508: Influence of earliest gestational age of prior spontaneous preterm birth on subsequent mid-trimester cervical length, pregnancy duration and cerclage efficacy

Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

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Gestational Age at Cervical Length and Fetal Fibronectin Assessment and the Incidence of Spontaneous Preterm Birth in Twins

Journal of Ultrasound in Medicine ◽

10.7863/ultra.34.6.977 ◽

2015 ◽

Vol 34 (6) ◽

pp. 977-984 ◽

Cited By ~ 10

Author(s):

Nathan S. Fox ◽

Daniel H. Saltzman ◽

Ariel Fishman ◽

Chad K. Klauser ◽

Simi Gupta ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

Fetal Fibronectin

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The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.13575 ◽

2015 ◽

Vol 123 (6) ◽

pp. 877-884 ◽

Cited By ~ 21

Author(s):

LM Kindinger ◽

LC Poon ◽

S Cacciatore ◽

DA MacIntyre ◽

NS Fox ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Meta Analysis ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

Individual Patient Level ◽

Patient Level ◽

Length Measurements ◽

Twin Pregnancies

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Bacterial vaginosis in early pregnancy is associated with low birth weight and small for gestational age, but not with spontaneous preterm birth: A population-based study on Danish women

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767050500361604 ◽

2006 ◽

Vol 19 (1) ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Poul Thorsen ◽

Ida Vogel ◽

Jørn Olsen ◽

Bernard Jeune ◽

Jes G. Westergaard ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Bacterial Vaginosis ◽

Early Pregnancy ◽

Gestational Age ◽

Small For Gestational Age ◽

Population Based ◽

Spontaneous Preterm Birth ◽

Population Based Study

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Prediction of Spontaneous Preterm Birth in At-risk Women Using Thrombospondin 1 from Cervicovaginal Fluid: A Prospective Observational Study

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1486-7148 ◽

2021 ◽

Vol 81 (09) ◽

pp. 1055-1064

Author(s):

Johannes Stubert ◽

Kathleen Gründler ◽

Bernd Gerber ◽

Dagmar-Ulrike Richter ◽

Max Dieterich

Keyword(s):

At Risk ◽

Preterm Birth ◽

Predictive Value ◽

Transvaginal Ultrasound ◽

Area Under The Curve ◽

Cervical Length ◽

Multiple Gestation ◽

Spontaneous Preterm Birth ◽

Thrombospondin 1 ◽

Cervicovaginal Fluid

Abstract Introduction Thrombospondin 1, desmoplakin and stratifin are putative biomarkers for the prediction of preterm birth. This study aimed to validate the predictive capability of these biomarkers in patients at risk of preterm birth. Materials and Methods We included 109 women with symptoms of threatened spontaneous preterm birth between weeks 20 0/7 and 31 6/7 of gestation. Inclusion criteria were uterine contractions, cervical length of less than 25 mm, or a personal history of spontaneous preterm birth. Multiple gestations were also included. Samples of cervicovaginal fluid were taken before performing a digital examination and transvaginal ultrasound. Levels of cervicovaginal thrombospondin 1, desmoplakin and stratifin were quantified by enzyme-linked immunosorbent assays. The primary endpoint was spontaneous preterm birth before 34 + 0 weeks of gestation. Results Sixteen women (14.7%) delivered before 34 + 0 weeks. Median levels of thrombospondin 1 were higher in samples where birth occurred before 34 weeks vs. ≥ 34 weeks of gestation (4904 vs. 469 pg/mL, p < 0.001). Receiver operator characteristics analysis resulted in an area under the curve of 0.86 (p < 0.0001). At an optimal cut-off value of 2163 pg/mL, sensitivity, specificity, positive predictive value and negative predictive value were 0.94, 0.77, 0.42 and 0.99, respectively, with an adjusted odds ratio of 32.9 (95% CI: 3.1 – 345, p = 0.004). Multiple gestation, cervical length, and preterm labor had no impact on the results. Survival analysis revealed a predictive period of more than eight weeks. Levels of desmoplakin and stratifin did not differ between groups. Conclusion Thrombospondin 1 allowed long-term risk estimation of spontaneous preterm birth.

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Maternal Lipidomic Signatures in Relation to Spontaneous Preterm Birth and Large-For-Gestational Age Neonates

10.21203/rs.3.rs-138617/v1 ◽

2021 ◽

Author(s):

Max Aung ◽

Pahriya Ashrap ◽

Deborah Watkins ◽

Bhramar Mukherjee ◽

Zaira Rosario ◽

...

Keyword(s):

Fatty Acids ◽

Preterm Birth ◽

Free Fatty Acids ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Lipid Analysis ◽

Lipid Classes ◽

Large For Gestational Age ◽

Spontaneous Preterm Birth ◽

Increased Risk

Abstract Background: Lipidome-wide metabolites may be useful biomarkers of pregnancy outcomes. We sought to characterize maternal lipidomic signatures associated with preterm birth and neonatal anthropometric parameters. Methods: Plasma samples were collected 24-28 weeks gestation, and lipidomic profiling was quantified using high-performance liquid chromatography tandem mass spectrometry. Lipid metabolites were analyzed individually and as whole lipid classes and subgroups based on degree of hydrocarbon chain saturation. Associations were estimated using linear and logistic regression.Results: After false discovery adjustment (q<0.15), four plasmenyl-phosphatidylethanolamines and three free fatty acids associated with increased risk for spontaneous preterm birth. Five phosphatidylinositols, two phosphatidylglycerols, and one phosphatidic acid were associated with large for gestational age neonates. The saturated plasmenyl-phosphatidylethanolamines held the association with increased risk for spontaneous preterm birth. Both the mono- and poly-unsaturated free fatty acids held the association for increased risk for spontaneous preterm birth. Mono- and poly-unsaturated phosphatidylinositols were associated with large for gestational age neonates. Whole lipid classes (plasmenyl-phophatidylcholines and plasmenyl-phosphatidylethanolamines) were associated with increased risk for large for gestational age at delivery.Conclusions: This study provides evidence that finer omics-scale analysis of the maternal lipidome may be more informative biomarkers of pregnancy outcomes compared to whole class level lipid analysis.

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