Second trimester serum predictors of preterm birth in a population-based sample of low-risk pregnancies

Genetic Disease Screening Program, California Department of Public Health, Richmond, CA 94804, USA.
Prenatal Diagnosis (Impact Factor: 3.27). 08/2010; 30(8):727-33. DOI: 10.1002/pd.2489
Source: PubMed


To examine the relationship between typically collected second trimester maternal serum biomarkers and preterm birth among pregnancies without intrauterine-growth-retardation or other specific risk factors.
Included were 102 861 singleton pregnancies without specific risks that resulted in the live birth of an infant of normal birth weight for gestational age without aneuploidy or a neural tube defect. Logistic binomial regression analyses were used to estimate the relative risk (RR) of giving birth preterm among pregnancies with an abnormal level of alpha-fetoprotein (AFP), human chorionic gonatotropin (hCG), and/or unconjugated estriol (uE3) compared to pregnancies with normal biomarker levels.
When compared to pregnancies with normal levels of AFP, hCG, and uE3, pregnancies with elevated levels of any biomarker [multiple of the median (MoM) >or= 2.0] were at an increased risk for preterm birth regardless of preterm grouping (RRs 1.3-5.4). Risks for preterm birth tended to increase substantially when at least two biomarkers were elevated (RRs 2.2-18.7).
The results suggest that second trimester maternal serum biomarkers may help identify pregnancies at increased risk for preterm birth when no other identified risks are present. Data indicates that biomarkers may be particularly predictive of early preterm birth.

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    • "Research suggests a complex, perhaps redundant , set of signals that vary over the course of gestation (Vigano et al. 2003; Erlebacher 2010; Sales et al. 2011). As noted by Haig (1993), Møller (1997), Forbes (2005), and Baird (2009), however, a relatively low level of gestational human chorionic gonadotropin (hCG) in maternal serum predicts spontaneous abortion better than other candidate signals (Dugoff et al. 2004; Goetzl et al. 2004; Cole 2010; Jelliffe-Pawlowski et al. 2010; Kirkegaard et al. 2011). Consistent with the assumption that male fetuses disproportionately rank low on fitness, gestations of males yield endemically lower hCG levels in maternal serum than those of females (Yaron et al. 2001; Cowans et al. 2009). "
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