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Lin D, Hu B, Xiu Y, Ji R, Zeng H, Chen H, Wu Y. Risk factors for premature rupture of membranes in pregnant women: a systematic review and meta-analysis. BMJ Open 2024; 14:e077727. [PMID: 38553068 PMCID: PMC10982755 DOI: 10.1136/bmjopen-2023-077727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/20/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To identify risk factors for premature rupture of membranes (PROM) in pregnant women. DESIGN Systematic review and meta-analysis. DATA SOURCES Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database (VIP) and China Biology Medicine Disc were searched from inception to October 2022. ELIGIBILITY CRITERIA Cross-sectional, case-control and cohort studies published in English or Chinese that reported the risk factors for PROM were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data and evaluated the risk of bias using the Newcastle-Ottawa Scale and American Agency for Healthcare Research and Quality tools. Analyses were performed using RevMan 5.4 software, and heterogeneity was assessed using χ2 tests and I2 statistics. The sensitivity analyses included a methodological transition between fixed-effect and random-effect models and the systematic stepwise exclusion of studies. RESULTS A total of 21 studies involving 18 174 participants with 18 risk factors were included. The significant risk factors were low Body Mass Index (BMI) (OR 2.18, 95% CI 1.32 to 3.61), interpregnancy interval (IPI) <2 years (OR 2.99, 95% CI 1.98 to 4.50), previous abortion (OR 2.35, 95% CI 1.76 to 3.14), previous preterm birth (OR 5.72, 95% CI 3.44 to 9.50), prior PROM (OR 3.95, 95% CI 2.48 to 6.28), history of caesarean section (OR 3.06, 95% CI 1.72 to 5.43), gestational hypertension (OR 3.84, 95% CI 2.36 to 6.24), gestational diabetes mellitus (GDM) (OR 2.16, 95% CI 1.44 to 3.23), abnormal vaginal discharge (OR 2.17, 95% CI 1.45 to 3.27), reproductive tract infection (OR 2.16, 95% CI 1.70 to 2.75), malpresentation (OR 2.26, 95% CI 1.78 to 2.85) and increased abdominal pressure (OR 1.45, 95% CI 1.07 to 1.97). The sensitivity analysis showed that the pooled estimates were stable. CONCLUSIONS This meta-analysis indicated that low BMI, IPI <2 years, previous abortion, previous preterm birth, prior PROM, history of caesarean section, gestational hypertension, GDM, abnormal vaginal discharge, reproductive tract infection, malpresentation and increased abdominal pressure might be associated with a greater risk of PROM. Associations between smoking status, short cervical length, fine particulate matter (PM2.5) and PROM require further investigation. PROSPERO REGISTRATION NUMBER CRD42022381485.
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Affiliation(s)
- Danna Lin
- School of Nursing, Shantou University Medical College, Shantou, China
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Bing Hu
- Nursing Department, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Yuqi Xiu
- School of Nursing, Shantou University Medical College, Shantou, China
| | - Ruiting Ji
- School of Nursing, Shantou University Medical College, Shantou, China
| | - Huifang Zeng
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Hongyan Chen
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Yanchun Wu
- Nursing Research Institute, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Rode L, Wulff CB, Ekelund CK, Hoseth E, Petersen OB, Tabor A, El-Achi V, Hyett JA, McLennan AC. First-trimester prediction of preterm prelabour rupture of membranes incorporating cervical length measurement. Eur J Obstet Gynecol Reprod Biol 2023; 284:76-81. [PMID: 36940605 DOI: 10.1016/j.ejogrb.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES To examine early pregnancy risk factors for preterm prelabour rupture of membranes (PPROM) and develop a predictive model. STUDY DESIGN Retrospective analysis of a cohort of mixed-risk singleton pregnancies screened in the first and second trimesters in three Danish tertiary fetal medicine centres, including a cervical length measurement at 11-14 weeks, at 19-21 weeks and at 23-24 weeks of gestation. Univariable and multivariable logistic regression analyses were employed to identify predictive maternal characteristics, biochemical and sonographic factors. Receiver operating characteristic (ROC) curve analysis was used to determine predictors for the most accurate model. RESULTS Of 3477 screened women, 77 (2.2%) had PPROM. Maternal factors predictive of PPROM in univariable analysis were nulliparity (OR 2.0 (95% CI 1.2-3.3)), PAPP-A < 0.5 MoM (OR 2.6 (1.1-6.2)), previous preterm birth (OR 4.2 (1.9-8.9)), previous cervical conization (OR 3.6 (2.0-6.4)) and cervical length ≤ 25 mm on transvaginal imaging (first-trimester OR 15.9 (4.3-59.3)). These factors all remained statistically significant in a multivariable adjusted model with an AUC of 0.72 in the most discriminatory first-trimester model. The detection rate using this model would be approximately 30% at a false-positive rate of 10%. Potential predictors such as bleeding in early pregnancy and pre-existing diabetes mellitus affected very few cases and could not be formally assessed. CONCLUSIONS Several maternal characteristics, placental biochemical and sonographic features are predictive of PPROM with moderate discrimination. Larger numbers are required to validate this algorithm and additional biomarkers, not currently used for first-trimester screening, may improve model performance.
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Affiliation(s)
- Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Camilla B Wulff
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte K Ekelund
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eva Hoseth
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Olav B Petersen
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ann Tabor
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vanessa El-Achi
- Department of Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jon A Hyett
- The Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, New South Wales 2170, Australia; Department of Obstetrics and Gynaecology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Andrew C McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Sydney Ultrasound for Women, Sydney, New South Wales, Australia
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Demirer B, Samur G. Possible effects of dietary advanced glycation end products on maternal and fetal health: a review. Nutr Rev 2022:6762058. [PMID: 36250798 DOI: 10.1093/nutrit/nuac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Excessive accumulation of advanced glycation end products (AGEs) in the body has been associated with many adverse health conditions. The common point of the pathologies associated at this point is oxidative stress and inflammation. Pregnancy is an important period in which many physiological, psychological, and biological changes are experienced. Along with the physiological changes that occur during this period, the mother maintaining an AGE-rich diet may cause an increase in the body's AGE pool and may increase oxidative stress and inflammation, as seen in healthy individuals. Studies have reported the negative effects of maternal AGE levels on maternal and fetal health during pregnancy. Although gestational diabetes, preeclampsia, endothelial dysfunction, and pelvic diseases constitute maternal complications, a number of pathological conditions such as intrauterine growth retardation, premature birth, neural tube defect, neurobehavioral developmental disorders, fetal death, and neonatal asphyxia constitute fetal complications. It is thought that the mechanisms of these complications have not been confirmed yet and more clinical studies are needed on this subject. The possible effects of dietary AGE levels during pregnancy on maternal and fetal health are examined in this review.
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Affiliation(s)
- Büşra Demirer
- Nutrition and Dietetics, Karabuk University, Karabuk, Turkey
| | - Gülhan Samur
- Nutrition and Dietetics, Hacettepe University, Ankara, Turkey
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Gurbuz O, Yorgancı A, Ozgu-Erdinc AS, Tasci Y. First trimester screening of serum advanced glycation end products levels of pregnant women who have risk factors for gestational diabetes and their obstetric outcomes: a preliminary case-control study. J OBSTET GYNAECOL 2022; 42:3048-3054. [PMID: 35653797 DOI: 10.1080/01443615.2022.2081796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Advanced glycation end-products (AGE) are complex compounds formed by nonenzymatic glycosylation of proteins, nucleic acids, and lipids with glucose in the blood. We aimed to investigate whether there was a difference in first-trimester serum AGE levels of pregnant women with and without risk factors for gestational diabetes mellitus (GDM) and their obstetric outcomes. There were 44 women in study group who have risk factors for GDM and 44 as controls. Demographic features, serum AGE levels, adverse perinatal and neonatal outcomes were compared between groups. Five patients (11.4%) in the study group and one patient (2.3%) in the control group were diagnosed as GDM (p = .2). The serum AGE values were not statistically different between the study and control groups. There were no statistical differences between groups in terms of adverse perinatal and neonatal outcomes. However, in the group with adverse perinatal outcome (n = 25), AGE values were higher than the control group. The results of our preliminary study suggested that high-risk women for GDM did not have increased serum levels of AGE in the first trimester. Nevertheless, a high first-trimester serum AGE level was found to be associated with adverse perinatal outcomes. IMPACT STATEMENTWhat is already known on this subject? Advanced glycation end products (AGE) are markers that are associated with diabetes and its complications. For pregnant women, a high third trimester serum AGEs levels were found in women who had gestational diabetes.What do the results of this study add? The results of our study revealed that first trimester screening of serum AGE levels of women who had risk factors for gestational diabetes was not discriminate. Nevertheless, a high first trimester serum AGE levels was associated with adverse perinatal outcome.What are the implications of these findings for clinical practice and/or further research? Whether reducing exogenous sources of AGE (western-style diet, smoking) before pregnancy will be associated with better pregnancy outcomes should be investigated in future studies.
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Affiliation(s)
- Ozge Gurbuz
- Clinics of Obstetrics and Gynecology, Ministry of Health, Gaziantep Şehitkamil State Hospital, Gaziantep, Turkey
| | - Ayçağ Yorgancı
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Yasemin Tasci
- School of Medicine, Department of Obstetrics and Gynecology, Kütahya Health Sciences University, Kütahya, Turkey
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Gupta JK, Alfirevic A. Systematic review of preterm birth multi-omic biomarker studies. Expert Rev Mol Med 2022; 24:1-24. [PMID: 35379367 PMCID: PMC9884789 DOI: 10.1017/erm.2022.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 11/07/2022]
Abstract
Preterm birth (PTB) is one of the leading causes of deaths in infants under the age of five. Known risk factors of PTB include genetic factors, lifestyle choices or infection. Identification of omic biomarkers associated with PTB could aid clinical management of women at high risk of early labour and thereby reduce neonatal morbidity. This systematic literature review aimed to identify and summarise maternal omic and multi-omic (genomics, transcriptomics, proteomics and metabolites) biomarker studies of PTB. Original research articles were retrieved from three databases: PubMed, Web of Science and Science Direct, using specified search terms for each omic discipline. PTB studies investigating genomics, transcriptomics, proteomics or metabolomics biomarkers prior to onset of labour were included. Data were collected and reviewed independently. Pathway analyses were completed on the biomarkers from non-targeted omic studies using Reactome pathway analysis tool. A total of 149 omic studies were identified; most of the literature investigated proteomic biomarkers. Pathway analysis identified several cellular processes associated with the omic biomarkers reported in the literature. Study heterogeneity was observed across the research articles, including the use of different gestation cut-offs to define PTB. Infection/inflammatory biomarkers were identified across majority of papers using a range of targeted and non-targeted approaches.
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Affiliation(s)
- Juhi K. Gupta
- Wolfson Centre for Personalised Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3GL, UK
- Harris-Wellbeing Research Centre, University Department, Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Ana Alfirevic
- Wolfson Centre for Personalised Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3GL, UK
- Harris-Wellbeing Research Centre, University Department, Liverpool Women's Hospital, Liverpool L8 7SS, UK
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Is there a maternal blood biomarker that can predict spontaneous preterm birth prior to labour onset? A systematic review. PLoS One 2022; 17:e0265853. [PMID: 35377904 PMCID: PMC8979439 DOI: 10.1371/journal.pone.0265853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/08/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The ability to predict spontaneous preterm birth (sPTB) prior to labour onset is a challenge, and it is currently unclear which biomarker(s), may be potentially predictive of sPTB, and whether their predictive power has any utility. A systematic review was conducted to identify maternal blood biomarkers of sPTB. Methods This study was conducted according to PRISMA protocol for systematic reviews. Four databases (MEDLINE, EMBASE, CINAHL, Scopus) were searched up to September 2021 using search terms: “preterm labor”, “biomarker” and “blood OR serum OR plasma”. Studies assessing blood biomarkers prior to labour onset against the outcome sPTB were eligible for inclusion. Risk of bias was assessed based on the Newcastle Ottawa scale. Increased odds of sPTB associated with maternal blood biomarkers, as reported by odds ratios (OR), or predictive scores were synthesized. This review was not prospectively registered. Results Seventy-seven primary research articles met the inclusion criteria, reporting 278 unique markers significantly associated with and/or predictive of sPTB in at least one study. The most frequently investigated biomarkers were those measured during maternal serum screen tests for aneuploidy, or inflammatory cytokines, though no single biomarker was clearly predictive of sPTB based on the synthesized evidence. Immune and signaling pathways were enriched within the set of biomarkers and both at the level of protein and gene expression. Conclusion There is currently no known predictive biomarker for sPTB. Inflammatory and immune biomarkers show promise, but positive reporting bias limits the utility of results. The biomarkers identified may be more predictive in multi-marker models instead of as single predictors. Omics-style studies provide promising avenues for the identification of novel (and multiple) biomarkers. This will require larger studies with adequate power, with consideration of gestational age and the heterogeneity of sPTB to identify a set of biomarkers predictive of sPTB.
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Choltus H, Lavergne M, De Sousa Do Outeiro C, Coste K, Belville C, Blanchon L, Sapin V. Pathophysiological Implication of Pattern Recognition Receptors in Fetal Membranes Rupture: RAGE and NLRP Inflammasome. Biomedicines 2021; 9:biomedicines9091123. [PMID: 34572309 PMCID: PMC8466405 DOI: 10.3390/biomedicines9091123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
Preterm prelabor ruptures of fetal membranes (pPROM) are a pregnancy complication responsible for 30% of all preterm births. This pathology currently appears more as a consequence of early and uncontrolled process runaway activation, which is usually implicated in the physiologic rupture at term: inflammation. This phenomenon can be septic but also sterile. In this latter case, the inflammation depends on some specific molecules called “alarmins” or “damage-associated molecular patterns” (DAMPs) that are recognized by pattern recognition receptors (PRRs), leading to a microbial-free inflammatory response. Recent data clarify how this activation works and which receptor translates this inflammatory signaling into fetal membranes (FM) to manage a successful rupture after 37 weeks of gestation. In this context, this review focused on two PRRs: the receptor for advanced glycation end-products (RAGE) and the NLRP7 inflammasome.
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Affiliation(s)
- Helena Choltus
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Marilyne Lavergne
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Coraline De Sousa Do Outeiro
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Karen Coste
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Corinne Belville
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Loïc Blanchon
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Vincent Sapin
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
- CHU de Clermont-Ferrand, Biochemistry and Molecular Genetic Department, 63000 Clermont-Ferrand, France
- Correspondence: ; Tel.: +33-473-178-174
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Choltus H, Lavergne M, Belville C, Gallot D, Minet-Quinard R, Durif J, Blanchon L, Sapin V. Occurrence of a RAGE-Mediated Inflammatory Response in Human Fetal Membranes. Front Physiol 2020; 11:581. [PMID: 32670078 PMCID: PMC7330021 DOI: 10.3389/fphys.2020.00581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Context: Sterile inflammation has been shown to play a key role in the rupture of the fetal membranes (FMs). Moreover, an early and exacerbated runaway inflammation can evolve into a preterm premature rupture of membranes and lead to potential preterm birth. In this context, we investigated the receptor for advanced glycation end products (RAGE), an axis implied in physiological sterile inflammation, in conjunction with two major ligands: AGEs and High-Mobility Group Box 1 (HMGB1). Our first objective was to determine the spatiotemporal expression profiles of the different actors of the RAGE-signaling axis in human FMs, including its intracellular adaptors Diaphanous-1 and Myd88. Our second goal was to evaluate the functionality of RAGE signaling in terms of FMs inflammation. Methods The presence of the actors (RAGE, HMGB1, Myd88, and Diaphanous-1) at the mRNA level was investigated by reverse transcription quantitative polymerase chain reaction (RT-qPCR) in the human amnion and choriodecidua at the three trimesters and at term. Measurements were conducted at two distinct zones: the zone of intact morphology (ZIM) and the zone of altered morphology (ZAM). Then, proteins were quantified using Western blot analysis, and their localization was evaluated by immunofluorescence in term tissues. In addition, pro-inflammatory cytokine secretion was quantified using a Multiplex assay after the treatment of amnion and choriodecidua explants with two RAGE ligands (AGEs and HMGB1) in the absence or presence of a RAGE inhibitor (SAGEs). Results The FMs expressed the RAGE-signaling actors throughout pregnancy. At term, RNA and protein overexpression of the RAGE, HMGB1, and Diaphanous-1 were found in the amnion when compared to the choriodecidua, and the RAGE was overexpressed in the ZAM when compared to the ZIM. The two RAGE ligands (AGEs and HMGB1) induced differential cytokine production (IL1β and TNFα) in the amnion and choriodecidua. Conclusion Considered together, these results indicate that RAGE signaling is present and functional in human FMs. Our work opens the way to a better understanding of FMs weakening dependent on a RAGE-based sterile inflammation.
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Affiliation(s)
- Héléna Choltus
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marilyne Lavergne
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Corinne Belville
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Denis Gallot
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU de Clermont-Ferrand, Obstetrics and Gynecology Department, Clermont-Ferrand, France
| | - Régine Minet-Quinard
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU de Clermont-Ferrand, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France
| | - Julie Durif
- CHU de Clermont-Ferrand, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France
| | - Loïc Blanchon
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vincent Sapin
- CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU de Clermont-Ferrand, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France
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Bouvier D, Giguère Y, Blanchon L, Bujold E, Pereira B, Bernard N, Gallot D, Sapin V, Forest JC. Study of sRAGE, HMGB1, AGE, and S100A8/A9 Concentrations in Plasma and in Serum-Extracted Extracellular Vesicles of Pregnant Women With Preterm Premature Rupture of Membranes. Front Physiol 2020; 11:609. [PMID: 32655405 PMCID: PMC7324632 DOI: 10.3389/fphys.2020.00609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 37 weeks of gestation, complicates approximately 2–4% of pregnancies and is responsible for 40% of all spontaneous preterm births. PPROM arises from complex pathophysiological pathways with a key actor: inflammation. Sterile inflammation is a feature of senescence-associated fetal membrane maturity. During specific steps of sterile inflammation, cells also release highly inflammatory damage-associated molecular pattern markers (DAMPs), such as high-mobility group box 1 (HMGB1) or S100A8/A9, known to link and activate the receptor for advanced glycation end products (RAGE). The objective of this study was to measure longitudinally during pregnancy concentrations of the soluble form of RAGE (sRAGE) and its main ligands (AGE, HMGB1, S100A8/A9) in blood specimens. We studied 246 pregnant women (82 with PPROM and 164 matched control pregnant women without complications) from a cohort of 7,866 pregnant women recruited in the first trimester and followed during pregnancy until delivery. sRAGE, AGE, HMGB1, and S100A8/A9 concentrations were measured in plasma and in serum-extracted extracellular vesicles from first trimester (T1), second trimester (T2), and delivery (D). In plasma, we observed, in both PPROM and control groups, (i) a significant increase of HMGB1 concentrations between T1 vs. T2, T1 vs. D, but not between T2 vs. D; (ii) a significant decrease of sRAGE concentrations between T1 and T2 and a significant increase between T2 and D; (iii) a significant decrease of AGE from T1 to D; (iv) no significant variation of S100A8/A9 between trimesters. In intergroup comparisons (PPROM vs. control group), there were no significant differences in time variation taking into account the matching effects. There was a correlation between plasma and serum-extracted extracellular vesicle concentrations of sRAGE, AGE, HMGB1, and S100A8/A9. Our results suggest that the rupture of fetal membranes (physiological or premature) is accompanied by a variation in plasma concentrations of sRAGE, HMGB1, and AGE. The study of RAGE and its main ligands in extracellular vesicles did not give additional insight into the pathophysiological process conducting to PPROM.
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Affiliation(s)
- Damien Bouvier
- Biochemistry and Molecular Genetic Department, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France.,Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Yves Giguère
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Loïc Blanchon
- Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Emmanuel Bujold
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Bruno Pereira
- Biostatistics Unit Direction de la Recherche Clinique et des Innovations (DRCI), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Bernard
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada
| | - Denis Gallot
- Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, Université Clermont Auvergne, Clermont-Ferrand, France.,Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France.,Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Claude Forest
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, QC, Canada
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Bouvier D, Forest JC, Blanchon L, Bujold E, Pereira B, Bernard N, Gallot D, Sapin V, Giguère Y. Risk Factors and Outcomes of Preterm Premature Rupture of Membranes in a Cohort of 6968 Pregnant Women Prospectively Recruited. J Clin Med 2019; 8:jcm8111987. [PMID: 31731659 PMCID: PMC6912547 DOI: 10.3390/jcm8111987] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
We revisited risk factors and outcomes related to the preterm premature rupture of membranes (PPROM). A total of 7866 pregnant women were recruited during 5 years at their first prenatal visit to the perinatal clinic of the institution. We compared three groups (women without prematurity, women with spontaneous preterm labor with intact membranes (sPL with IM), women with PPROM) regarding 60 criteria about characteristics, lifestyle, medical, gynecological, obstetrical history of mothers, medication during pregnancy, events at delivery, and complications in neonates. Logistic regression analyses adjusting for potential confounding factors were used. Of the 6968 women selected, 189 (2.8%) presented a PPROM, and 225 (3.2%) an sPL with IM. The specific risk factors for PPROM were body mass index (BMI) <18.5 kg/m2 (adjusted odds ratio, aOR: 2.00 (1.09-3.67)), history of PPROM (aOR: 2.75 (1.19-6.36)), nulliparity (aOR: 2.52 (1.77-3.60)), gestational diabetes (aOR: 1.87 (1.16-2.99)), and low level of education (aOR: 2.39 (1.20-4.78)). The complications associated with PPROM were abruption placentae, cesarean, APGAR 5' <4, birth weight <2500 g, stillbirth, neonatal jaundice, and hospitalization of mother and neonates. All these complications were also associated with sPL with IM. Our study confirms some of the risk factors of PPROM and highlights a new one: gestational diabetes. Outcomes of PPROM are related to prematurity.
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Affiliation(s)
- Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France;
- Correspondence: ; Tel.: +33-4-73-75-48-82
| | - Jean-Claude Forest
- Department of Molecular Biology, Medical biochemistry and Pathology, Faculty of Medicine, Centre de recherche du CHU de Québec-Université Laval, Québec City, QC G1V 0A6, Canada; (J.-C.F.); (Y.G.)
| | - Loïc Blanchon
- Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France;
| | - Emmanuel Bujold
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada;
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Nathalie Bernard
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC G1L 3L5, Canada;
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France;
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France;
| | - Yves Giguère
- Department of Molecular Biology, Medical biochemistry and Pathology, Faculty of Medicine, Centre de recherche du CHU de Québec-Université Laval, Québec City, QC G1V 0A6, Canada; (J.-C.F.); (Y.G.)
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Underhill LA, Avalos N, Tucker R, Zhang Z, Messerlian G, Lechner B. Serum Decorin and Biglycan as Potential Biomarkers to Predict PPROM in Early Gestation. Reprod Sci 2019:1933719119831790. [PMID: 30895897 DOI: 10.1177/1933719119831790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Preterm birth is a leading cause of neonatal mortality in the US and globally, with preterm premature rupture of fetal membranes (PPROM) accounting for one third of preterm births. Currently no predictive diagnostics are available to precisely assess risk and potentially reduce the incidence of PPROM. Bigycan and decorin, the main proteoglycans present in human fetal membranes, are involved in the physiological maturation of fetal membranes as well as in the pathophysiology of preterm birth. The serum protein sex hormone-binding globulin (SHBG) has recently been identified as a predictor of spontaneous preterm birth. We hypothesize that the balance between serum decorin and biglycan on one hand and SHBG on the other hand may provide insight into the status of the fetal membranes in early pregnancy, thereby predicting PPROM prior to symptoms. Using chart review, 18 patients with confirmed cases of PPROM were identified from 2013-2016. Second trimester residual serum was retreived from freezer storage for these cases along with 5 matched controls for each case. The biomarkers biglycan, decorin and SHBG were analyzed first separately, then in combination to determine their ability to predict PPROM. The predictive score for the combined model displays an AUC = 0.774. The ROC curve of the predicted score has an optimal threshold of 0.238 and a sensitivity and specificity of 0.72 and 0.84 respectively. This prenatal serum panel is a promising serum screening-based biochemical model to predict PPROM in asymptomatic women.
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Affiliation(s)
- Lori A Underhill
- 1 Warren Alpert Medical School at Brown University, Providence, RI ,USA
- 2 Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
| | - Nora Avalos
- 2 Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
| | - Richard Tucker
- 2 Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
| | - Zheng Zhang
- 3 School of Public Health, Brown University, Providence, RI, USA
| | - Geralyn Messerlian
- 2 Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
| | - Beatrice Lechner
- 1 Warren Alpert Medical School at Brown University, Providence, RI ,USA
- 2 Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA
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Good clinical practice advice: Prediction of preterm labor and preterm premature rupture of membranes. Int J Gynaecol Obstet 2019; 144:340-346. [PMID: 30710365 DOI: 10.1002/ijgo.12744] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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