Washington University in Saint Louis, Department of Obstetrics and Gynecology, 660 S. Euclid Ave, Saint Louis, MO 63110, USA.
Placenta. 2013 Jan;34(1):14-9. doi: 10.1016/j.placenta.2012.10.013. Epub 2012 Nov 28.
Markers of placental dysfunction are used for risk prediction of adverse obstetric outcomes including preeclampsia and growth restriction. Although medically indicated preterm birth is often distinguished from spontaneous preterm birth, we hypothesize that similar placental dysfunction may underlay all preterm birth. We aimed to investigate whether first trimester placental protein 13 (PP-13), pregnancy associated plasma protein A (PAPP-A) and uterine artery pulsatility index, with maternal characteristics could be used to predict all preterm birth.
Prospective cohort study of singleton gestations between 11 and 14 weeks who underwent serum measurement of PP-13, PAPP-A, and measurement of uterine artery Doppler pulsatility index. Primary outcomes were preterm birth (PTB) at less than 37 and 33 weeks. Analysis performed both including and excluding preeclampsia to assess the utility of the predictors for all types of preterm birth. Predictive models assembled using logistic regression with each predictor alone and in combination, along with maternal characteristics. Predictive utility of models was assessed using receiver operating curve (ROC) analysis and sensitivities for fixed false positive values.
Of 471 women, PTB occurred in 12.5% and early PTB (<33 weeks) occurred in 4.7%. PP-13 was decreased in PTB <37 weeks. PAPP-A was decreased in a dose-response pattern for PTB at <37 weeks and <33 weeks. Uterine artery pulsatility index was increased in early PTB. All patterns of predictors remained the same whether patients with preeclampsia were excluded or included suggesting predictive utility for all causes of PTB. Predictive models all demonstrated good predictive ability with ROC ≥ 0.90.
PP-13, PAPP-A, and uterine artery Doppler pulsatility index obtained in the first trimester are good predictors of all types of preterm birth, both indicated and spontaneous. Models including first trimester markers combined with maternal characteristics demonstrated good predictive ability and could be investigated for application of targeted prophylactic strategies.
胎盘功能障碍的标志物用于预测不良产科结局的风险，包括子痫前期和生长受限。虽然医学上指出的早产通常与自发性早产区分开来，但我们假设所有早产可能都有类似的胎盘功能障碍。我们旨在研究在 11 至 14 周的单胎妊娠中，是否可以使用第一孕期胎盘蛋白 13（PP-13）、妊娠相关血浆蛋白 A（PAPP-A）和子宫动脉搏动指数，结合母亲特征来预测所有早产。
对 11 至 14 周进行血清 PP-13、PAPP-A 测量和子宫动脉多普勒搏动指数测量的单胎妊娠进行前瞻性队列研究。主要结局是小于 37 周和 33 周的早产（PTB）。为了评估这些预测因子对所有类型早产的效用，我们分别在包括和不包括子痫前期的情况下进行了分析。使用逻辑回归对每个单独和联合的预测因子以及母亲特征进行了预测模型的组装。使用接收器工作曲线（ROC）分析评估模型的预测能力，并使用固定的假阳性值评估敏感性。
在 471 名妇女中，有 12.5%发生了 PTB，<33 周的早期 PTB 发生了 4.7%。37 周前的 PTB 中 PP-13 降低。PAPP-A 与 37 周前和 33 周前的 PTB 呈剂量反应模式降低。早期 PTB 中子宫动脉搏动指数增加。无论是否排除子痫前期患者，所有预测因子的模式均相同，提示对所有原因的 PTB 具有预测效用。预测模型的 ROC 均≥0.90，均显示出良好的预测能力。
在第一孕期获得的 PP-13、PAPP-A 和子宫动脉多普勒搏动指数是所有类型早产（包括有指征和自发性早产）的良好预测因子。包括第一孕期标志物和母亲特征的模型显示出良好的预测能力，可以进一步研究用于有针对性的预防策略。
