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Clinical Trial
. 2015 Apr;212(4):487.e1-487.e11.
doi: 10.1016/j.ajog.2015.02.010. Epub 2015 Feb 14.

The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool

Tracy A Manuck  1 , M Sean Esplin  2 , Joseph Biggio  3 , Radek Bukowski  4 , Samuel Parry  5 , Heping Zhang  6 , Hao Huang  6 , Michael W Varner  2 , William Andrews  3 , George Saade  4 , Yoel Sadovsky  7 , Uma M Reddy  8 , John Ilekis  8 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Genomics and Proteomics Network for Preterm Birth Research
Collaborators, Affiliations
Clinical Trial

The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool

Tracy A Manuck et al. Am J Obstet Gynecol. 2015 Apr.

Abstract

Objective: Spontaneous preterm birth (SPTB) is a complex condition that is likely a final common pathway with multiple possible causes. We hypothesized that a comprehensive classification system appropriately could group women with similar STPB causes and could provide an explanation, at least in part, for the disparities in SPTB that are associated with race and gestational age at delivery.

Study design: This was a planned analysis of a multicenter, prospective study of singleton SPTBs. Women with SPTB at <34 weeks' gestation were included. We defined 9 potential SPTB phenotypes based on clinical data: infection/inflammation, maternal stress, decidual hemorrhage, uterine distention, cervical insufficiency, placental dysfunction, premature rupture of the membranes, maternal comorbidities, and familial factors. Each woman's condition was evaluated for each phenotype. Delivery gestational age was compared between those with and without each phenotype. Phenotype profiles were also compared between women with very early (20.0-27.9 weeks' gestation) SPTB vs those with early SPTB (28.0-34.0 weeks' gestation) and between African American and white women. Statistical analysis was by t test and χ(2) test, as appropriate.

Results: The phenotyping tool was applied to 1025 women with SPTBs who delivered at a mean 30.0 ± 3.2 (SD) weeks' gestation. Of these, 800 women (78%) had ≥2 phenotypes. Only 43 women (4.2%) had no phenotypes. The 281 women with early SPTBs were more likely to have infection/inflammation, decidual hemorrhage, and cervical insufficiency phenotypes (all P ≤ .001). African American women had more maternal stress and cervical insufficiency but less decidual hemorrhage and placental dysfunction compared with white women (all P < .05). Gestational age at delivery decreased as the number of phenotypes that were present increased.

Conclusion: Precise SPTB phenotyping classifies women with SPTBs and identifies specific differences between very early and early SPTB and between African American and white women.

Keywords: phenotype; preterm; racial disparity; spontaneous preterm birth.

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Conflict of interest statement

Conflict of Interest/Disclosure Statement: Dr. Sean Esplin serves on the scientific advisory board and holds stock in Sera Prognostics, a private company that was established to create a commercial test to predict preterm birth and other obstetric complications. The remaining authors report no conflict of interest.

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