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
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.
Available from: Elizabeth Anderson
- "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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ABSTRACT: Evolutionary theory, when coupled with research from epidemiology, demography, and population endocrinology, suggests that contracting economies affect the fitness and health of human populations via natural selection in utero. We know, for example, that fetal death increases more among males than females when the economy unexpectedly contracts; that unexpected economic contraction predicts low secondary sex ratios; and that males from low sex ratio birth cohorts live, on average, longer than those from high sex ratio cohorts. We also know that low levels of human chorionic gonadotropin (i.e., hCG) measured in the serum of pregnant women predict fetal death. We do not, however, know whether male survivors of conception cohorts subjected to contracting economies exhibit, as theory predicts, higher hCG than those from other cohorts. We show, in 71 monthly conception cohorts including nearly two million California births, that they do. We thereby add to the literature suggesting that the economy, a phenomenon over which we collectively exercise at least some control, affects population health. Our findings imply that the effect arises via natural selection - a mechanism we largely ignore when attempting to explain, or alter, how collective choice affects our biology.
Evolutionary Applications 12/2012; 5(8):796-805. DOI:10.1111/j.1752-4571.2012.00258.x · 3.90 Impact Factor
Available from: fetalmedicine.com
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ABSTRACT: To examine the potential value of maternal serum level of α-fetoprotein (AFP) in the first trimester of pregnancy in the prediction of spontaneous early preterm delivery.
Maternal serum concentration of AFP at 11-13 weeks' gestation was measured in a case-control study of singleton pregnancies delivering phenotypically normal neonates, including 33 cases with spontaneous delivery before 34 weeks and 99 matched controls delivering after 37 weeks. The median multiple of the median (MoM) serum AFP in the two outcome groups was compared and the bivariate gaussian distributions were simulated in a previously described screened population of 33,370 pregnancies to estimate the performance of screening for early delivery by a combination of maternal characteristics and obstetric history with serum AFP.
In the preterm delivery group compared to the term delivery group, the median serum AFP MoM was higher (1.33 vs. 0.97, p = 0.006). The estimated detection rate of preterm delivery, at a false-positive rate of 10%, from maternal characteristics and obstetric history was 27.5% and this increased to 36.0% with the addition of serum AFP.
Measurement of serum AFP at 11-13 weeks improves the prediction of early preterm delivery provided by maternal characteristics and obstetric history.
Fetal Diagnosis and Therapy 03/2011; 30(2):88-93. DOI:10.1159/000324352 · 2.94 Impact Factor
Available from: Joana Pinto
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ABSTRACT: This work describes an exploratory NMR metabonomic study of second trimester maternal urine and plasma, in an attempt to characterize the metabolic changes underlying prenatal disorders and identify possible early biomarkers. Fetal malformations have the strongest metabolic impact in both biofluids, suggesting effects due to hypoxia (leading to hypoxanthine increased excretion) and a need for enhanced gluconeogenesis, with higher ketone bodies (acetone and 3-hydroxybutyric acid) production and TCA cycle demand (suggested by glucogenic amino acids and cis-aconitate overproduction). Choline and nucleotide metabolisms also seem affected and a distinct plasma lipids profile is observed for mothers with fetuses affected by central nervous system malformations. Urine from women who subsequently develop gestational diabetes mellitus exhibits higher 3-hydroxyisovalerate and 2-hydroxyisobutyrate levels, probably due to altered biotin status and amino acid and/or gut metabolisms (the latter possibly related to higher BMI values). Other urinary changes suggest choline and nucleotide metabolic alterations, whereas lower plasma betaine and TMAO levels are found. Chromosomal disorders and pre-preterm delivery groups show urinary changes in choline and, in the latter case, in 2-hydroxyisobutyrate. These results show that NMR metabonomics of maternal biofluids enables the noninvasive detection of metabolic changes associated to prenatal disorders, thus unveiling potential disorder biomarkers.
Journal of Proteome Research 06/2011; 10(8):3732-42. DOI:10.1021/pr200352m · 4.25 Impact Factor
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