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

CPQCC Publication
TitleAssociation of early-preterm birth with abnormal levels of routinely collected first- and second-trimester biomarkers.
Publication TypeJournal Article
Year of Publication2013
AuthorsJelliffe-Pawlowski LL, Shaw GM, Currier RJ, Stevenson DK, Baer RJ, O'Brodovich HM, Gould JB
JournalAm J Obstet Gynecol
Date Published2013 Jun
KeywordsAdolescent, Adult, alpha-Fetoproteins, Biomarkers, California, Case-Control Studies, Cohort Studies, Female, Humans, Logistic Models, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Pregnancy-Associated Plasma Protein-A, Premature Birth, Prenatal Diagnosis, Risk, Young Adult

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.

Alternate JournalAm. J. Obstet. Gynecol.
PubMed ID23395922
PubMed Central IDPMC3672244
Grant ListRC2 HL101748 / HL / NHLBI NIH HHS / United States