title: First-trimester prediction of preterm birth using ADAM12, PAPP-A, uterine artery Doppler, and maternal characteristics.
abstract: OBJECTIVE
  The objective of this study was to estimate the efficiency of first-trimester a disintegrin and metalloprotease 12 (ADAM12), pregnancy-associated plasma protein A (PAPP-A), uterine artery Doppler, and maternal characteristics in the prediction of preterm birth (PTB).
  
  
  METHODS
  This was a prospective cohort study of patients presenting for first-trimester aneuploidy screening. Maternal serum ADAM12 and PAPP-A levels were measured by immunoassay, and mean uterine artery Doppler pulsatility indices were calculated. The primary outcome was PTB <34 weeks' gestation, and the secondary outcome was PTB <37 weeks' gestation. Logistic regression was used to model the prediction of PTB using ADAM12, PAPP-A, uterine artery Doppler, and maternal characteristics, individually and in combination. Sensitivity, specificity, and area under the receiver-operating characteristic curves were compared between models.
  
  
  RESULTS
  Of 578 patients, 36 (6.2%) delivered <34 weeks, and 78 (13.5%) delivered <37 weeks. For a 20% fixed false positive rate, ADAM12, PAPP-A, and uterine artery Doppler identified 58%, 52%, and 62% of patients with PTB <34 weeks and 42%, 48%, and 50% of patients with PTB <37 weeks, respectively. Combining these first-trimester parameters did not improve the predictive efficiency of the models.
  
  
  CONCLUSIONS
  First-trimester ADAM12, PAPP-A, and uterine artery Doppler are each modestly predictive of PTB; however, combinations of these parameters do not further improve their screening efficiency.
authors: Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, USA. goetzingerk@wudosis.wustl.edu
authors: Katherine R
authors: KR
authors: Goetzinger
authors: Alison G
authors: AG
authors: Cahill
authors: Janet
authors: J
authors: Kemna
authors: Linda
authors: L
authors: Odibo
authors: George A
authors: GA
authors: Macones
authors: Anthony O
authors: AO
authors: Odibo
mesh_terms: D051722:ADAM Proteins / Q000097:blood*; D000072199:ADAM12 Protein; D000328:Adult; D001741:Black or African American; D015992:Body Mass Index; D015331:Cohort Studies; D005189:False Positive Reactions; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D008565:Membrane Proteins / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D047928:Premature Birth / Q000175:diagnosis* / Q000208:ethnology; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D011673:Pulsatile Flow; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055988:Uterine Artery / Q000000981:diagnostic imaging*
chemical_list: D008565:Membrane Proteins; D051722:ADAM Proteins; D000072199:ADAM12 Protein; C000606480:ADAM12 protein, human; D011266:Pregnancy-Associated Plasma Protein-A