title: Vaginal fetal fibronectin measurements from 8 to 22 weeks' gestation and subsequent spontaneous preterm birth.
abstract: OBJECTIVE
  We sought to determine the range of fetal fibronectin values in the vagina from 8 to 22 weeks' gestation, the factors associated with both low and high values, and whether high values are associated with gestational age at birth.
  
  
  METHODS
  Vaginal fetal fibronectin was quantitatively determined in a prospective cohort study of 13,360 women being evaluated for participation in the National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit treatment trials for bacterial vaginosis and Trichomonas vaginalis. Fetal fibronectin values were correlated with gestational age at screening, race, the presence of bacterial vaginosis and Trichomonas vaginalis, and gestational age at delivery.
  
  
  RESULTS
  Vaginal fetal fibronectin values at each gestational age ranged from unmeasurable to >1000 ng/mL, with median values always being <10 ng/mL. Fetal fibronectin values declined progressively with increasing gestational age at sampling. Bacterial vaginosis and black race were associated with higher values, whereas nulliparity was associated with lower values. High values after 13 weeks' gestation were associated with a 2- to 3-fold increased risk of subsequent spontaneous preterm birth overall and a 4-fold increased risk of very early preterm birth.
  
  
  CONCLUSIONS
  Elevated vaginal fetal fibronectin levels from 13 to 22 weeks' gestation are associated with a significantly increased risk of spontaneous preterm birth.
authors.affiliation: Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development, Bethesda, MD, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: M
authors.initials: M
authors.lastname: Klebanoff
authors.forename: J C
authors.initials: JC
authors.lastname: Carey
authors.forename: C
authors.initials: C
authors.lastname: Macpherson
authors.forename: K J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: A H
authors.initials: AH
authors.lastname: Moawad
authors.forename: B
authors.initials: B
authors.lastname: Sibai
authors.forename: R P
authors.initials: RP
authors.lastname: Heine
authors.forename: J M
authors.initials: JM
authors.lastname: Ernest
authors.forename: M P
authors.initials: MP
authors.lastname: Dombrowski
authors.forename: M
authors.initials: M
authors.lastname: Miodovnik
authors.forename: R J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: J D
authors.initials: JD
authors.lastname: Iams
authors.forename: O
authors.initials: O
authors.lastname: Langer
authors.forename: M J
authors.initials: MJ
authors.lastname: O'sullivan
authors.forename: J M
authors.initials: JM
authors.lastname: Roberts
mesh_terms: D044383:Black People; D015331:Cohort Studies; D005260:Female; D005333:Fetus / Q000378:metabolism*; D005353:Fibronectins / Q000378:metabolism*; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000378:metabolism; D011446:Prospective Studies; D012307:Risk Factors; D014621:Vagina / Q000378:metabolism*; D016585:Vaginosis, Bacterial / Q000378:metabolism
chemical_list: D005353:Fibronectins