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Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth.

CPQCC Publication
TitleMaternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth.
Publication TypeJournal Article
Year of Publication2015
AuthorsJelliffe-Pawlowski LL, Baer RJ, Blumenfeld YJ, Ryckman KK, O'Brodovich HM, Gould JB, Druzin ML, El-Sayed YY, Lyell DJ, Stevenson DK, Shaw GM, Currier RJ
Date Published2015 Oct
KeywordsAdolescent, Adult, alpha-Fetoproteins, Anemia, Biomarkers, Birth Intervals, California, Cesarean Section, Cohort Studies, Continental Population Groups, Diabetes Mellitus, Female, Humans, Hypertension, Inhibins, Logistic Models, Pregnancy, Pregnancy Complications, Pregnancy Trimester, First, Pregnancy Trimester, Second, Pregnancy-Associated Plasma Protein-A, Premature Birth, Risk Factors, Young Adult

OBJECTIVE: To examine the relationship between maternal characteristics, serum biomarkers and preterm birth (PTB) by spontaneous and medically indicated subtypes.

DESIGN: Population-based cohort.

SETTING: California, United States of America.

POPULATION: From a total population of 1 004 039 live singleton births in 2009 and 2010, 841 665 pregnancies with linked birth certificate and hospital discharge records were included.

METHODS: Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models and 95% confidence intervals. First-trimester and second-trimester serum marker levels were analysed in a subset of 125 202 pregnancies with available first-trimester and second-trimester serum biomarker results.


RESULTS: In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, pre-existing hypertension with and without pre-eclampsia, gestational hypertension with pre-eclampsia, pre-existing diabetes, anaemia, previous PTB, one or two or more previous caesarean section(s), interpregnancy interval ≥ 60 months, low first-trimester pregnancy-associated plasma protein A, high second-trimester α-fetoprotein, and high second-trimester dimeric inhibin A). These risks occurred in 51.6-86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically indicated PTB <32 weeks in women with pre-existing hypertension and pre-eclampsia (adjusted odds ratio 89.7, 95% CI 27.3-111.2).

CONCLUSIONS: Our findings suggest a shared aetiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies.

TWEETABLE ABSTRACT: Findings suggest a shared aetiology across preterm birth subtypes. Patterns may inform risk reduction efforts.

Alternate JournalBJOG
PubMed ID26111589
PubMed Central IDPMC4704442
Grant ListR00 HD065786 / HD / NICHD NIH HHS / United States