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. 2013 Jun;208(6):492.e1-11.
doi: 10.1016/j.ajog.2013.02.012. Epub 2013 Feb 24.

Association of early-preterm birth with abnormal levels of routinely collected first- and second-trimester biomarkers

Laura L Jelliffe-Pawlowski  1 , Gary M Shaw, Robert J Currier, David K Stevenson, Rebecca J Baer, Hugh M O'Brodovich, Jeffrey B Gould
Affiliations

Association of early-preterm birth with abnormal levels of routinely collected first- and second-trimester biomarkers

Laura L Jelliffe-Pawlowski et al. Am J Obstet Gynecol. 2013 Jun.

Abstract

Objective: The purpose of this study was to examine the relationship between typically measured prenatal screening biomarkers and early-preterm birth in euploid pregnancies.

Study design: The study included 345 early-preterm cases (<30 weeks of gestation) and 1725 control subjects who were drawn from a population-based sample of California pregnancies who had both first- and second-trimester screening results. Logistic regression analyses were used to compare patterns of biomarkers in cases and control subjects and to develop predictive models. Replicability of the biomarker early-preterm relationships that was revealed by the models was evaluated by examination of the frequency and associated adjusted relative risks (RRs) for early-preterm birth and for preterm birth in general (<37 weeks of gestation) in pregnancies with identified abnormal markers compared with pregnancies without these markers in a subsequent independent California cohort of screened pregnancies (n = 76,588).

Results: The final model for early-preterm birth included first-trimester pregnancy-associated plasma protein A in the ≤5th percentile, second-trimester alpha-fetoprotein in the ≥95th percentile, and second-trimester inhibin in the ≥95th percentile (odds ratios, 2.3-3.6). In general, pregnancies in the subsequent cohort with a biomarker pattern that were found to be associated with early-preterm delivery in the first sample were at an increased risk for early-preterm birth and preterm birth in general (<37 weeks of gestation; adjusted RR, 1.6-27.4). Pregnancies with ≥2 biomarker abnormalities were at particularly increased risk (adjusted RR, 3.6-27.4).

Conclusion: When considered across cohorts and in combination, abnormalities in routinely collected biomarkers reveal predictable risks for early-preterm birth.

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Conflict of interest statement

Disclosure: None of the authors have a conflict of interest.

Figures

Figure 1
Figure 1
Selection of cases and controls for singleton pregnancies with expected delivery in 2009 or 2010. aExclusions based on screening and registry data included 197 mother-infant pairs with hromosomal defects, 10 with NTDs, 1,093 with a stated history of smoking, and 715 with diabetes. bAdditional exclusions based on CPQCC/NICU data included 55 mother-infant pairs with other critical birth defects, 55 additional pairs with reported diabetes during or before pregnancy, 13 additional pregnancies with reports of smoking, 10 pregnancies with preeclampsia, and 9 pregnancies with oligio- or polyhydramnios.
Figure 2
Figure 2
Observed associations between target biomarker and early preterm birth (combined over spontaneous labor and medically indicated) in the training study set (2009–2010 cohort) and in the testing study set (2011 cohort). OR, Odds Ratio; RR, Relative Risk; 95% CI, Confidence Interval; PAPPA, pregnancy associated plasma protein A; AFP, alpha-fetoprotein; INH, inhibin; MoM, multiple of the median
Figure 3
Figure 3
Percent of preterm pregnancies by biomarker pattern: Singleton pregnancies with expected delivery in 2011.
See this image and copyright information in PMC

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