomarker (type, rationale for its selection, type of biological sample, and assay used, and (d) concentration of biomarkers in cases and controls. DATA COLLECTION AND ANALYSIS The search yielded 7255 citations and data were extracted from 217 articles which met our inclusion and exclusion criteria. MAIN RESULTS A total of 116 different biomarkers were reported and these were assayed 578 times in the 217 included studies. Over two thirds of the 217 studies were performed on North American or European populations. No reliable biomarkers emerged as a risk predictor of PTB. CONCLUSIONS Identifying similar studies on biomarkers for the prediction of PTB was a very challenging task due heterogeneities in study design, sampling issues (types, timing and processing), assay methods, and analyses. Major areas of concern identified in this review include poor phenotype definition, nonideal study designs and poor rationale for biomarker selection and assays and population stratification issues.
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Affiliation(s)
- Ramkumar Menon
- Department of OB & GYN, Division of Maternal- Fetal Medicine, The University of Texas Medical Branch at Galveston, TX, USA.
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Abdallah MW, Grove J, Hougaard DM, Nørgaard-Pedersen B, Ibrahimov F, Mortensen EL. Autism spectrum disorders and maternal serum α-fetoprotein levels during pregnancy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:727-34. [PMID: 22152641 DOI: 10.1177/070674371105601204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Numerous studies have been trying to disentangle the complex pathophysiology of autism spectrum disorders (ASD). In our study, we explored the potential role of maternal serum (MS) alpha-fetoprotein (AFP) in the prediction and the pathophysiology of ASD. METHODS A total of 112 patients with ASD and 243 control subjects were included in a case-control study, using a historic birth cohort maintained at Statens Serum Institute. Measurements of MS-AFP were obtained from a multicentre screening program, whereas clinical data were obtained from nationwide registers. Association between MS-AFP and ASD status was analyzed using logistic regression models and nonparametric tests. RESULTS Crude, but not adjusted, estimates showed that MS-AFP levels were slightly, but significantly, higher in mothers of children with ASD, compared with their control subject counterparts. People with ASD had an odds ratio of 2.33, with 95% confidence intervals of 1.00 to 5.39, to have MS-AFP above 2.5 multiple of median. Excluding subjects with congenital malformation comorbidities did not alter the direction of our estimates (OR 2.60; 95% CI 1.04 to 6.51, P = 0.04). CONCLUSION Biologic plausibility of its role in the pathophysiology of ASD makes AFP a good candidate for further larger-scale studies to confirm such an association and to determine whether this pattern is unique to ASD or related to other psychiatric disorders as well.
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Affiliation(s)
- Morsi W Abdallah
- Department of Epidemiology, Aarhus University School of Public Health, Denmark.
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Conde-Agudelo A, Papageorghiou AT, Kennedy SH, Villar J. Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis. BJOG 2011; 118:1042-54. [PMID: 21401853 DOI: 10.1111/j.1471-0528.2011.02923.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies and help in understanding the pathways that lead to preterm birth. OBJECTIVE To investigate the accuracy of novel biomarkers to predict spontaneous preterm birth in women with singleton pregnancies and no symptoms of preterm labour. SEARCH STRATEGY Electronic searches in PubMed, Embase, Cinahl, Lilacs, and Medion, references of retrieved articles, and conference proceedings. No language restrictions were applied. SELECTION CRITERIA Observational studies that evaluated the accuracy of biomarkers proposed in the last decade to predict spontaneous preterm birth in asymptomatic women. We excluded studies in which biomarkers were evaluated in women with preterm labour. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data on study characteristics, quality, and accuracy. Data were arranged in 2 × 2 contingency tables and synthesised separately for spontaneous preterm birth before 32, 34, and 37 weeks of gestation. We used bivariate meta-analysis to estimate pooled sensitivities and specificities, and calculated likelihood ratios (LRs). MAIN RESULTS A total of 72 studies, including 89,786 women and evaluating 30 novel biomarkers, met the inclusion criteria. Only three biomarkers (proteome profile and prolactin in cervicovaginal fluid, and matrix metalloproteinase-8 in amniotic fluid) had positive LRs > 10. However, each of these biomarkers was evaluated in only one small study. Four biomarkers had a moderate predictive accuracy (interleukin-6 and angiogenin, in amniotic fluid; human chorionic gonadotrophin and phosphorylated insulin-like growth factor binding protein-1, in cervicovaginal fluid). The remaining biomarkers had low predictive accuracies. CONCLUSIONS None of the biomarkers evaluated in this review meet the criteria to be considered a clinically useful test to predict spontaneous preterm birth. Further large, prospective cohort studies are needed to evaluate promising biomarkers such as a proteome profile in cervicovaginal fluid.
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Affiliation(s)
- A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, USA
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Kumbak B, Sahin L. Elevated maternal serum alpha-fetoprotein levels in patients with subchorionic hematoma. J Matern Fetal Neonatal Med 2009; 23:717-9. [PMID: 19883262 DOI: 10.3109/14767050903366093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Subchorionic hematoma might be associated with poor pregnancy outcome. Two intra cytoplasmic sperm injection pregnancies complicated with subchorionic hematoma were found to have elevated mid-trimester maternal serum alpha-fetoprotein levels. One of them had miscarriage at 16 weeks' gestation and the other delivered a healthy baby by cesarean section. The valid interpretation of triple test result might be complicated by subchorionic hematoma. Therefore, it is better not to order triple test in such cases to avoid unnecessarily provoking the anxiety of the couple.
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Affiliation(s)
- Banu Kumbak
- Yeditepe University Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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