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Published on: June 29, 2013
First-trimester prediction of preterm birth using ADAM12, PAPP-A, uterine artery Doppler, and maternal
Katherine R Goetzinger1, Alison G Cahill, Janet Kemna
1Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, USA. goetzingerk@wudosis.wustl.edu
Insights
First-trimester screening markers, including ADAM12, PAPP-A, and uterine artery Doppler, offer modest prediction for preterm birth (PTB). Combining these markers does not enhance their predictive efficiency for PTB.
Area of Science:
- Maternal-fetal medicine
- Obstetrics
- Reproductive endocrinology
Background:
- Predicting preterm birth (PTB) is crucial for improving neonatal outcomes.
- First-trimester screening offers an opportunity for early PTB risk assessment.
Purpose of the Study:
- To evaluate the predictive efficiency of first-trimester a disintegrin and metalloprotease 12 (ADAM12), pregnancy-associated plasma protein A (PAPP-A), uterine artery Doppler, and maternal characteristics for PTB.
- To determine if combining these markers improves PTB prediction.
Main Methods:
- Prospective cohort study of 578 patients undergoing first-trimester aneuploidy screening.
- Maternal serum ADAM12 and PAPP-A levels, and uterine artery Doppler pulsatility indices were measured.
- Logistic regression models were used to assess prediction of PTB (<34 and <37 weeks' gestation).
Main Results:
- 36 (6.2%) patients delivered <34 weeks and 78 (13.5%) delivered <37 weeks.
- At a 20% false positive rate, individual markers predicted 52-62% of PTB <34 weeks.
- Combining first-trimester markers did not improve the predictive efficiency for PTB.
Conclusions:
- First-trimester ADAM12, PAPP-A, and uterine artery Doppler are each modestly predictive of PTB.
- Combining these first-trimester screening parameters does not enhance their efficiency in predicting PTB.
Objective:
The objective of this study was to estimate the efficiency of first-trimester a disintegrin and metalloprotease 12 (ADAM12), pregnancy-associated plasma protein A (PAPP-A), uterine artery Doppler, and maternal characteristics in the prediction of preterm birth (PTB).
Methods:
This was a prospective cohort study of patients presenting for first-trimester aneuploidy screening. Maternal serum ADAM12 and PAPP-A levels were measured by immunoassay, and mean uterine artery Doppler pulsatility indices were calculated. The primary outcome was PTB <34 weeks' gestation, and the secondary outcome was PTB <37 weeks' gestation. Logistic regression was used to model the prediction of PTB using ADAM12, PAPP-A, uterine artery Doppler, and maternal characteristics, individually and in combination. Sensitivity, specificity, and area under the receiver-operating characteristic curves were compared between models.
Results:
Of 578 patients, 36 (6.2%) delivered <34 weeks, and 78 (13.5%) delivered <37 weeks. For a 20% fixed false positive rate, ADAM12, PAPP-A, and uterine artery Doppler identified 58%, 52%, and 62% of patients with PTB <34 weeks and 42%, 48%, and 50% of patients with PTB <37 weeks, respectively. Combining these first-trimester parameters did not improve the predictive efficiency of the models.
Conclusion:
First-trimester ADAM12, PAPP-A, and uterine artery Doppler are each modestly predictive of PTB; however, combinations of these parameters do not further improve their screening efficiency.
