SIGNIFICANCE OF EARLY MARKERS OF PREGNANCY FOR PRETERM DELIVERY

58. KONGRES ANTROPOLOŠKOG DRUŠTVA SRBIJE (ADS 2025), [pp. 76-84]

AUTHOR(S) / АУТОР(И): Slavica Vujović , Svetlana Perović , Anđelka Šćepanović , Staša Šćepanović, Aleksandra Filipović 

Download Full Pdf   

DOI: 10.46793/ADS25.76V

ABSTRACT / САЖЕТАК:

The goal of the paper is to examine the clinical utility of the first-trimester maternal serum levels of pregnancy-associated plasma protein-A and free beta-human chorionic gonadotropin with regards to their ability to predict preterm delivery. As part of the screening for trisomy 21, 700 pregnant women were tested for values ​​of pregnancy-associated plasma protein-A (PAPP-A) and free beta- human chorionic gonadotropin (freeβ-hCG), combined with the nuchal translucency (NT). The analysis showed that the age of the pregnant women correlated with whether or not they had preterm delivery, whereby a statistically highly significant difference was found (χ2 = 19.320; df = 2; p < 0.01), as consequence of the fact that the younger women did not have preterm delivery much more frequently (100.0%) in comparison with the middle-aged and older women from the study (90.5% and 77.9% respectively). Furthermore, the analysis in which we took account of the number of earlier abortions presented a statistically substantial difference (F = 14.384; df = 5; p < 0.05), showing that women with no preterm delivery often had no earlier abortions (80.1%), as opposed to those who did (70.0%). Therefore, hormones could not be used individually as a clinical test for the preterm delivery prediction; nevertheless, this is an important finding because it may enable the development of an algorithm to estimate an individualized risk of preterm delivery based on multiple factors, including the first-trimester biochemical markers. The clinical value of using these hormonal levels to predict and manage preterm delivery requires further investigation.

KEYWORDS / КЉУЧНЕ РЕЧИ:

preterm delivery; pregnancy-associated plasma protein-A; free beta-human chorionic gonadotropin; first-trimester biochemical markers

REFERENCES / ЛИТЕРАТУРА:

  • Abu-Raya, B., Michalski, C., Sadarangani, M., Lavoie, PM. (2020). Maternal immunological adaptation during normal pregnancy. Front Immunol 11:575197.
  • Argente, J., Chowen, J. A., Pérez-Jurado, L. A., Frystyk, J. & Oxvig, C. (2017). One level up: Abnormal proteolytic regulation of IGF activity plays a role in human pathophysiology. EMBO Mol. Med. 9(10), 1338–1345. https://doi.org/10.15255/emmm.201707950
  • Pregnancy-associated pla Barrios, V., García, R. M., Cárdenas, M. A., Pérez, E., Montoya, M. F., Álvarez, S., & González, J. (2021). Pregnancy-associated pla sma protein (PAPP)-A2 in physiology and disease. Cells 10, 3576. https://doi.org/10.3390/cells10123576
  • Celik, E., Melekoğlu, R., Baygül, A., Kalkan, U. & Şimşek, Y. (2022). The predictive value of maternal serum AFP to PAPP-A or b-hCG ratios in spontaneous preterm birth. J. Obstet. Gynaecol. 42(6), 1956–1961. https://doi.org/10.1080/01443615.2022.2055452 (Epub 2022 May 27 PMID: 35620869).
  • Chiu, C. P. H., Tang, K. H., Lee, S. K., Yip, A. K. Y., Chan, K. Y., & Lau, T. K. (2022). Prediction of spontaneous preterm birth and preterm prelabor rupture of membranes using maternal factors, obstetric history and biomarkers of placental function at at 11–13 weeks. Ultrasound Obstet. Gynecol. 60(2), 192–199. https://doi.org/10.1002/uog.24917 )
  • Costa, MA. (2016). The endocrine function of human placenta: an overview. Reprod BioMed Online 32:14–43. doi: 10.1016/j.rbmo.2015.10.005
  • Giorgione, V., Quintero Mendez, O., Pinas, A., Ansley, W. & Thilaganathan, B.(2022). Routine first-trimester pre-eclampsia screening and risk of preterm birth. Ultrasound Obstet. Gynecol. 60, 185–191. https://doi.org/10.1002/uog.24915
  • Green, ES, Arck, PC. (2020). Pathogenesis of preterm birth: bidirectional inflammation in mother and fetus. Semin Immunopathol. 42:413–29. doi: 10.1007/s00281-020-00807-y
  • Dodd, J. M., Jones, L., Flenady, V., Cinotta, R., and Crowther, C. A. (2013). Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth, Cochrane Database of Systematic Reviews. 7, CD004947, https://doi.org/10.1002/14651858.CD004947.pub3.
  • Harrison, M. S. & Goldenberg, R. L. (2016). Global burden of prematurity. Semin. Fetal Neonatal. Med. 21(2), 74–79. https://doi.org/10.1016/j.siny.2015.12.007
  • Jaremek, A, Jeyarajah, MJ, Bhattad, GJ, Renaud, SJ. (2021). Omics approaches to study formation and function of human placental syncytiotrophoblast. Front Cell Dev Biol (2021) 9:674162. doi: 10.3389/fcell.2021.674162
  • Kugelman, A. and Colin, A. A. (2013). Late preterm infants: near term but still in a critical developmental time period, Pediatrics. 132, no. 4, 741–751, https://doi.org/10.1542/peds.2013-1131, 2-s2.0-84885169230
  • Mor, G, Aldo, P, Alvero, AB. (2017). The unique immunological and microbial aspects of pregnancy. Nat Rev Immunol (2017) 17:469–82. doi: 10.1038/nri.2017.64
  • Morssink, L.P., Heringa, M.P., Beekhuis, J.R., De Wolf, B.T.H.M., and A. Manting (1997). The association between hypertensive disorders of pregnancy and abnormal second-trimester maternal serum levels of hCG and alpha-fetoprotein. Obstet Gynecol. 89, 666-70 (https://doi.org/10.1016/s0029-7844(97)00088-4)
  • Nunthapiwat, S., Tongsong, T., Luewan, S., & Srisupundit, K. (2019). Second Trimester serum biomarker screen for fetal aneuploidies as a predictor of preterm delivery: A population-based study. Gynecol. Obstet. Invest. 84(4), 326–333. https://doi.org/10.1159/000495614
  • Palacio, M., Jauniaux, E., Kingdom, J., Dell, E., Shejdrake, A., and C.H. Rodeck (1993). Perinatal outcome in pregnancies with a positive serum screening for Down’s syndrome due to elevated levels of free β-human chorionic gonadotropin. Ultrasound Obstet Gynecol. 13, 58-62 (https://doi.org/10.1046/j.1469-0705.1999.13010058.x)
  • Paquette, A. G., Irwin, J. C., Santos, A., Johnson, E. M., Willing, M., & Mattison, D. R. (2023). Placental transcriptomic signatures of spontaneous preterm birth. Am. J. Obstet. Gynecol. 228(1), 73e1-73e18. https://doi.org/10.1016/j.ajog.2022.07.015
  • Pinette, M.G., Pan, Y., Pinette, S.G., Byers, S.A., and Blackstone, I. (1997). Elevated maternal serum alpha-fetoprotein, abnormal midtrimester ultrasound placental findings and adverse pregnancy outcome. J Maternal Fetal Invest. 7, 188-92 (https://doi.org/10.1016/s0002-9378(12)80033-0)
  • Preston, M., Hall, M., Shennan, A. & Story, L.(2024). The role of placental insufficiency in spontaneous preterm birth: A literature review. Eur. J. Obstet. Gynecol. Reprod. Biol. 295, 136–142. https://doi.org/10.1016/j.ejogrb.2024.02.020
  • Raty, R., Koskinen, P., Alanen, A., Irjala, K., Matinlauri, I., and U. Ekblad (1999). Prediction of pre-eclampsia with maternal mid-trimester total renin, Inhibin A, AFP and Free β-hCG levels. Prenat Diagn. 19, 122-27 (https://doi.org/10.1002/(sici)1097-0223(199902)19:2%3C122::aid-pd491%3E3.0.co;2-r)
  • Stojilković-Mikić, T. And P. Johnson (1999). Second trimester maternal serum β-human chorionic gonadotropin and pregnancy outcome. Br J Obstet Gyneacol. 106, 598-00 (https://doi.org/10.1111/j.1471-0528.1999.tb08331.x)
  • Wensorm, K.D., Owen, J., Boots, L.R., and Du Bard, M.B. (1994). Elevated second trimester human chorionic gonadotropin levels in association with poor pregnancy outcome. Am J Obstet Gynecol. 171, 1038-41 (https://doi.org/10.1016/0002-9378(94)90030-2)
  • Wu, B., Li, L., Zhang, W., Li, J., Zhang, Y., & Zhang, Y. (2022). A retrospective cohort study on the effects of down’s screening markers and maternal characteristics on pregnancy outcomes in preeclampsia. Clin. Exp. Hypertens. 44(7), 610–618. https://doi.org/10.1080/10641963.2022.2096055
  • Yan, C., Zhang, Y., Li, Z., Wang, H., & Li, X. (2023). A systematic review of prediction models for spontaneous preterm birth in singleton asymptomatic pregnant women with risk factors. Heliyon 9(9), e20099. https://doi.org/10.1016/j.heliyon.202