A cohort study found that white blood cell count and endocrine markers predicted preterm birth in symptomatic women.
OBJECTIVE
This cohort study investigated potential clinical and biochemical predictors of subsequent preterm birth in women presenting with threatened preterm labor.


METHODS
Subjects were 218 pregnant women admitted to hospital with a diagnosis of threatened preterm labor at 22-36 weeks gestation. Exclusion criteria were multiple pregnancy, fetal anomalies, diabetes mellitus, abruptio placenta, preeclampsia, intrauterine growth restriction, cervical dilatation > 4 cm, and clinical signs of infection. Analyses used logistic regression.


RESULTS
The presence of ruptured membranes was the best predictor of birth within 48 hours. Other important predictors were maternal white blood cell count at 22-27 weeks gestation and maternal adrenocorticotropin and corticotropin-releasing hormone concentrations at 28-36 weeks gestation.


CONCLUSIONS
Subclinical infection may be an important etiologic factor in preterm births of gestational age < 28 weeks. For those at > or = 28 weeks gestation, the findings support the etiologic role of activation of the fetal and/or maternal hypothalamic pituitary adrenal axis leading to preterm birth.
Campbell
M Karen
MK
Department of Epidemiology and Biostatistics, University of Western Ontario, Kresge Building, London, Ontario, Canada. karen.campbell@fmd.uwo.ca
Challis
John R G
JR
DaSilva
Orlando
O
Bocking
Alan D
AD
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications; D005865:Gestational Age; D006801:Humans; D007958:Leukocyte Count; D007752:Obstetric Labor, Premature / Q000097:blood / Q000209:etiology; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood* / Q000209:etiology; D012307:Risk Factors
D015415:Biomarkers; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone