Nozaki Yuki, Imai Kenji, Miki Rika, Tano Sho, Fuma Kazuya, Matsuo Seiko, Ushida Takafumi, Kajiyama Hiroaki, Kotani Tomomi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
J Obstet Gynaecol Res. 2025 Sep;51(9):e70071. doi: 10.1111/jog.70071.
Preterm delivery (PTD) is a leading cause of neonatal morbidity and mortality. Accurate prediction is crucial for optimizing clinical outcomes, particularly in women with a short cervix. Although fetal fibronectin (FFN) is widely used to predict PTD, placental alpha-microglobulin-1 (PAMG-1) has gained attention for its potential to improve predictive accuracy. This study aimed to evaluate the utility of quantitative PAMG-1 assessment for predicting impending PTD in asymptomatic women with a short cervix (≤25 mm) between 24 and 34 weeks of gestation.
This observational cohort study analyzed 212 cervicovaginal fluid samples from 77 patients (132 from 49 singleton and 80 from 28 twin pregnancies). PAMG-1 and FFN levels were measured, and multivariate logistic regression was performed to evaluate their association with PTD risk.
In singleton pregnancies, positive PAMG-1 was independently associated with impending PTD, with odds ratios of 7.84 (95% confidence interval [CI], 2.02-30.50; p = 0.003) and 7.34 (95% CI, 2.75-19.60; p < 0.001) for PTD within 1 and 2 weeks, respectively. Quantitative PAMG-1 showed a dose-dependent relationship, with PTD risks increasing from 4.3% (<1000 pg/mL) to 50.0% (≥3000 pg/mL) within 1 week and from 10.0% to 90.0% for PTD within 2 weeks. In twin pregnancies, both PAMG-1 and FFN showed limited predictive utility.
This study highlights the potential of PAMG-1 quantification as a valuable tool for refining PTD risk stratification, particularly in singleton pregnancies. While further prospective multicenter validation is needed, these findings provide new clinical insights for improving PTD management.
早产是新生儿发病和死亡的主要原因。准确预测对于优化临床结局至关重要，尤其是对于宫颈短的女性。尽管胎儿纤连蛋白（FFN）被广泛用于预测早产，但胎盘α-微球蛋白-1（PAMG-1）因其提高预测准确性的潜力而受到关注。本研究旨在评估定量PAMG-1评估对预测妊娠24至34周无症状宫颈短（≤25mm）女性即将发生早产的效用。
这项观察性队列研究分析了77例患者的212份宫颈阴道液样本（49例单胎妊娠中的132份和28例双胎妊娠中的80份）。测量了PAMG-1和FFN水平，并进行多因素逻辑回归以评估它们与早产风险的关联。
在单胎妊娠中，PAMG-1阳性与即将发生的早产独立相关，在1周和2周内发生早产的比值比分别为7.84（95%置信区间[CI]，2.02-30.50；p = 0.003）和7.34（95%CI，2.75-19.60；p < 0.001）。定量PAMG-1显示出剂量依赖性关系，1周内早产风险从4.3%（<1000 pg/mL）增加到50.0%（≥3000 pg/mL），2周内早产风险从10.0%增加到90.0%。在双胎妊娠中，PAMG-1和FFN的预测效用均有限。
本研究强调了PAMG-1定量作为优化早产风险分层的有价值工具的潜力，尤其是在单胎妊娠中。虽然需要进一步的前瞻性多中心验证，但这些发现为改善早产管理提供了新的临床见解。
