title: Metabolomics in premature labor: a novel approach to identify patients at risk for preterm delivery.
abstract: OBJECTIVE
  Biomarkers for preterm labor (PTL) and delivery can be discovered through the analysis of the transcriptome (transcriptomics) and protein composition (proteomics). Characterization of the global changes in low-molecular weight compounds which constitute the 'metabolic network' of cells (metabolome) is now possible by using a 'metabolomics' approach. Metabolomic profiling has special advantages over transcriptomics and proteomics since the metabolic network is downstream from gene expression and protein synthesis, and thus more closely reflects cell activity at a functional level. This study was conducted to determine if metabolomic profiling of the amniotic fluid can identify women with spontaneous PTL at risk for preterm delivery, regardless of the presence or absence of intraamniotic infection/inflammation (IAI).
  
  
  METHODS
  Two retrospective cross-sectional studies were conducted, including three groups of pregnant women with spontaneous PTL and intact membranes: (1) PTL who delivered at term; (2) PTL without IAI who delivered preterm; and (3) PTL with IAI who delivered preterm. The first was an exploratory study that included 16, 19, and 20 patients in groups 1, 2, and 3, respectively. The second study included 40, 33, and 40 patients in groups 1, 2, and 3, respectively. Amniotic fluid metabolic profiling was performed by combining chemical separation (with gas and liquid chromatography) and mass spectrometry. Compounds were identified using authentic standards. The data were analyzed using discriminant analysis for the first study and Random Forest for the second.
  
  
  RESULTS
  (1) In the first study, metabolomic profiling of the amniotic fluid was able to identify patients as belonging to the correct clinical group with an overall 96.3% (53/55) accuracy; 15 of 16 patients with PTL who delivered at term were correctly classified; all patients with PTL without IAI who delivered preterm neonates were correctly identified as such (19/19), while 19/20 patients with PTL and IAI were correctly classified. (2) In the second study, metabolomic profiling was able to identify patients as belonging to the correct clinical group with an accuracy of 88.5% (100/113); 39 of 40 patients with PTL who delivered at term were correctly classified; 29 of 33 patients with PTL without IAI who delivered preterm neonates were correctly classified. Among patients with PTL and IAI, 32/40 were correctly classified. The metabolites responsible for the classification of patients in different clinical groups were identified. A preliminary draft of the human amniotic fluid metabolome was generated and found to contain products of the intermediate metabolism of mammalian cells and xenobiotic compounds (e.g. bacterial products and Salicylamide).
  
  
  CONCLUSIONS
  Among patients with spontaneous PTL with intact membranes, metabolic profiling of the amniotic fluid can be used to assess the risk of preterm delivery in the presence or absence of infection/inflammation.
authors.affiliation: Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA. prbchiefstaff@med.wayne.edu
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Shali
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.forename: Edi
authors.initials: E
authors.lastname: Vaisbuch
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Kusanovic
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gomez
authors.forename: Jyh Kae
authors.initials: JK
authors.lastname: Nien
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Yoon
authors.forename: Moshe
authors.initials: M
authors.lastname: Mazor
authors.forename: Jingqin
authors.initials: J
authors.lastname: Luo
authors.forename: David
authors.initials: D
authors.lastname: Banks
authors.forename: John
authors.initials: J
authors.lastname: Ryals
authors.forename: Chris
authors.initials: C
authors.lastname: Beecher
mesh_terms: D000293:Adolescent; D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000737:chemistry / Q000382:microbiology; D002821:Chorioamnionitis / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D005583:Fourier Analysis; D008401:Gas Chromatography-Mass Spectrometry; D005865:Gestational Age; D006801:Humans; D013058:Mass Spectrometry; D055432:Metabolomics; D007752:Obstetric Labor, Premature / Q000145:classification; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors