Biomarkers of inflammation and placental dysfunction are associated with subsequent preterm birth.
OBJECTIVE
To assess whether the analysis of high sensitivity C-Reactive Protein (hsCRP), a biomarker of inflammation, and placental growth factor (PlGF), a biomarker of placental dysfunction, could help identify patients at risk for preterm birth (PTB).


METHODS
We performed a prospective cohort study of women with symptoms of preterm labor (22-33 6/7 weeks). Maternal serum was analyzed for hsCRP and PlGF. Median biomarker values were used as analytic cut-points. We performed chi-square tests of association between biomarkers and PTB, nonparametric tests to compare medians, and logistic regression to determine the odds of PTB associated with biomarker values. Test characteristics of each biomarker were calculated.


RESULTS
56.3% of the cohort (N = 96) delivered preterm. Median hsCRP (N = 78) was 4.34 mg/L, and median PlGF (N = 86) was 558.25 mg/l. In the setting of inflammation (high hsCRP), women with low PlGF had a 6.84-fold (95%CI: 1.57-29.80) increased risk of PTB. In the setting of placental dysfunction (low PlGF), women with high hsCRP had a 5.97-fold (95%CI: 1.52-23.43) increased risk of PTB.


CONCLUSIONS
Our results suggest an interplay between inflammation and placental dysfunction in the pathogenesis of PTB. Analyzing biomarkers that reflect different pathways of PTB may hold promise for identifying patients at greatest risk.
Bastek
Jamie A
JA
Maternal and Child Health Research Program, Center for Research on Reproduction and Women's Health, Department of Obstetrics & Gynecology, University of Pennsylvania Medical Center, 421 Curie Boulevard, 1353 BRB 2/3, Philadelphia, PA 19104, USA. jbastek@obgyn.upenn.edu
Brown
Amy G
AG
Anton
Lauren
L
Srinivas
Sindhu K
SK
D'addio
Antonietta
A
Elovitz
Michal A
MA
D015415:Biomarkers / Q000032:analysis / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood*; D010920:Placenta / Q000503:physiopathology; D010922:Placenta Diseases / Q000097:blood* / Q000503:physiopathology; D000072483:Placenta Growth Factor; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000032:analysis / Q000097:blood; D047928:Premature Birth / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012307:Risk Factors
D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D002097:C-Reactive Protein