title: Biomarkers of inflammation and placental dysfunction are associated with subsequent preterm birth.
abstract: 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.
authors.affiliation: 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
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Bastek
authors.forename: Amy G
authors.initials: AG
authors.lastname: Brown
authors.forename: Lauren
authors.initials: L
authors.lastname: Anton
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'addio
authors.forename: Michal A
authors.initials: MA
authors.lastname: Elovitz
mesh_terms: 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
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D002097:C-Reactive Protein