title: The role of folate receptor autoantibodies in preterm birth.
abstract: OBJECTIVE
  Cellular uptake of folate is mediated by folate receptor (FR)α. Prior studies indicate that a FRα autoantibody (FRAb) is implicated in poor pregnancy outcomes. The aims of this study were to determine the prevalence of FRAbs in women with preterm and term pregnancies, and to investigate the role of maternal FRAbs in preterm birth.
  
  
  METHODS
  This prospective observational study included 23 mothers and 25 preterm infants (two twin births) born at gestational age (GA) ≤32 wk and/or birth weight ≤1500 g (group 1) and 25 mother-term infant pairs (infants born at GA ≥37 wk, group 2). Blocking and binding FRAbs in maternal and in cord blood were determined. The association between maternal FRAbs and pregnancy outcome was measured using multiple logistic regression, adjusted for maternal age and previous preterm birth.
  
  
  RESULTS
  The prevalence of FRAbs was 65.2% in women with preterm birth, which was twofold higher than in those with term pregnancy (28%; relative risk [RR], 2.3; 95% confidence interval [CI], 1.2-4.7). The prevalence of FRAbs in preterm infants (64%) was significantly higher than in term infants (24%; RR, 2.7; 95% CI, 1.3-5.7). Pregnant women with positive FRAbs had 4.9 times higher odds of having preterm birth (odds ratio, 4.9; 95% CI, 1.4-17.7), adjusted for maternal age and previous preterm birth.
  
  
  CONCLUSIONS
  These findings suggest that the presence of FRAbs might be a contributing factor to preterm birth, which could be prevented with appropriate testing and therapeutic interventions. Further studies are warranted to investigate the possible mechanisms of fetal sensitization resulting in FRAb production in utero and its possible clinical correlates.
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, SUNY Downstate College of Medicine, New York, NY, USA.
authors.forename: Hanh D
authors.initials: HD
authors.lastname: Vo
authors.affiliation: Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, NY, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sequeira
authors.affiliation: Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, NY, USA.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Quadros
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, SUNY Downstate College of Medicine, New York, NY, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Schwarz
authors.affiliation: Department of Pediatrics, Division of Neonatology, SUNY Downstate College of Medicine, New York, NY, USA. Electronic address: agnes.perenyi@downstate.edu.
authors.forename: Agnes R
authors.initials: AR
authors.lastname: Perenyi
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D001724:Birth Weight; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D058975:Folate Receptor 1 / Q000097:blood*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D008297:Male; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood*; D011446:Prospective Studies
chemical_list: D001323:Autoantibodies; C548696:FOLR1 protein, human; D058975:Folate Receptor 1
keywords: Folate; Folate receptor autoantibody; Poor pregnancy outcome; Premature birth