title: New biomarkers for the prediction of spontaneous preterm labour in symptomatic pregnant women: a comparison with fetal fibronectin.
abstract: OBJECTIVE
  To identify cervicovaginal fluid (CVF) biomarkers predictive of spontaneous preterm birth in women with symptoms of preterm labour.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Melbourne, Australia.
  
  
  METHODS
  Women with a singleton pregnancy admitted to the Emergency Department between 22 and 36 weeks of gestation presenting with symptoms of preterm labour.
  
  
  METHODS
  Two-dimensional electrophoresis was used to analyse the CVF proteome. Validation of putative biomarkers was performed using enzyme-linked immunosorbent assay (ELISA) in an independent cohort. Optimal concentration thresholds of putative biomarkers were determined and the predictive efficacy for preterm birth was compared with that of fetal fibronectin.
  
  
  METHODS
  Prediction of spontaneous preterm labour within 7 days.
  
  
  RESULTS
  Differentially expressed proteins were identified by proteomic analysis in women presenting with 'threatened' preterm labour without cervical change who subsequently delivered preterm (n = 12 women). ELISA validation using an independent cohort (n = 129 women) found albumin and vitamin D-binding protein (VDBP) to be significantly altered between women who subsequently experienced preterm birth and those who delivered at term. Prediction of preterm delivery within 7 days using a dual biomarker model (albumin/VDBP) provided 66.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 96.7% negative predictive value (NPV), compared with fetal fibronectin yielding 66.7, 87.9, 36.4 and 96.2%, respectively (n = 64). Using the maximum number of screened samples, the predictive utility of albumin/VDBP yielded a sensitivity of 77.8%, specificity and PPV of 100% and NPV of 98.0% (n = 109).
  
  
  CONCLUSIONS
  The dual biomarker model of albumin/VDBP is more efficacious than fetal fibronectin in predicting spontaneous preterm delivery in symptomatic women within 7 days. A clinical diagnostic trial is required to test this model on a larger population to confirm these findings and to further refine the predictive values.
authors: Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic., Australia; Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Vic., Australia.
authors: S
authors: S
authors: Liong
authors: M K W
authors: MK
authors: Di Quinzio
authors: G
authors: G
authors: Fleming
authors: M
authors: M
authors: Permezel
authors: G E
authors: GE
authors: Rice
authors: H M
authors: HM
authors: Georgiou
mesh_terms: D000328:Adult; D000418:Albumins / Q000378:metabolism; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000378:metabolism; D001826:Body Fluids / Q000737:chemistry / Q000378:metabolism*; D002584:Cervix Uteri / Q000737:chemistry / Q000378:metabolism*; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005353:Fibronectins / Q000378:metabolism*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011247:Pregnancy; D020395:Receptors, Interleukin-7 / Q000378:metabolism; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014621:Vagina / Q000737:chemistry / Q000378:metabolism*; D014809:Vitamin D-Binding Protein / Q000378:metabolism
chemical_list: D000418:Albumins; D015415:Biomarkers; D005353:Fibronectins; D020395:Receptors, Interleukin-7; D014809:Vitamin D-Binding Protein; C415350:interleukin-7 receptor, alpha chain
keywords: Biomarkers; cervicovaginal fluid; pregnancy; preterm labour; proteomics