Elevated levels of decidual insulin-like growth factor binding protein-1 in cervical fluid in early and mid-pregnancy are associated with an increased risk of spontaneous preterm delivery.
OBJECTIVE
To study whether elevated levels of decidual insulin-like growth factor binding protein-1 (IGFBP-1) in the cervical fluid of unselected asymptomatic women in early or mid-pregnancy are associated with spontaneous preterm delivery (PTD).


METHODS
Prospective population-based cohort study.


METHODS
Maternity Clinics, University Central Hospital, Helsinki, Finland.


METHODS
A total of 5180 unselected pregnant women.


METHODS
Cervical swab samples were collected during the first and second trimester ultrasound screening. The concentration of IGFBP-1 was measured by immunoenzymometric assay, which detects the decidual phosphoisoforms of IGFBP-1 (phIGFBP-1). Concentrations of 10 micrograms/l or more were considered to be elevated.


METHODS
Spontaneous PTD. Results In the first trimester, 24.5% of women, and in the mid-second trimester, 20.2% of women, had an elevated cervical fluid phIGFBP-1 level. The rates of spontaneous PTD before 32 and before 37 weeks of gestation were higher in women with an elevated cervical fluid phIGFBP-1 level, compared with women who had cervical phIGFBP-1 of <10 micrograms/l (1.1% versus 0.3% and 5.7% versus 3.2%, respectively). An elevated phIGFBP-1 level in the first trimester was an independent predictor for PTD before 32 and before 37 weeks of gestation, with odds ratios of 3.0 (95% CI 1.3-7.0) and 1.6 (95% CI 1.2-2.3), respectively. Cervical phIGFBP-1 levels of 10 micrograms/l or more in the first trimester predicted PTD before 32 and before 37 weeks of gestation, with sensitivities of 53.8% and 37.0%, respectively. The negative predictive values were 99.7% and 96.8%.


CONCLUSIONS
Elevated cervical fluid phIGFBP-1 levels in the first trimester were associated with an increased risk of spontaneous PTD.
Rahkonen
L
L
Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland. leena.rahkonen@hus.fi
Rutanen
E-M
EM
Nuutila
M
M
Sainio
S
S
Saisto
T
T
Paavonen
J
J
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002584:Cervix Uteri / Q000737:chemistry* / Q000166:cytology*; D003656:Decidua / Q000737:chemistry*; D005260:Female; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000378:metabolism*; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000378:metabolism / Q000517:prevention & control*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
D015415:Biomarkers; D018970:Insulin-Like Growth Factor Binding Protein 1