Elevated mid-trimester amniotic fluid ADAM-8 concentrations as a potential risk factor for preterm delivery.
OBJECTIVE
To determine during mid-trimester amniocentesis if elevated concentrations of ADAM-8 (A Disintegrin And Metalloprotease 8) and/or cortisol can recognize women at risk for spontaneous preterm delivery.


METHODS
The study involved 312 women who underwent mid-trimester amniocentesis. Thirteen patients, who progressed to preterm delivery, were matched with 21 controls for age, parity, gestational age at amniocentesis, and year of amniocentesis. ADAM-8 and cortisol levels were measured by enzyme-linked immunosorbent assay and radioimmunoassay, respectively.


RESULTS
ADAM-8 mean amniotic fluid concentrations were significantly higher in women with preterm delivery than in women delivering at term (mean 1213.9 [SE 96.7] pg/mL [range, 780 to 1854 pg/mL] vs mean 937.2 [SE 50.3] pg/mL [range, 486 to 1508 pg/mL], P < .02). Amniotic fluid ADAM-8 concentrations higher than 1149 pg/mL had the highest specificity and odds ratio (OR) in the identification of the women with increased risk for preterm delivery (sensitivity 61.5%; specificity 81.7%; OR, 9.6 [95% confidence interval (CI), 1.8 to 50.3]). Women with preterm delivery had suggestively higher amniotic fluid concentrations of cortisol (mean 1.3 [SE 0.2] microg/dL [range, 0.4 to 2.2 microg/dL]) than women delivering at term (mean 1.0 [SE 0.09] microg/dL [range, 0.6 to 1.7 microg/dL], P < .07). Furthermore, cortisol levels were positively correlated with ADAM-8 levels (Spearman's r = .418, P < .014).


CONCLUSIONS
Elevated mid-trimester amniotic fluid ADAM-8 concentrations possibly are a risk factor for preterm delivery, particularly if ADAM-8 levels are greater than 1149 pg/mL. Potential intrauterine inflammation is also associated with suggestively increased amniotic fluid cortisol levels.
Vrachnis
Nikolaos
N
Second Department of Obstetrics and Gynecology, Aretaeion Hospital, University of Athens, Greece. nvrachnis@hotmail.com
Malamitsi-Puchner
Adriadne
A
Samoli
Evi
E
Botsis
Dimitrios
D
Iliodromiti
Zoe
Z
Baka
Stavroula
S
Hassiakos
Dimitrios
D
Creatsas
George
G
D051722:ADAM Proteins / Q000032:analysis / Q000378:metabolism*; D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D007249:Inflammation; D008565:Membrane Proteins / Q000032:analysis / Q000378:metabolism*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth; D012016:Reference Values; D012307:Risk Factors
D008565:Membrane Proteins; D051722:ADAM Proteins; C068490:ADAM8 protein, human; D006854:Hydrocortisone