Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

Abstract

Background: Preterm delivery (PTD) is a major cause of perinatal mortality and delayed psychomotor development in children. The application of new biochemical and biophysical markers can improve the accuracy of the prediction of spontaneous PTD.Objectives: To examine the performance of screening for spontaneous PTD by a combination of maternal history, biochemical and biophysical markers at 11 + 0 -13 + 6 weeks' (wks) gestation. Material and methods:This was a case-control study of 180 pregnant women between 11-13 + 6 weeks' gestation. Study group consisted of 100 healthy participants and 80 participants with at least one risk factor of spontaneous PTD in their medical history. Following parameters were recorded: Maternal history, cervical length (Cx), uterine artery pulsatility index (UtA PI), pregnancy-associated plasma protein A (PAPP-A), free beta subunit of human chorionic gonadotropin (β-hCG), alpha-fetoprotein (AFP). Based on the gestational age at delivery the study group was retrospectively divided into three groups: 1. Patients who delivered at term (control group); 2. Patients who delivered before 34 weeks' gestation (early PTD); 3. Patients who delivered between 34 and 37 weeks' gestation (late PTD). In these groups potential biomarkers for spontaneous PTD were analysed.Results: A multivariable stepwise logistic regression analysis indicated that early PTD can be predicted based on a combined analysis of maternal history, cervical length and AFP and PAPP-A concentrations: Detection rate (DR): 93%; false positive rate (FPR): 10%. The performance of screening for late PTD is less effective: Combined analysis of maternal risk factors, cervical length and AFP and PAPP-A concentrations allows to detect 88% of cases at a FPR of 10%. Conclusions:The best fitted model for the prediction of spontaneous preterm delivery before 34 weeks is based on a combined analysis of maternal risk factors, measurement of the cervical length and measurement of AFP and PAPP-A concentrations. The best fitted model for the prediction of preterm delivery between 34-37 weeks' gestation is based on a combined analysis of maternal factors, measurement of the cervical length and measurement of AFP concentrations.