Evaluation of risk factors and modern possibilities for prediction of preterm labour
DOI:
https://doi.org/10.14739/2310-1210.2019.6.186500Keywords:
preterm birth, progesterone, insulin, cortisol, prognosisAbstract
The aim is based on the comprehensive examination of pregnant women to determine the risk factors for preterm labor and develop criteria for its prediction.Materials and methods. In a prospective opened study took part 63 patients at 22–34 weeks of gestation. The study was carried out on the basis of PI “Regional Perinatal Center” ZRC, which is the clinical base of the Department of Obstetrics and Gynecology, ZSMU. The average age of pregnant women was 27.1 ± 0.8 (M ± SD) years. Pregnant women were divided into two groups, depending on the gestation period course. Thus, group I included 44 pregnant women who had TPL (threatened preterm labor), and group II – 19 patients with normal course of pregnancy.In the first day, body mass index was determined and laboratory examinations (progesterone, insulin and cortisol level) were performed.Results. According to the ROC analysis, we obtained the following distribution points: the age of pregnant women over 35 years (sensitivity 33.3 %, specificity 96.1 %), the area under the ROC curve of 0.542 (95 % CI 0.411–0.668, P = 0.6953); body mass index (BMI) ≤22.95 kg/m² (sensitivity 66.7 %, specificity 84.3 %), the area under the ROC curve 0.694 (95 % CI 0.566–0.804, P = 0.01); insulin >31.36 μMe/ml (sensitivity 41.7 %, specificity 90.2 %), the area under the ROC curve 0.505 (95 % CI 0.376–0.633, P = 0.96); cortisol ≤609.7 ng/ml (75 % sensitivity, 55 % specificity), the area under the ROC curve of 0.694 (95 % CI 0.518–0.765, P = 0.07); progesterone <247.8 ng/ml (sensitivity 41.7 %, specificity 88.2 %), the area under the ROC curve 0.579 (95% CI 0.448–0.703, P = 0.4).Conclusions. The results of the conducted research indicate that multivariate logistic regression analysis allows determining the risk factors of preterm labor. Among the established prognostic markers for spontaneous preterm birth, the most comprehensive information is the complex assessment of age, BMI and hormonal profile. The findings suggest that dependent risk factors for preterm birth include: the level of progesterone lower than 139.5 ng/ml, cortisol less than 577.9 ng/ml, BMI less than 24 kg/m2 and maternal age of over 25 years. Independent factors should include the maternal age of over 35 years, the level of insulin above 31.36 ng/ml and progesterone less than 247.8 ng/ml. Considering the study results, high specificity and sensitivity of the proposed multivariate models, it would be appropriate to include measurements of progesterone, insulin and cortisol levels in the standard examination complex for pregnant women from 22 to 34 weeks of gestation. It will enable the identification of a risk group for preterm labor and implementation of timely prevention.
References
Serov, V. N., Sidelnikova, V. M., Agadzhanova, A. A., & Tetruashvili, N. K. (2003). Rannie poteri beremennosti – novoe ponimanie gormonalnyh narushenij [Early pregnancy losses – a new understanding of hormonal disorders]. Russian Medical Journal, 11(16), 907-908. [in Russian].
Zhuk, C. I., & Chechuga, S. B. (2008). Sovremennye aspekty patogeneza, diagnostiki i lechenija gipergomocisteinemii u zhenshhin s nevynashivaniem beremennosti [Modern concepts of the pathogenesis, diagnosis and treatment of hyperhomocysteinemia in women with miscarriage]. Women’s doctor, 5, 14. [in Russian].
Di Renco, D.K. (2008). Sovremennyj vzgljad na vedenie prezhdevremennyh rodov [Modern view on management of preterm birth]. Women’s doctor, 4, 41. [in Russian].
Usanov, V. D., Shtah, A. F., Ishkova, M. V., Magdeeva, N. I., Popova, O. A., & Timshin, A. V. (2010). Akusherskie aspekty prezhdevremennyh rodov. Sovremennye predstavlenija [Obstetric aspects of preterm birth. Modern views]. University proceedings. Volga region, 1(13), 120-132. [in Russian].
Hodzhaeva, Z. S. (2010). Taktika vedenija spontannyh prezhdevremennyh rodov s pozicij dokazatelnoj mediciny [Management tactics of spontaneous preterm birth from the point of view of evidence-based medicine]. Gynaecology, 2, 12-16. [in Russian].
Slattery, M., & Morrison, J. (2002). Preterm delivery. The Lancet, 360(9344), 1489-1497. doi: 10.1016/s0140-6736(02)11476-0
Hamilton, B., Martin, J., Ventura, S., Sutton, P. & Menacker, F. (2006). Births: Preliminary Data for 2007. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. CDC, 54. 1-17.
Goldenberg, R., & Rouse, D. (1998). Prevention of Premature Birth. New England Journal Of Medicine, 339(5), 313-320. doi: 10.1056/nejm199807303390506
McCormick, M. (1985). The Contribution of Low Birth Weight to Infant Mortality and Childhood Morbidity. New England Journal Of Medicine, 312(2), 82-90. doi: 10.1056/nejm198501103120204
Zhukovec, I. V., & Zarickaja, Je. N. (2012). Sintez steroidnyh gormonov vo vremja beremennosti [The synthesis of steroid hormones during pregnancy]. Yakut Medical Journal, 2, 96-98. [in Russian].
Andréen, L., Nyberg, S., Turkmen, S., van Wingen, G., Fernández, G., & Bäckström, T. (2009). Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology, 34(8), 1121-1132. doi: 10.1016/j.psyneuen.2009.02.003
Schiller, C., Meltzer-Brody, S., & Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48-59. doi: 10.1017/s1092852914000480
Stopińska-Głuszak, U., Wasilewska-Dziubińska, E., Słowińska-Srzednicka, J. (2008) Progesteron – neurosteroid syntetyzowany w układzie nerwowym [Progesterone – neurosteroid synthesized in nervous system.]. Postępy Nauk Medycznych, 3, 154-158. [in Polish].
Ananth, C., Ananth, C., & Vintzileos, A. (2006). Epidemiology of preterm birth and its clinical subtypes. The Journal Of Maternal-Fetal & Neonatal Medicine, 19(12), 773-782. doi: 10.1080/14767050600965882
Spiridonova, N. V., & Melkadze, E. V. (2013). Sostojanie novorozhdennyh u zhenshhin pri prezhdevremennyh rodah v zavisimosti ot nalichija ugrozy preryvanija beremennosti v I, II, III trimestrah gestacii [The condition of newborns in women with preterm birth depending on a miscarriage risk during the I, II, III gestation trimesters]. Mother and Child. Proceedings of the XIV All-Russian scientific forum. (pp. 461-462). Moscow. [in Russian].
Hassan, S., Romero, R., Vidyadhari, D., Fusey, S., Baxter, J., & Khandelwal, M. et al. (2011). Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound In Obstetrics & Gynecology, 38(1), 18-31. doi: 10.1002/uog.9017
Behrman, R. E. (2007). Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Behrman, R. E., & Butler, A. S. (Eds). Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11362/ doi: 10.17226/11622
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
