title: Prediction of spontaneous preterm birth in women with cervical insufficiency: Comprehensive analysis of multiple proteins in amniotic fluid.
abstract: OBJECTIVE
  The purpose of this study is to determine whether proinflammatory cytokines and matrix metalloproteinases (MMPs) in amniotic fluid (AF), alone or in combination with clinical risk factors, can predict spontaneous preterm delivery (SPTD) at < 34 weeks in women with cervical insufficiency.
  
  
  METHODS
  This retrospective cohort study included 57 consecutive singleton pregnant women (17-28 gestational weeks) with cervical insufficiency who underwent amniocentesis. AF was assayed for five cytokines (interleukin [IL]-6, IL-8, monocyte chemotactic protein-1, macrophage inflammatory protein [MIP]-1α, and MIP-1β) and five MMPs (MMP-1, MMP-2, MMP-3, MMP-8, and MMP-9) using multiplex immunoassay kits. The primary outcome measure was SPTD at < 34 weeks.
  
  
  RESULTS
  The AF concentrations of MMP-1, MMP-3, MMP-8, MMP-9, IL-6, IL-8, MIP-1α and MIP-1β were significantly higher in women with SPTD at < 34 weeks. Women who had SPTD at < 34 weeks were younger, had significantly more advanced cervical dilatation at presentation and a higher rate of positive AF cultures. Using stepwise regression analysis, a combined prediction model was developed that included maternal age, cervical dilatation at presentation, AF MMP-1 and AF MMP-8 (area under the curve [AUC] 0.951). The AUC for this model was significantly greater than for any single protein alone in AF or for each of the clinical risk factors alone.
  
  
  CONCLUSIONS
  A model combining proteins in AF and clinical factors can improve the accuracy of risk prediction for preterm birth and this combination is more accurate than each of the biomarkers alone in women with cervical insufficiency.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.|Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seung Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.|Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Kyo Hoon
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.|Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Jung
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.|Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Soo-Hyun
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.|Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Aeli
authors.initials: A
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D005865:Gestational Age; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D020782:Matrix Metalloproteinases / Q000378:metabolism*; D008875:Middle Aged; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis* / Q000378:metabolism; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D002581:Uterine Cervical Incompetence / Q000378:metabolism*
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators; D020782:Matrix Metalloproteinases
keywords: amniotic fluid; cervical insufficiency; matrix metalloproteinase; prediction; preterm delivery